Thomas has turned 3 and has continued to
demonstrate improvement in his speech therapy. One issue associated with a
cleft palate is ear infections which can result with an accumulation of fluid
in the ears. Over the past year, Thomas has been to the pediatrician three
times for ear infections with fluid in his ears. The Hooks were referred to
their ENT, for frequent infections and fluid buildup can result in a hearing
loss. Thomas underwent a hearing evaluation which revealed that his hearing was
normal. The ENT explained that children with a cleft palate are prone to fluid
collecting in their ears which is known as “Glue Ear.” Since Thomas has had
these recurrent ear infections and fluid buildup, the ENT recommended a
surgical procedure to insert tiny tubes called grommets. He stated that it will
help to ventilate his ears and reduce the chance for fluid to collect in his
ears. It could help reduce the chances of damage to Thomas’ hearing. He added,
that the tubes tend to fall out after 6 months, and could require reinsertion. He
also explained that ear infections are no longer an issue as the child grows
older. The Hooks agreed to the procedure which was done in the hospital as an
outpatient. In addition to the recurrent ear infections, Thomas had seen the
dentist twice over the past year and required fillings in 4 teeth, some of
which had dual surface involvement.
During
their last visit to the pediatrician, the Hooks brought up their concerns that
Thomas has demonstrated an increase in ADHD behaviors. From squirming and an
inability to cuddle, his parents have noticed an inability for Thomas to
maintain an interest in any toy or activity for very long. He would run around
the house and fall frequently due to what appeared to be clumsiness. It is not
uncommon for children with ADHD to be accident prone due to their impulsivity. They
act without thinking and consequently have more accidents than the average
child (Web MD).
Thomas
also displayed problems taking turns when playing with his peers in the park.
He would push his way onto the ladder of a slide instead of waiting his turn.
Children with ADHD act on impulse and do not delay gratification. When they
want something, they want it now. At this age, many parents of boys fluff this off
as “boys will be boys.” They do not see it as a sign of a disability such as
ADHD.
Given Marcus’ history, his son’s behaviors
sparked concern. His parents took him to their pediatrician who told them that
Thomas was still young and may outgrow this. Aware of Marcus’ history, he did
add that if the behaviors continued or grew worse, Thomas may need to be
evaluated for ADHD. He recommended that they enroll Thomas in a nursery school
program to provide the training through experiences with peers in a structured
setting. He suggested seeing how that goes and if there was no sign of
improvement then bring Thomas back and he would provide them with a referral
for further evaluation.
ADHD is difficult to diagnose. Doctors often
rely on a family history, interview with child, reports from school, etc.
Doctors are often too quick to diagnose a child as having ADHD so the Hook’s
pediatrician is not discounting the ADHD diagnosis but feels further
information is needed and had made a recommendation that would provide insight
into another setting other than home.
The Hooks left their pediatrician’s office
feeling conflicted. They were happy that he hadn’t dismissed their concerns and
made suggestions for follow up. His recommendation for a nursery school program
posed several issues. First, there was the issue of full day vs. half day, and
then the resulting financial implications. A full day program would cost more
and still require child care for the gap in time from when school ended to when
they returned from work. Half day
programs cost less, but involved the additional cost of child care. Another
consideration was whether Thomas at 3 years of age, could handle a full day
program given his issues of impulsivity, and limited attention span. The
thought of all this, along with the medical, dental, and behavioral issues that
have plagued the Hooks over the past 3 years, left them feeling overwhelmed.
Understanding the stress the Hooks were under, a friend from their church
offered to take Thomas for a weekend, so that Marcus and Taylor could get away.
They returned rested and were better able to consider their options and make a
decision. They worked out an arrangement with their current child care
provider, which reduced her time by the amount of time in the half day nursery
school. They were also successful in finding an affordable program in their
Hoboken community that would meet their needs.
Stress is experienced by all new parents who
have to cope with the demands of an infant and the life style changes to their marriage.
