Don't discount the help a stimulant can help. If kids are using ALL their energy at school to mask or focus (or both), they can have MAJOR restraint collapse at home.

So I don't agree that a stimulant should be immediately ruled out. Speak with a provider about whether it might help.

Anonymous wrote:If she did a neuropsych, she did hours and hours of tests. What did you tell her about that process? What did you tell her about the results if you didn’t use the word autism?

You have to tell her something about the results - she knows something is up, and she seems to be imagining the worst (that you think she is broken). Clearer messaging from you could help with how she sees herself.

You and the other PPs are right. We gave her a very simple explanation that the testing can tell us how her brain works. I need to work on my messaging. I didn’t get into the weeds with the diagnosis before… the ADHD is more significant with impulsivity and emotional disregulation. Attention shows up as an issue when she can’t hear what we are saying to her. It was apparent in the testing, too. The autism is on the mild end of the spectrum - her sensory issues have evolved over the years and are more subtle now. She has some trouble understanding social rules, unless they are explicit. The psychologist noticed some quirks that don’t register usually for me.

Anonymous wrote:I posted above recommending considering anti-anxiety meds. I wanted to add that you should tell her about autism. Understanding that things are difficult because of autism, rather than something inherently wrong with her, can be very helpful. We did an additional debrief session with my child and the neuropsychologist.

07:45 PP here. I agree! My dd knows, it's part of the amazing person she is. When she was 7 she did a class on Outschool about autism, for kids, run by Gabrielle Hughes (I think) who is an autistic adult. She got a lot out of that.

If she did a neuropsych, she did hours and hours of tests. What did you tell her about that process? What did you tell her about the results if you didn’t use the word autism?

You have to tell her something about the results - she knows something is up, and she seems to be imagining the worst (that you think she is broken). Clearer messaging from you could help with how she sees herself.

Normally for kids like this meds means an antidepressant like Zoloft or Prozac and it might help.

Where is your child presenting with adhd symptoms?

Fwiw my son is similar to another poster here- his worst adhd symptom is emotional dysregulation, but he also does have hallmark impulse control and hyperactivity symptoms.

A stimulant is not a magic bullet for us either. It can exacerbate his anxiety. But overall it’s the most effective five medication he’s on to control the massive volatility in his mood and behavior.

We are experimenting with an SSRI but that can also make impulse control worse from an adhd standpoint, so it’s a lot of trial and error. If your child is mostly suffering from emotional dysregulation, an SSRI might be a good tool. If there are classic adhd symptoms related to focus, then you might need medications to manage mood and behaviors.

Who manages medication for your child? A psychiatrist is probably best.

Oh and when my ADHD'er feels a little broken in need of a reset (I totally know this feeling), the biggest thing that has helped us is basically no screens for a couple weeks and instead 1:1 time with parent for as much of that time as we can. Somehow that seems to really reset things even though we don't do a ton of screen time regularly anyways but it just opens up more time for rejuvenating things on the weekend. I don't make it some dramatic things like NO MORE SCREENS, just when he asks I'm nonchalantly like nah, let's do something else - how about x? and do it with him. Then he kind of gets out of the mode anyway.

My son only has an ADHD diagnosis, but do want to share that it presents primarily as emotional dysregulation as someone else said. Difficulty coping, many of the things you described. And a stimulant does actually make a big difference for our home. There are also non-stimulant adhd meds that are supposed to be even more helpful with emotional regulation for some kids but weren't a good fit for mine. So I wouldn't count out ADHD meds and would consult with a good psychiatrist to explore options.

I also agree it is usually in the best interest of the child to know their diagnoses. A therapist might be able to help you have those conversations so maybe that would be helpful. For ADHD though, therapists can sometimes have limited effect because it isn't an issue that the kid doesn't know the "right" behavior but that in the moment they have trouble regulating their emotions around it and/or act impulsively. Doesn't mean it isn't worth a try but just good to know.

The most helpful thing for my child with ADHD for routines has been pictures of himself doing the task. Not clip art or a picture, literally pictures of himself - helped SO MUCH. One day we did the morning routine together and I took pictures of him doing it. Then I put them on a Powerpoint in order with little boxes to check. I put it in a plastic sheet cover and he checks them off. Then on the back is what he "earns' for doing it - playtime etc. ADHD Dude has helpful tips like this.

Anonymous wrote:As I recall, third grade was when the social complexities really stepped up and started to leave my DD behind. You mentioned your DD is 8, is she in third grade?

