Cents -- not sense -- sorry typing too fast! There's probably a pun in there somewhere.

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:What are the evidenced based therapies for anxiety? People always say do your research. But I’m not a scientist. I don’t understand what research papers say.

I just posted but according to our psychiatrist meds + therapy. (True for adults too)

OP here - so would this be anxiety medication in addition to ADHD medication? Seems like a lot at once. And the dr who performed the neuropathy is hopeful treating the ADHD will largely address the anxiety.

We have a very good psychiatrist who prescribes, and this is his approach:

First medicate whichever issue is causing the most difficulty. For many kids with anxiety, that will be the anxiety UNLESS you think it's the ADHD that is causing the anxiety. Start with one medication that tends to work best for the most kids, start low, and gradually increase until the symptoms are tolerable with only tolerable side effects. Then you can start slowly adding in another medication to deal with the other problem.
For my kid with anxiety and ADHD, we ended up dropping the ADHD medication for a while as it was hard to find one that didn't make the anxiety worse, or cause tics. But fast forward a couple of years and the anxiety had largely resolved, in part with CBT/DBT skills training. She now takes an extremely low dose medicine for the ADHD, and deals with the anxiety through the skills she learned in DBT.
THere are ADHD medications that are less likely to cause anxiety -- but the nonstimulant ADHD medications don't tend to work for as many kids. And finding a stimulant that doesn't make the anxiety worse is largely hit or miss.
I'm not sure if you said how old your kid is, but my approach is as follows: 1) Help your kid with scaffolding to take off the stress and lessen the anxiety. 2) Don't sweat the small stuff. If they aren't in HS yet, grades truly don't matter. It's okay not to do all your homework or make your bed or whatever. Let that stuff go, so long as it won't create long-term effects. 3) Learn the skills that will happen lessen the anxiety. There are a LOT of tricks/skills you can use to work around ADHD. The more a kid learns those and figures out which ones work for them, the more at ease that kid will be in their own skin.
I do question whether having a ton of therapies might be counter-productive, as it might make the kid feel that the ADHD is running their life. Acknowledging it and learning to deal with it is helpful, but making their whole life about the ADHD and anxiety is probably not helpful. The thing that helped my kid's anxiety the MOST was getting into a club at school that she was super invested in .... the more time she spent on that activity, the less time she had to run the gears in her head on over-drive about what she could've/would've/should've done.
Just my two sense as a mom with ADHD with two kids with ADHD.

Anonymous wrote:I always get blasted on here when I point out that everyone is out for SN parents’ money and that you need to be very discerning about what you throw money at.

Just because someone did testing and said your child has all of these conditions does not mean they all need therapy or the type of therapy suggested or all the therapy at the same time.

Nothing can substitute for you yourself knowing your child and identifying the key challenges that need support right now.

If she is in K and struggling with reading and writing, then you need OT and a strong IEP with pullouts.

If she is in MS and not completing homework, then more structure and routine.

If she has anxiety affecting her daily, then evidence-based therapy like SPACE.

and so on.

I agree with this. There are always people that will take your money and guilt you into spending more.
There are some really great CBT based books for kids that can really help with anxiety and also with some of the ADHD symptoms. Make sure you've read some basic books on parenting a kid with ADHD, because you can get at least 50% of the way there with structure and solutions that you implement at home.
We found the weekly therapy to be basically useless. Insurance did cover a small amount of it, but it was a very small percentage for the mental health therapy, and a somewhat higher percentage for the OT. I definitely wouldn't be doing more than 2x a week of anything --- kids need time to be a kid, and having them in therapies every day of the week will just lead to exhaustion for you and then. Thisi s a marathon situation, not a sprint. If the anxiety is extreme, I would focus on that but make sure you are using someone that uses CBT, not just talk therapy, and has an anticipated end date for the treatment.

We are paying for an Exec Function coach for HS, and maybe should have started that in MS.

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:What are the evidenced based therapies for anxiety? People always say do your research. But I’m not a scientist. I don’t understand what research papers say.

I just posted but according to our psychiatrist meds + therapy. (True for adults too)

OP here - so would this be anxiety medication in addition to ADHD medication? Seems like a lot at once. And the dr who performed the neuropathy is hopeful treating the ADHD will largely address the anxiety.

Most doctors want kids to try therapy before moving to meds for anxiety.

It's 7.5% of AGI. Count everything not just the kid stuff.
https://www.irs.gov/taxtopics/tc502

Neuropsych not neuropathy … that was an autocorrect

Anonymous wrote:

Anonymous wrote:What are the evidenced based therapies for anxiety? People always say do your research. But I’m not a scientist. I don’t understand what research papers say.

