So, I've been doing a lot of reading about ADHD since I finished my internship at Ladd and finished student teaching. I've been home more, and Milo has been having continuing difficulties. He fits the bill perfectly, even though I was starting to worry that he had something else more serious going on. I was getting really frustrated with his aggressive behavior and defiance, but the more I read, the more I find that this is exactly how ADHD presents in kids his age. Along with the inability to sit still for any length of time, of course. He talks excessively, he is unable to wait for anything, ever, he's constantly frustrated, he cannot control his impulses AT ALL, he HAS to do the things he's thinking about RIGHT when he thinks of them. He hits for no reason, other kids are afraid of him and they stay away from him as much as possible. It's really sad to see the other kids run away from him, when he arrives at daycare/preschool, they eye him warily.
I know that there's a lot of mixed feelings about ADHD, and trust me, I'm one of those people who thinks it's WAY over-diagnosed, but this child is suffering and so is everyone around him. He was kicked out of preschool because two children withdrew from the center to get away from him. They were afraid to come to daycare, because my tiny, 37lb, 3yr old, child was scaring them and hurting them. Ouch. The most frustrating part of him being kicked out, though, is that all of his care providers were telling me that he was doing much better and every day when I would pick him up and ask how he was, they'd say good things. Ultimately, the director made the final decision after receiving complaints and withdrawal notices from other students and parents in his class, but his teachers all agree that they think the decision was too rash.
I'm doing everything I can to help him, and the fact that I allowed them to give him medication, even an alternative medication, at 2 1/2 years old, should speak to that, I feel. If I had been made aware of the on-going issues since we switched his medication, I would have taken him back to the doctor sooner. The medication he was initially given is a trans-dermal patch that delivers a mild blood pressure medication, intended to slightly slower one's blood pressure. Obviously he wasn't taking it for that reason, but as a side effect, the medication controls ticks, impulsive behavior, and curbs aggression. It worked really well for a few months, and then Milo's sensitive skin started to break out in rashes and welts wherever the patches had been. We had to up his dosage not long after he started using it, as well. His doctor felt that the rashes and welts were keeping the medication from getting through, and they switched him to a pill to take twice a day.
The pill is another kind of the same medication, called Guanfacine. He was told to start with half a mg twice a day. This did absolutely nothing. We switched it to 1mg, twice a day on the second day. This helped off and on, but not consistently. It didn't prevent the random outbursts, and his sleeping habits got worse and worse. We gave it a try for a while, and it did seem to help SOME, but not nearly enough, and during this time, he was kicked out of preschool. He kicked another child in the nose when she was sleeping, causing a horrible bloody nose. None of the staff members saw the incident, so no one is sure if he did it intentionally to be mean, or if he was perhaps trying to wake her up by nudging her and just connected with her nose on accident, but in any event, it was a big deal. He also spent a whole morning defiantly calling everyone "fuck head," despite pleas to stop and many replacement phrases to use instead, time outs, etc.
At home, we all live and breathe by Milo's moods. If Milo is happy, everyone is happy. If Milo is unhappy, EVERYONE is unhappy. He has the most horrific tantrums, sometimes completely at random, like upon waking from a nap or from a night's sleep. If you tell him no about anything. If we run out of Strawberry Kiwi Capri Suns. If we don't have the snack he wants, when he wants it. If I won't let him eat ice cream for dinner, or refuse to let him have dessert without eating dinner. Etc etc.. I could go on and on and on. If he wants to play with a toy of Kasin's and we wont let him, he wants to go outside and we say no...
Anyways, when he got kicked out of preschool, I took him back to the Dr. His teacher had been taking notes for me, although she never showed them to me before that. I took the notes with us, and the Dr. agreed that the medication wasn't doing enough for him. He decided to DOUBLE HIS DOSAGE. 2mg, twice a day. I was blindly optimistic about this, hoping that it would make a big difference... but instead of helping, it made things worse. He became agitated, extremely irritable, very unhappy, and extremely groggy and sleepy during the day. He would fall asleep in completely random places at daycare, like on an old rubber tire in the sand box. This is definitely not something he would have ever done before. He seemed constantly exhausted and angry, and after a week, I was done. It wasn't stopping him from having melt downs, it wasn't helping him control any impulses, it wasn't stopping him from being aggressive, it was just making him extremely unhappy and sleepy during the day, while keeping him awake all night. He had extremely vivid, weird dreams, and wouldn't sleep for more than a couple of hours at night. I had to go down to his room and settle him back into bed multiple times per night, and he would act completely awake, ready for the day to begin, at like 3am. It was outrageous. I really couldn't take it anymore.