I wonder if the social changes in the other kids are something she is struggling to understand/handle? It may or may not be something she’s fully aware of or could articulate. And some kids express their anxiety and overwhelm through anger.

If she’s open to speaking with a therapist, it seems like a good idea.

Yes, she is in 3rd grade. She is young for her grade, but quite articulate when she isn't angry. My impression is that she has some kids who really like her, but she doesn't understand how to maintain the friendships (yet?). She does well with quieter kids who think her lively personality is interesting. She loves to be funny and charming, so that helps. She seems to worry about these kids moving on or focusing on other kids instead - maybe because she doesn't understand friendship. She does not do well with kids who have more complicated social motives -- I see that developing. She talks about those kids as people she doesn't like. Some of them are former friends (or kids from playdates).

I posted above recommending considering anti-anxiety meds. I wanted to add that you should tell her about autism. Understanding that things are difficult because of autism, rather than something inherently wrong with her, can be very helpful. We did an additional debrief session with my child and the neuropsychologist.

As I recall, third grade was when the social complexities really stepped up and started to leave my DD behind. You mentioned your DD is 8, is she in third grade?

I wonder if the social changes in the other kids are something she is struggling to understand/handle? It may or may not be something she’s fully aware of or could articulate. And some kids express their anxiety and overwhelm through anger.

If she’s open to speaking with a therapist, it seems like a good idea.

My similar sounding kid started Prozac at 9 for anxiety and added Adderall at 11 after being diagnosed with ADHD (and ASD).

My kid’s ADHD presents as emotional dysregulation more than the classic academic presentation (which was also there, but overshadowed). The ADHD medication does help, although it is not a magic bullet.

My kid has been in individual therapy for years off and on, but had gotten more out of social skill groups. He was extremely resistant to talking about or even being told his diagnoses, so being around other kids with similar challenges has been really helpful.

I would definitely seek out a psychiatrist to talk about medication (versus just using your pediatrician) because ADHD medication can make anxiety worse. SSRIs need to be tapered on and off. We also used a gradual approach to the ADHD medication. But it means you need to be patient for weeks while you try to determine if it is effective (especially the SSRI).

I 2nd the anxiety idea. It can show up in ways like anger. My dd (9, dx asd) can be pretty anxious, although not typically angry. But the few meltdowns she has have been caused by it.

As far as the bedtime routine, what about something on a chart or Ipad that she can 'check off' or complete herself? So it's not you 'trying to change her' but rather she handles herself. Some kids like those charts but some don't. There are apps though for it.

My dd isn't medicated-athough I'm open to it if ever needed-but she is in therapy, has a nice therapist she sees via zoom. It seems helpful to her. Your dd might like having someone to talk to that's not you/dad.

I agree that a stimulant is unlikely to help with what you describe. But it sounds like there's lots of anxiety and a SSRI (or SNRI) can help a lot.

We are in a situation with a recent dx from a neuropsych, trying to figure out our next steps. Our child somehow is ok at school. She has a great teacher. She seems to have trouble with social skills, but she isn’t having trouble focusing in the classroom.

However, at home… things are a little rough. She is stuck on the idea that we always think things are wrong with her. She obsessively, angrily tracks how life is unfair - especially when we ask her to go to bed. She hasn’t always been like this, exactly. She feels a little broken, like she needs a reset. I can break through it by not focusing on the garbage coming out of her mouth (she hates me?), staying super calm, using a tiny bit of humor and being excessively flexible… in the end, she left the living room couch, she decided to change into pjs, floss and go to the bathroom last night… but she did not brush her teeth. I told her that I make recommendations, but she is responsible for this self care in the end. I know she will brush in the morning because she is actually pretty mature and responsible underneath this weird anger thing that is happening regularly now. She is 8 and a half. Maybe she is angry about the testing. I need to talk to her about this differently (and ask her more questions when she isn’t full of rage). She says we hate her and we are trying to change her too much. We have not told her the diagnosis.

I’ve been explaining to my husband that I don’t think a stimulant is going to fix any of this. He would love to give her some kind of medication to make this better. It is true that this way of parenting her feels like a lot… but it has always felt very different from our slightly older kid. We do work with a parenting coach, but I think we need some new strategies with this new diagnosis. Maybe she just needs a good 1:1 therapist? We still have not tried that. The CAAT unstuck group seems like another option.

Sorry that I wrote so much!