This is only compounded by having to deal with a first child who has a
disability. Studies show that having a child with a disability can destabilize
marriages and lead to divorce. Some parents refrain from having a second child
due to the stress and strain it puts on the couple physically, emotionally, and
financially. There is also the fear that it could happen again. Studies suggest
that “raising a child with a disability decreases subsequent fertility, both by
directly decreasing the likelihood of subsequent childbearing and indirectly increasing the
likelihood of marital disruption. Decisions to have another child are based on
more than a first child with a disability, but on a variety of social and demographic
factors, such as a woman’s age, race, social class, educational attainment,
marital status, and labor force participation.” Positive factors for the Hooks
were their community support, they were college educated, had jobs, and had
reached an age of maturity when they had Thomas, as opposed to being teenagers.
They were also a white middle class family.
Stress is higher among poor, unmarried minorities in disadvantage areas,
who are unemployed and have a limited education (NCBI).
The Hooks experienced some relief after
resolving the issues with nursery school and child care. Thomas’ first year at
nursery school was fraught with frequent reports from his teachers regarding
his calling out, inability to share, and his inability to sit still. There were
isolated episodes of temper outbursts when he was prevented from doing
something he wanted. The teachers were
patient and made every effort to work with Thomas. They agreed to keep Thomas
at the school and asked that Mrs. Hook speak to her pediatrician about possible
medication to help improve Thomas’ behavior in school. Although there wasn’t a
definitive diagnosis of ADHD, all of the reports from the teachers, Taylor
experiences with Thomas at home, and the knowledge of a possible genetic
component, all seemed to indicate that Thomas suffered from ADHD. There was a
part of Taylor that feared her own drinking may have caused his ADHD. The idea
that she could have caused this was devastating.
The information available on the
causes of ADHD provides numerous possibilities. There is no single direct
cause. Some cases are believed to be genetic; some are alcohol or drug related,
some are believed to involve neurotransmitters while other cases appear random
with no apparent etiology. Treatment options include medication, psychological
and behavioral therapies (Web MD).
1) What
ADHD treatment alternatives are available for Thomas?
2) What
role does diet play in children with ADHD? I.e. chemicals in certain foods
3) Is a
referral to special education for Thomas inevitable? Why or why not?
Decision
Point: Does Taylor get medication for Thomas or does she decide to pull Thomas
out of the nursery school program?
1) What ADHD treatment alternatives are available for Thomas?
ReplyDeleteNormal treatments for ADHD include prescription medicines like Ritalin, and standard behavioral treatments to be effective in helping treat symptoms of the disorder. There are also alternative treatments that not many people know about. Specific diets, supplements, parent training, Neurofeedback and memory training are all things used to treat symptoms of ADHD. Research shows that processed sugars and carbohydrates can have an effect on a child’s activity level. They can make blood sugar levels increase very quickly which can cause a child to be much more active due to an adrenaline rush. Adding more fiber to a child’s diet can help to balance blood sugar levels. Research has also shown that children with ADHD have less omega-3 fatty acids in their blood. Supplementing these is now recommended and has shown an improvement in ADHD symptoms. Neurofeedback and memory training are used to teach the child how to increase his or her arousal levels. It has been shown that children with ADHD have less “fast” brain waves and more “slow” ones than typically developing children, so using this Neurofeedback helps to retrain the brain, but this treatment is very costly (WebMD 2014).
2) What role does diet play in children with ADHD? I.e. chemicals in certain foods
Diets can make the brain function better and make ADHD symptoms less severe, specifically working on lack of focus or restlessness. As I said before, processed sugars and carbohydrates can have an effect on a child’s activity level. It has been said that artificial colors (especially red & yellow), flavors, and preservatives could lead to hyperactivity in children. Some studies have proven this to be true and others have not shown a correlation (WebMD 2014).
3) Is a referral to special education for Thomas inevitable? Why or why not?
If Thomas continues to go down the path he is going down without any treatment, then a referral for special education will be inevitable. Since ADHD adversely impacts education, a child with ADHD is eligible for special education services. Thomas will have an individualized educational plan created for him in order for him to be the most successful (School Psychologist Files 2014).
Decision Point: Does Taylor get medication for Thomas or does she decide to pull Thomas out of the nursery school program?
Taylor should not pull Thomas out of the nursery school program. If he is enrolled in some type of behavioral therapy or gets medication, or both, for him than he should be functional in a nursery. Children need to spend time with other children and by him being enrolled in daycare, it will help him to work on his ADHD. As long as the nursery Thomas is at offers a highly-structured surrounding and consistency through routines, policies and procedures then there should not be an issue keeping Thomas enrolled (The National Resource Center on ADHD, 2010).