Pre-IEP meeting for ADHD kindergartner - questions on how to handle

[Anonymous]

Here's our background - my son is six. His birthday is a week before the cut off, so we held him back and started him in kindergarten a year "late". He has ADHD, and according to the diagnosing Dr, it's "severe" inattentive/hyperactive type. We have him on medication that helps him to control a good bit of the the behavior. Previous to this year (where he is in Arlington Public School for K) we went through three pre-schools in nine months - the first we left because the instructor publicly belittled and humiliated him for his poor behavior (instructor ended up fired for it after a county licensing investigation), the second we went to, a catholic school, the teacher permanently placed him and his desk in the corner and the kids all called him the naughty boy and he cried all the time (and acted worse). Finally we found a third place that could handle him and about that same time got the ADHD diagnosis and started him on meds.

He has always had major behavior and impulsivity problems - on meds they still exist. So we had a pre-meet with the school about a month ago to get the IEP qualification process started. I have another child with an IEP but his is for dyslexia and it was a clear learning disability. At the early meeting the school told us that they would have a hard time justifying anything for DS unless he was showing academic problems.

Well, he's not. But is it because he's basically a year older than the kids or because really the ADHD doesn't affect him anymore? I still see tons of really poor behavior and impulse control issues that he can't control. And, while these things are somewhat acceptable in kindergarten they really aren't in first grade. I talked with his teacher at length last week and she really thinks he needs some extra help and services, but she's concerned that we will have a hard time convincing the rest of the team of the need - apparently DS was an angel when he was observed last week (of cousre he was...).

So, questions for you all. Am I being unreasonable in asking for some behavioral help? I don't want all our struggles with my other child to color this - it just took so long to get help there that I don't want to put it off now if I see a problem that can be nipped earlier rather than later. Given how hard it was for DS with the social and behavior things in his past schools, I don't want him to be treated like the naughty kid and ostracized again for behavior he can't control, I'd rather the school help me to teach him appropriate reactions and control.

Since we have a medical ADHD diagnosis, I'd think that we could qualify for the OHI category, but I'm concerned that the school won't even move forward with testing, that they'll say that he isn't suffering academically and he has no problem accessing the academics. Can you think of any suggestions you might have for ways I can suggest the school move forward with a t least a more in depth analysis of his challenges?

Thanks for your avice. Our meeting with the school is on Thursday and I want to be prehaperd.

[Anonymous]

OP, I'm so sorry for all the trials and tribulations. I would encourage you to ask for DS to be evaluated by the learning specialist and the OT. If they tell you know keep going back and asking for services. Photocopy the diagnosis (the one page) and highlight the diagnosis. Make multiple copies and keep handing out to everyone whom you meet with.


Kids with ADHD often has learning disabilities and often need OT to help regulate themselves. Unfortunately, kids often get labelled "behavioral" problems when they have learning issues. I would also seek out a private OT if you have done this already.

GL, and we're here for you!

[Anonymous]

Have you considered adjusting his meds? If he is still having "tons of really poor behavior and impulse control issues" then it seems you could either try a different medication or increasing the dose slightly. I'm assuming the teacher has things like a success chart in place already? I would also consider behavioral therapy outside of school, and see if your school has any sort of lunch bunch/friendships group he could take part in.

But the meds really should be working better. We've found that if the dosage is even the slightest bit too low, we see no improvement. It's almost like you need to get past a particular threshold for them to kick in. For us, it is 15 mg Focalin XR. 10 mg doesn't cut it, but 15 does the trick.

[Anonymous]

Thanks all! We can't change his meds until he learns to swallow whole pills (we've tried all sorts of tricks, still working on that) as we've tried, literally, everything that comes in capsule form. So far this one (metadate) is the one that works the best without weight loss (he went from a 54 pound kid to 41 - and a >20% weight loss is not acceptable) associated with it. His behavior just can't seem to get much better, no matter how high we ramp the drugs and his weight starts falling, so this seems like a happy medium for now. He's not intolerable like he used to be, but he's still often worse than he should be in terms of not blowing his top when things don't go his way, keeping his hands to himself, waiting his turn etc. Things that hopefully, he can mature out of in addition to having the meds help him. But for the moment, it's not great.

