Next steps - 4 year old ADHD

[Anonymous]

My son (almost 5) was "early diagnosed" with ADHD in 2015 by a dev ped at KKI. Main issue is hyperactivity which results in lots of drama at school (inappropriate physicality, touching, hitting, silliness), but which is totally manageable at home. No issues with ODD, anxiety, inattention. We are ready to talk to specialists about next steps *practical advice*, because DH and I both agree that for the first time he is clearly "missing out" compared to his peers (it's only been in the last 3-5 months that kids are really starting to develop friendships, focus themselves on fun stuff at school, etc, and he's missing out on these things).

When he was first diagnosed, general feedback from all quarters was to wait. He wasn't such a danger to himself and others that he needed meds at age 3. We were also advised (and agreed) that social skills groups or behavior therapy at that age would have little impact, because he was actually quite well behaved in smaller group settings. But now he's almost 5, and he is old enough to know better, and he is old enough for meds. So it's time to move forward.

I could just go back to the dev ped or pediatrician and tell them that we're ready for meds (which I think we are) and I know they would prescribe them. We could do another eval with the dev ped, but I think it would come out exactly the same as last year's (i.e. he has adhd), and their advice to medicate would be based solely on my word that he's a disaster in school. Based on research, I'm pretty confident he doesn't need a psychoeducational assessment or neuropsych or whatever the next step is.

But I'd really love for someone to observe him in school and make sure that mom and dad aren't blowing this out of proportion. Certainly, lots of kids at age 5 have ADHD and don't need to be medicated. I think ours does, but I'd like someone to observe him in school -- his main problem area -- to make sure we're not messing this decision up. Maybe this observer has other excellent strategies for his teachers that minimize the issues. Maybe they could suggest whether social skills groups or behavior therapy would help at this point, or they could rule it out.

Basically, I'm looking for an objective third party to help us make this decision with as much information as possible.

I'm thinking that psychologists might offer this? We found OT to be useless. What are recommended next steps here?

[Anonymous]

Have you had child find observe? They do this, to offer suggestions. I would do that first. They can give you a report. If you do a neuropsychologist this is also often part of it.

[Anonymous]

Your school should do this for you if you request it.

[Anonymous]

Is your child in public school?

[Anonymous]

Our school regularly did this for kids but usually when a bit older.

The school psychologist in to observe the child over an hour on several different days (for a total of 4-5 hours) and literally tracke everything the kid did
11:01 touched neighbor,
11:02 got up out of seat,
11:03 received rediretion from teacher,
11:04-05 on task for mah problems
11:05 poked other neighbor

etc.

It was very helpful for parents to see just how much the child was/was not 'on task.'

[Anonymous]

OP here. Thanks for the responses! DS is in private preschool, and we will be leaving the DC region before K next year. For a variety of reasons, I'd rather do this through a private channel. For instance, I spoke to DC child find a while back and they were very helpful and kind, but they said that most of their findings would be in the form of proposed therapies and strategies that use the DCPS resources that are at DCPS schools. So for instance, if they thought he needed one on one behavioral therapy or speech therapy, it would be with a DCPS therapist during school hours at a DCPS location. During my conversations with them, they conveyed that the eval would be more of a "here is what DCPS thinks you should do within the DCPS system given our resources" and less of a useful tool to work within his current private preschool. If we were sticking around DC, I might be inclined to do that, but doesn't seem to make much sense if we are leaving next summer.

[Anonymous]

then I think she needs a child behavioral therapist, right, one who works with young children preschool age? that's what child find would send, so she needs to find a private one?

I think?

[Anonymous]

For all kids, healthy diet, physical activity, and sleep.

From a parenting perspective, I got a lot out of behavior therapy at KKI's outpatient center in Columbia, MD.

In terms of school, they already have someone they use for observations, but you may want to ask if they will allow a behavioral assessment, e.g.,: http://cecp.air.org/fba/
It can help identify needed supports, which might be as basic as visual schedules, sensory break, etc.

From a social skills perspective, try one-on-one play dates. This is a helpful resource:
https://www.amazon.com/Its-Much-Work-Your-Friend/dp/0743254651/ref=sr_1_1?s=books&ie=UTF8&qid=1474575542&sr=1-1&keywords=it%27s+so+much+work+to+be+your+friend

If you haven't initiated the IEP process, you may want to consider doing this now even if you're moving. The process can take a while and it will probably make transitioning to the next school easier.