How do you know when "impulsive" is more?

[Anonymous]

I have a 5 year old son who is by all acounts impulsive. He is frequently in trouble at school for hitting other children and not sitting still. We have had him evaluated for ADHD and we were told to "watch it." The primary symptom is impulsiveness and he is 5 and many times that is immaturity. He is on grade level at school but is having a really hard time keeping his hands to himself and sitting still. When I suggested ADHD to the school they did not seem that concerned. (MOCO).

So, have him evaluated again? (Private eval not covered by insuarance....wait and hope he grows up a bit......the notes from school are getting a bit tiresome.) Can I ask the school to do the eval?

[Anonymous]

Can you or the teachers identify any "triggers" like kids getting in his space, transitions, etc?

People have posted about the ADHD studies at NIMH in Bethesda. They are free and the quality is supposed to be excellent. You might want to give a call and see if your DS might qualify. You also get a written report which would be helpful going forward.

Has he ever had an OT eval? That might be one other box to check. He might also benefit from the How Does Your Engine Run program.

There is some good info in this book, I got it at the Borders in Chevy Chase. The authors are local, Dr. DeGangi has an extensive OT background and is at ITS in Kensington, we did a few consults with her and found it very helpful.

I'd also think about adding some healthy fat to his diet, try Nordic Naturals products for kids. Also, I'd make sure that he is getting plenty of rest and that he eats protein frequently to keep his blood sugar stable, helped one of my "handsy" kids with control.

Good luck!

[Anonymous]

You are not going to find a five-year old, boy or girl, who is not impulsive. Or a six to sixteen year old, for that matter. It's a continuum. Does he have NO impulse control? As PP stated, are there specific triggers or events over which he has little impulse control? Can you work on them? For instance, it sounds like anger management is the issue here, frankly, if he is triggered to hit other kids. Trouble sitting still is also typical for his age.

How about a martial arts class?

[Anonymous]

OP, was your school not involved in the first eval? My pediatrician used the Vanderbilt and the school used the Conners for the initial ADHD assessment. With both, three people filled out the surveys. It was required that one of the three be a teacher and one be a parent. If your son wasn't assessed by his teacher, I'd suggest that you request that the assessment be redone.

[Anonymous]

OP here, thank you for the responses. He was assessed by an OT for SPD and was not found not to have it. We did OT for a while for fine motor skills and he was released.

He was evaluated for ADHD in preschool, so his kindergarten teacher has not filled anything out. I could have the assessment redone.

What I am hearing from the school is not really aggression issues, is more just impulse control, the hitting is not aggressive if that makes sense, just not keeping his hands to himself.

There has always been something a little "off" about him (I can't think off another word). His preschool had concerns also, but we have had evaluations done and they all come back with wait and see.

[Anonymous]

There has always been something a little "off" about him (I can't think off another word). His preschool had concerns also, but we have had evaluations done and they all come back with wait and see.

Based on what you say here, OP, I think I'd go back and get the best private evals. I could arrange, with multiple persons filling out the forms as a PP suggests.

1. It sounds like he "stands out," for want of a better term, among all the young immature kids who have impulse moments once in a while.

2. (and why I bothered to post) You don't want him to develop a bad self worth. There is a chance this may be starting if there are so many behavior notes coming home that you're already "tired" of them. Find out if there's a neuro reason for his stand-out, challenging behaviors -- so the adults in charge can adjust their communications with him accordingly.

[Anonymous]

I agree about a private eval. If you can get in with Dr. Dan Shapiro, you'll be in excellent hands.

[Anonymous]

I agree with an updated eval, but while that process is going on, does the teacher have a behavior plan for your child? If not, I would ask about one. A specific one geared toward him.

[Anonymous]

wondering about sensory issues. If he really likes to touch other kids, to get that stimulus and is too impulsive to control himself. anyway, good luck. I think you'll have to somehow get the evaluation done. Maybe in a year-- you can put money into an FSA to pay for it, or save up. It sounds to me like you've suspected something for quite some time-- go with your gut and get him some early intervention. We waited, sort of "watchful waiting" and my daughter missed several school years in a fog of impulsiveness, distraction and no executive function. I wanted to wish it away, or see if she would develop out of it. Only the evaluation, diagnosis and treatment (cognitive and medical) helped. BTW, as a fifth grader she's doing really well in most situations, on most days. It gets better.

[Anonymous]

OP, I posted previously asking about whether the teacher had completed any evaluations. The impulse control issue you describe (not being able to keep his hands to himself) sounds a lot like one of the issues that my oldest child experienced. It continued all through elementary school and into early middle school. I honestly thought it was a behavior issue and it was kind of frustrating because by middle school, kids should be able to remember to keep to themselves and not invade the personal space of others. Also, as a PP pointed out, it made my son different and created self esteem issues because he had no friends and it sometimes got him in trouble in school.

