Anonymous wrote:Huge thanks to 19:28 poster for the kindness and reassurance that shines from your post, as well as for generously sharing your experience. I am glad that things are better for your children. You absolutely got to the heart of many of my fears.

I spoke to Maddux when my oldest was in first grade and they were extremely nice but said they would not be able to support him. Both of my SN DCs have had violent outbursts at school which means that a private is not really an option (we also could not afford it).

Thank you again everyone. You have convinced me that medication would be a better step than a move. I was worried that I would be being selfish by medicating them to tamp down their feelings, rather than trying to address the anxiety school produces in them with a more fundamental lifestyle change, but I think that our problems would just follow us.

Anonymous wrote:OP here. Thank you for the responses. I am not from the U.S. originally so I do worry about how I would fit in somewhere in, say, the Midwest. My in laws are local (DC suburbs) and my own family are all still overseas.

Re meds we have tried Ritalin and Adderall, both of which made oldest DC very jittery and agitated. Then guanfacine which they’ve both been on for ages, which helped at first but now doesn’t seem to be helping as much (and makes them fall asleep and wake up very early… couldn’t give it at night as it gave nightmares). I am a bit scared of SSRIs and things like Abilify because of the lasting side effects. Like, I don’t want to add more issues with medication if a lifestyle change could help.
Part of the issue is that I have not been able to find anyone who can handle DC. We tried nannies in the pandemic and 3 of them quit. So we are doing almost all afterschool care ourselves, plus some grandparent help. I don’t think most nannies could handle my kids behavior, even if we could financially swing it. Private schools would almost certainly kick them out due to behavioral issues. Just feel a bit trapped.

Anonymous wrote:

Anonymous wrote:We did see someone remotely from KKI for a while. It was more parent coaching. By behavioral therapy do you mean ABA? I looked into that too but did not get a good vibe from the coach they sent.

PCIT. KKI has an in person behavioral clinic as well. At this point there are also a lot of private providers doing PCIT. Because I see a lot of random stuff on your list (craniosacral therapy?) but not actual evidence-based behavioral therapy.

I do think ABA could also be appropriate but I understand that right now there is a lot of difficulty accessing good providers.

Anonymous wrote:We did see someone remotely from KKI for a while. It was more parent coaching. By behavioral therapy do you mean ABA? I looked into that too but did not get a good vibe from the coach they sent.

Anonymous wrote:Hi everyone, OP here. This has been such a helpful thread. Thank you all again.

My oldest has had a FBA and BIP in 1st grade. Oldest DC then seemed to settle down for a couple of years and is now ramping up again in 4th. My middle is in 1st and has a safety plan as well as an IEP. With my oldest, we considered applying for a private placement but there wasn’t really an obvious option - there is Ivymount, but I don’t think that starts until 3rd or 4th. We also looked at another DCPS with a “high functioning” ASD pull out program (Takoma) but decided against it as it would have meant a long daily bus ride across town. In the end we used a lawyer and got partially reimbursed by DCPS for play therapy (and tutoring, although we never bothered as DC is at or above grade level academically and our priority was behavior).

A few other things we have tried: play therapy, Dr Dan Shapiro’s parenting classes, reading The Explosive Child and The Out of Sync Child, weekly OT, craniosacral therapy, probiotic supplements. This thread has given me a lot more useful leads to follow up, and I truly appreciate it.

We had a psychiatrist who moved overseas, and then used Georgetown’s psychiatric clinic which I found to be awful. Now using our pediatrician for prescriptions. I would be extremely grateful for a psychiatrist recommendation to help us navigate medication beyond guanfacine. I have also found it makes my kids wake up incredibly early, and fall asleep very early… I don’t know if anyone else has experienced this side effect.

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Have you tried other meds besides Guanfacine? There are way more effective meds out there for this profile and Guanfacine is usually one of the first things tried bc it’s low stakes.

guanfacine can cause irritability and mood swings. I’ve seen a child become periodically distraught and sobbing on guanfacine in response to really small things.

OP needs to work with a really, really good psychiatrist who understands that the #1 goal is reducing behavioral outbursts not ADHD per se. We are in a confusing moment with a lot of misinformation about ADHD causing everything under the sun and the notion that treating ADHD is the #1 priority. In OP’s shoes I would find a doctor who is very conservative and doesn’t do polypharmacy - so wean them off guanfacine and start a very very low dose SSRI, probably.

No good psychiatrist would have a blanket rule against polypharmacy. It's not appropriate in every case, of course, and you don't want to add meds to counter the side effects of other meds, but sometimes polypharmacy is absolutely indicated and appropriate.