So on Thursday, I stopped giving it to him. It had been a full week, the sleepiness was wearing off, but I felt that it wasn't benefiting him nearly enough, given the remaining symptoms and the side effects. I also had to completely FIGHT with him to get him to TAKE the medication, twice a day. Since it is a pill, I was to crush it and mix it into yogurt or applesauce. I knew he wouldnt finish a whole cup of anything at prescribed times, so I'd been doing this in teaspoons and giving him just a spoon full of yogurt with the crushed pill mixed into it. This was working fairly well at first, but he started to hate it and we would have to chase him down and fight him to take the medicine every time. Sometimes Ross and I both had to hold him down to do it. To say the least, I was over it.
By 4pm, time for his second dose of the day, he was positively VIBRATING with energy. He was completely manic. It was insane. He didn't take a nap, despite my efforts, and never seemed worse for the ware. I gave him a 1mg pill to get him to simmer down a bit, and it helped enough to get him to sleep that night. By bedtime, he was completely beyond frustrating for everyone to be around, so we were glad he got to sleep okay. He slept much better that night, although he did still wake up a couple of times.
I called in a refill on his patches the next day, gave him 1mg of the Guanfacine before preschool on Friday, his last day of daycare, and he was okay for the most part. He napped, he ate his lunch, and there were no horror stories at pick up time. I took him with me to the pharmacy and stuck a patch on his back ASAP. They haven't been helping much, honestly, but they're better than nothing. He isn't vibrating with insanity anymore, but he is pretty crazy just the same. The biggest difference, to me, is that he is SO MUCH HAPPIER. He has fun, runs around and plays, and laughs and jokes. It's such a huge relief to me, and I'm so glad he's back to being Milo. But at the same time, I know he wouldn't be successful in a preschool or daycare setting like this. He would wreak havoc. He would hurt other children. He would be in trouble constantly.
As a teacher, I know that it's important for these early school experiences to be positive, so that he's not burnt out on school and associating it with negative interactions before he even reaches school age. It breaks my heart that these are the experiences he's having already, that he's always in trouble, he doesn't want to go, and he has no friends. I know he's too young to completely understand at this point, but I do. I know that something has to change. I just don't know what.
Before someone asks, there are lots of other medications for ADHD, but they are all stimulant medications. These are not approved for use in children under 5 or 6 years old, although some studies have shown success in preschool aged children. From the reading I've done, these kinds of medications CAN help, but they also have some negative side effects, like weight loss, loss of appetite, and insomnia (NO!!!!). That being said, most reports say that the symptoms are "minimal." I'm not sure where we'll go from here, but I feel as though that will be the next step for him. I'm terrified. But I don't know what else to do. He goes to "Play Therapy" for an hour, once a week. It doesn't seem to be making any difference for him, and I really don't think that kind of therapy is appropriate for him, given his level of cognitive ability. It seems like something that would work much better for a child with a real delay or a disability, which Milo does not have.
We looked into getting him into the Public School system preschool, which is geared towards Special Needs children. He doesn't qualify for any of the special needs things that they generally address, but I was told there's a chance he'll get in based on behavior and social/emotional need.
It's so incredibly frustrating to feel this powerless in my child's life. There's nothing I can do. It's almost impossible to discipline him, because he just can't control his behavior. He doesn't WANT to upset us, he doesn't do it on purpose, he just CAN'T control those impulses to be destructive, or his extreme reactions to disappointment. It's even harder to hear other people say that he seems normal, that they don't believe he has ADHD, that my doctor must just diagnose that in everyone he sees. NO! I want to scream at people, "NO!" he REALLY does have SEVERE ADHD. At 2 1/2, it was painfully obvious to eVERYONe who knew him well. His pediatrician had absolutely NO doubt in his mind, and he is a seasoned, well-respected Dr. The worst thing that people say is, "Have you tried time outs?" or "He probably just needs to be spanked more." or other such things that suggest I just don't discipline him enough. Trust me, I try. And given his behavior issues with aggression and violent behavior, I don't feel that spanking/hitting him is appropriate. He will turn around and hit you back, for one. For two, I don't think it's a good message to send, "I'm not happy with you, so I'm going to hurt you. But you should never hurt anyone else." At the same time, I realize that he's 3 and won't necessarily put this all together, and that sometimes he's gunna need a swat to get his attention, but I really don't want to rely on physical harm as a form of discipline for this particular kid. Kasin was very receptive to a swat on the butt or the back of the hand, and he rarely needed it, but it worked great for him. Milo? Not so much.
It never stops shocking me how different they are from one another. Hopefully eventually I'll stop wondering where I went wrong with Milo.
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