A few months ago, he started medication for ADD. On eval (and for reasons that aren't relevant to this post, we didn't go through the whole private expensive eval but relied solely on the Conners and observations of parents, teachers and tutors), he presented as borderline ADD. Because he was doing so poorly in school despite lots of intervention and we really had no other ideas as to how to help him, we started him on medication for the ADD. Surprisingly, the impulsive touching others and invading the space of others stopped as soon as the medication started. It has made a world of difference in my son's life because for the first time, he has friends and he is really enjoying his school experience. I feel like a have this great new kid living in my house (which is something to say given that I'm talking about a middle schooler :lol. I am sharing because I wouldn't have thought that his lack of impulse control was anything but behavioral and because I am sorry for my son that I didn't take action earlier.

[Anonymous]

I'm one of the people a PP noted as recommending the NIMH research study on ADHD. I've posted a number of times on this forum about my experience with it (very positive). I think it would be very worthwhile for you to pursue another evaluation but it's tough for me to say whether I think you should first see a developmental ped or an OT specializing in sensory issues (a different one than you used last time). ADHD is a definite possibility but it also sounds like there are some sensory issues (deep muscle pressure/proprioceptive). These evaluations are costly, even with insurance. That's one of the reasons I recommend the NIMH ADHD research studies because the research team members are experts in their fields, they see the whole sprectrum of issues, they don't have an agenda and they have been very good at giving us feedback on what areas we might look into more. There's also no cost to you and we were able to get in much more quickly than we could for a dev ped. We included the report they provided as part of our documentation when we were going through the IEP process. It was very difficult for the school psychologist to dismiss their findings or promote her own as more accurate than the research team's.

In the meantime, if you haven't already, you might start learning more about ADHD. I've found CHADD to be an excellent resource, especially the monthly meetings with guest speakers. Even if your DS doesn't have ADHD, the techniques/approaches used with ADHD are just as effective with "normal" kids. It absolutely couldn't hurt. Good luck!

http://intramural.nimh.nih.gov/chp/adhd/index.html
http://www.chadd.org/

[Anonymous]

OP, I want to offer something else for you to consider, in addition to all the other excellent advice.

My son can often have such impulsive behaviors as you have described. I have noticed that they appear after he eats certain foods with artifical colors and especially artificial flavorings. If he doesn't eat these foods, he appears to behave perfectly normally and has a ge appropriate impulse control. If he eats foods with these artifical ingredients, the difference is like night and day. He blurts things out, hits people (not in an angry way, just like he lost control for a second) and he seems surprised by his own actions.

I mentioned to his K teacher that I'd prefer he not eat foods with artificial dyes or flavorings, but that I didn't forbid it if there was a party opr something. Well, he was always a great, well behaved student in K. THen one day she took me aside and told me that for a treat they had had some punch with artifical ingredients and WOW she could see the difference. She never believed it made a difference in kids before, but she could see how changed his behavior was so she agreed there was probably something about him in particular.

Anyhow, for this reason I try as much as possible to limit these ingredients from his diet. Supposedly there's not a lot of data to support the idea that these ingredients are linked with poor impulse control -- but I am an individual and I need to do what is working for us.

It might be that you already limit these ingredients; but if not, it might be something worth at least trying to see if you note any improvement. If you child does have a sensitivitty to these ingredients, you would be able to notice improvement after just a week or two of a changed diet; and if you do see a marked improvement, then that would be reason to continue.

www.feingold.org has a lot of information if you are interested in this.

[Anonymous]

I could've written 15:04'S post.

If you do nothing else re: your suspicions, I would urge you to cut out red, yellow and blue food dyes and BHT (a preservative).

[Anonymous]

Thank you so much for your thoughtful responses. We have already cut out all food dye and eat (almost) an all organic diet. We do let him have treats at b-day parties and special events though.

You know what's ironic? After posting this I got a note today about how he was "perfect and very attentive in school today when the other kids were having a hard time because of the snow." I have no idea what to do with that information.

I will look into the NIMH study. I called Dr. Shapiro's office and they are not taking new patients. We saw Dr. Conlon last time and I was not impressed.

He his on a behavior plan in which he earns smileys for keeping his hands ot himself and sitting still. A certain amount of smileys earns a reward both at home and at school. It was working well but this had been a bad week. His teacher chalked it up to all week of inside recess.

[Anonymous]

I know you said that your son was evaluated for SPD and not found to have it, but this does sound to me like he could be sensory seeking and that's why he's touching but not a result of aggression. You could try implementing some deep pressure activities before school and see if that makes a difference. Ideas: jump on trampoline; carry heavy objects around the house; lie on the floor and you smush him (not his head!) with a big pillow like a "sandwich".