[Anonymous]

Ask for a 504 plan. He has a medical condition and needs accommodations--simplified directions, a behavior plan, visual prompts are some that he might benefit from. I agree that if he isn't struggling to access the curriculum, then there isn't a need for services. But accommodations? Yes.

[Anonymous]

As an aside, have you tried putting the pills in a spoonful of ice cream or apple sauce? The whole pill, not the broken up capsule? That is the only way my dc will take a pill. He doesn't see it and just swallows the whole spoonful. Good luck with your meeting. If you aren't successful on your own, you may want to hire an advocate to help you.

[Anonymous]

OP here - thanks everyone. I have a feeling that a 504 plan may be where we end up. This week's meeting is the child study meeting. Basically the one to see if our issues are significant enough to merit the school psychologist and SpEd teacher doing any testing. The SpEd teacher and Vice Principal have done some in class observations, but they haven't done the full work up that happens when you decide to proceed.

Does anyone know if, in order to get a 504 plan, you need to go through with those evaluations? I would guess yes, but I don't know. What I'd really like, outcome wise this week, is to say "hey, something is going on here that's not right, I want you to do a more thorough analysis, then we'll figure out what, if any, accomodations or services he mgiht need."

Does that seem like a reasonable approach? Suggestions?

For my other child it was so obvious that there was a learning problem that these first steps were almost pro forma.

Thanks also for the pill swallowing ideas - we've tried pills in yogurt, applesauce and ice cream. We've practiced with tic tacs and nerds. I bought some fancy (waste of money) pill swallowing cup, some kind of throat spray called "pill glide" that basically sounded like lube for yout throat and some super wide straws that were supposed to help by getting a bigger gulp of water to push the pill in and back. Nothing works. The problem is that he knws it's there so he stops himself from naturally swallowing it and feels for it, then once he's done that he can't swallow it. I'm hoping that when he's just a little bigger if we try again it will be easier.

[Anonymous]

This is 14:15 again. So it sounds like his behavior/impulsivity is really the issue. Is he able to focus on tasks in the classroom? What exactly is going on in class that is still an issue? In my experience, the ONLY thing that has worked on the impulsivity is meds. There's a reason it's called impulsivity -- because it can't be controlled. We tried OT and CBT and had many classroom interventions (behavior charts, special chair, timers, weighted vest, checklists, etc.) but saw no discernable results until we started meds. When we've had to do a booster for our son in pill form rather than capsule, we've also buried it in a spoonful of ice cream and just had him swallow the ice cream immediately before it melts in his mouth. Have you tried the Daytrana patch? Regarding your son's weight, have you switched to whole milk, butter on pasta, lots of calorie dense snacks, high-calorie dessert every night? We pretty much let our son eat anything (even junk, within reason) if it means he keeps his weight up. It definitely takes some effort to make sure he eats enough -- we bribe with iPad time, whatever it takes!

[Anonymous]

OP again - thanks for the questions/thoughts. It's definitely impulsivity, he can't not interrupt when he has something to share. If he sees someone doing something "wrong" he can't not correct them (and usually it's not done in a nice way). He also has some emotional issues - if he feels wronged (the class was doing a project with apples, someone picked up "his apple" by mistake from a pile) he loses it and screams and yells at the child and disrupts the entire class.

We haven't tried the Daytrana patch yet, that may be next. And we've pretty much got every calorie we can going into him. For breakfast he usually has oatmeal made with whole milk, a scoop of protein powder, and honey and to drink he has a smoothie made of whole milke, coconut milk, greek yogurt, protein powder, berries, nanana and honey. He dosen't eat much at lunch - with the meds on board and me not tehre to supervise it's pretty haphazard. For dinner he gets a plate of whatever we're eating, which he'll pick at. then about an hour later he gets two bowls of cereal (usually kashi for high protein) with whole milk, a frozen toaster waffle with peanut butter or nutella on it, and some kind of yogurt drink to wash it down. He's getting a ton of calories in, but other than on our current med, he hasn't been able to keep any of them on.