Taylor
took Thomas to her pediatrician following the teacher’s suggestion. She
explained that Thomas had attended a half day nursery school program for the
past year and the teacher felt medication was needed to reduce Thomas’
hyperactivity. Her doctor told her that the most common drugs used for ADHD are
not approved by the FDA in children under six. He also felt Thomas should be
evaluated for ADHD before any medication is prescribed. He recommended behavior
therapy in conjunction with a strong routine and structured school program as a
preferable course of treatment for a preschool age child like Thomas. ADHD
medications in preschoolers have been known to cause more side effects, such as
a decrease in appetite, insomnia and anxiety. Medication has been also known to
slow the rate of growth in preschoolers. He suggested behavior therapy; along
with a small preschool program which employs a behavior modification program to
address behavioral issues in children like Thomas.
Taylor
left the pediatrician’s office feeling somewhat relieved that he was not in
favor of prescribing medication for children as young as Thomas. She really had
not been comfortable with the idea of medication for Thomas. Taylor told the
teacher what the pediatrician had said, and added that she had enrolled Thomas
in Hoboken’s Universal Pre-K program for four year olds. The program was a
free, full day program and offered special services such as speech or
counseling, as well as special education programs should one be needed.
This decision reduced the Hook’s financial burden of
nursery school and child care. The savings enabled them to seek help from a
behavioral psychologist. The psychologist took an in depth history and spent
time observing and talking to Thomas. The psychologist felt that Thomas showed
signs of anxiety which he stated were not uncommon in children with ADHD. He
explained that excess energy turns to anxiety when unused. Other factors
include mental stress and reprimanding. Thomas’ history reflected significant
factors for mental stress, given his repeated hospitalizations and surgeries.
His behaviors were cause for frequent reprimands by his parents and teachers.
In addition, school can be a source of mental stress for many children. These
factors combined with Thomas’ issues with communication caused by his cleft
palate contributed to his mental stress and resulting anxiety. The psychologist
agreed to see Thomas on a weekly basis. He offered the Hook’s suggestions for
working with Thomas at home, and emphasized the importance of consistency when
trying to modify behavior. One suggestion that was made was to provide Thomas
with plenty of opportunity to exercise in order to burn off excess energy.
Thomas’
first year at the Hoboken’s Pre-K Program was an improvement over his nursery
school program. The behavior therapy along with the suggested techniques the
Hook’s had used at home were helpful in reducing Thomas’ hyperactivity. The
school conferred with the behavioral psychologist and was able to implement
some of his suggestions, in addition to their behavior modification program
which rewarded positive behaviors and ignored negative ones. Although the Hooks
still received reports of behavioral issues, they were able to work together
with the school in managing Thomas at school.
Thomas turned five and started kindergarten. His speech
services continued with notable success. Thomas’ ear tubes had fallen out after
six months, but the ENT chose to delay reinsertion to see if Thomas’ ear
infections would return. He was cautiously waiting to see if Thomas had
outgrown them.
Given the fact that Thomas had
been attending a kindergarten program for the past six months and continued to
display ADHD behaviors, his psychologist wanted to perform various tests to
verify the suspected diagnosis of ADHD. He requested that a CPRS-R (Connors
Rating Scales-Revised) be done by the school. He also performed psychological
testing to evaluate Thomas’ cognitive functioning. It is not uncommon for
children with ADHD to suffer from academic issues in reading and/or math. The
testing would also rule out any intellectual deficits. The Hooks were very much
in favor of this testing since the teachers at school had made comments
alluding to the need for Thomas to be evaluated for special education services.
They pointed to his hyperactivity, inability to focus, his failure to complete
tasks, and inability to share or take turns. These are all behaviors that are
expected from a kindergarten age child. Due to his lack of focus, it was difficult
to ascertain his academic skills. He would never finish reciting the alphabet
or counting to a specified number. Writing tasks were often sloppy and
incomplete. He demonstrated organizational issues as well. Thomas’ cubby had always been messy and it took
him longer than average to get his belongings together at dismissal.
Taylor preferred that her
psychologist perform this testing, since she had heard and read about the
tendency for children like Thomas to be referred to special education due to
behavioral issues. Many referrals often
result in 504 services rather than special education programs. Parents can
obtain 504 or non IEP services by requesting them in writing to their district.
In order to qualify for IEP services, a child’s cognitive functioning must fall
significantly below his intellectual potential. If a student does not qualify
as having a disability which significantly affects his academic performance,
many of the services he can receive are through 504 not an IEP. Research shows
that ADHD is identified in boys sooner than girls and boys have a greater
incidence of being diagnosed with a disability than do girls.
When
testing was completed, it revealed that Thomas had an IQ of 110, which denotes
normal intelligence. Tests involving repetition of numbers were delayed. This
could reflect an inability to focus in order to remember presented
information. Ability to copy shapes was
below average. This could be a result of his lack of focus and tendency to rush
through the activity, or can be a graphomotor issue. It was noted that Thomas
failed to complete some of the items due to his short attention span and
hyperactivity. The test had to be given in blocks of time over 2 days to
complete many of the items required. Thomas’ lack of focus and hyperactivity
made testing more difficult.
After all the testing was
completed, and the Connors Rating Scales –R was scored, it was determined that
Thomas did have ADHD. Reports were forwarded to Thomas’ pediatrician and copies
of the reports were given to the Hooks, who could share the results with the
school if needed. Given that ADHD medication is not FDA approved in children
under six, the decision was made to delay the administration of medication
until Thomas turned six. This would coincide with Thomas’ entrance into first
grade where the focus on academics is much greater than in kindergarten. Thomas’ progress would be monitored in
social, behavioral, and academic areas. Any signs of academic deficits could be
better assessed with the behavioral
factors addressed through medication.
1) Are alternatives to ADHD medication just as effective as the medication?
2) Are specialized diets helpful in reducing ADHD behaviors?
3) Given the attention and focusing issues In children with ADHD, how accurate is the psychological testing?
Decision point- Do the Hooks agree to a special education program or do they opt for 504 services? What are the major differences between the two options?
2) Are specialized diets helpful in reducing ADHD behaviors?
3) Given the attention and focusing issues In children with ADHD, how accurate is the psychological testing?
Decision point- Do the Hooks agree to a special education program or do they opt for 504 services? What are the major differences between the two options?