I just posted but according to our psychiatrist meds + therapy. (True for adults too)

OP here - so would this be anxiety medication in addition to ADHD medication? Seems like a lot at once. And the dr who performed the neuropathy is hopeful treating the ADHD will largely address the anxiety.

As a parent of a high functioning autistic/adhd child who is now 10 but was diagnosed of having autism around age 2. Here’s what I have learned:
1. It’s a marathon and not a sprint
2. Don’t give up the dreams that you have for your child, that means prioritizing his/her and your family’s overall well being.
3. List them for Medicaid waiver. You may be on the list forever but in case something happens it may be an option.
4. If possible, both parents should continue to work full time and save for retirement
5. Sign up for able account for your child
6. For therapies, there is a lot out there but some of it is just not evidence based. So, knowing what your child needs is the best way to tease out what the specific needs are. If you got a neuropsych, ask the provider what the priorities are to focus on 1 year from now, 3 years from now and 5 years. This will help you get clarity.
7. If you are not in healthcare, use reputable online resources to gather information, this will help to again tease out what may help or not.
8. Have faith and good luck

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:It’s insane. We make a good living and our parents still cover the therapies for our adhd kid because they’re so expensive. I think about this all the time.

For what it’s worth, I’m not sure how much any of the therapy helps at a young age. Medication has been by far the most helpful thing. I would probably hold off on anxiety therapy until they’re older and can apply it. And OT we did for two years… it helps some but really for my child’s motor skill delays and adaptive skills that he was delayed in, not much for emotional regulation.

Agree with you on the limited use for OT … for therapy though, actual evidence-based therapies for anxiety will not drag on. They are time limited and may be worth investing in. Evidence based therapies also focus on the parent not the kid.

The evidence is strongest for kids w/ generalized anxiety is therapy + meds. It is absolutely worth doing early because you can actually rewire the brain as the younger the are, the more plasticity there is.

OT is a mixed bag based on people I have talked to. We did it for three years and motor planning and coordination improved immensely, but it was extremely incremental and only the cumulative effects were noticeable over a long period of time. Our insurance covered it once we hit our deductible but if finances or time were an issue, this is one I might skip. I think lots of outside time in nature (climbing trees, playing in the dirt) over time would be a good (free!) substitute.

I’m not sure about the plasticity claim, or the meds you are talking about.

OT for us had a very big initial benefit (child with poor motor planning went from not being able to play to being able to climb ladders on play structures, etc) but the biggest benefits were in the first year. After that money was better spent on 1:1 sports coaching.

Why do claim that there isn’t evidence for therapy/meds? We’ve had many professionals say similar things and a quick search confirms PP claims:

Evidence for meds and therapy: https://www.aafp.org/pubs/afp/issues/2022/1200/

Plasticity evidence, strong corrrlation across 28 studies: https://journals.sagepub.com/doi/10.1177/2514183X20974231#:~:text=Twenty%2Deight%20studies%20employing%20seven,in%20child%20and%20adolescent%20samples.

And for other question re: evidence based therapy, that usually means time-bound, goal-oriented programs like CBT or DBT, not just talk therapy.

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:It’s insane. We make a good living and our parents still cover the therapies for our adhd kid because they’re so expensive. I think about this all the time.

For what it’s worth, I’m not sure how much any of the therapy helps at a young age. Medication has been by far the most helpful thing. I would probably hold off on anxiety therapy until they’re older and can apply it. And OT we did for two years… it helps some but really for my child’s motor skill delays and adaptive skills that he was delayed in, not much for emotional regulation.

Agree with you on the limited use for OT … for therapy though, actual evidence-based therapies for anxiety will not drag on. They are time limited and may be worth investing in. Evidence based therapies also focus on the parent not the kid.

The evidence is strongest for kids w/ generalized anxiety is therapy + meds. It is absolutely worth doing early because you can actually rewire the brain as the younger the are, the more plasticity there is.

OT is a mixed bag based on people I have talked to. We did it for three years and motor planning and coordination improved immensely, but it was extremely incremental and only the cumulative effects were noticeable over a long period of time. Our insurance covered it once we hit our deductible but if finances or time were an issue, this is one I might skip. I think lots of outside time in nature (climbing trees, playing in the dirt) over time would be a good (free!) substitute.

I’m not sure about the plasticity claim, or the meds you are talking about.

OT for us had a very big initial benefit (child with poor motor planning went from not being able to play to being able to climb ladders on play structures, etc) but the biggest benefits were in the first year. After that money was better spent on 1:1 sports coaching.

Anonymous wrote:What are the evidenced based therapies for anxiety? People always say do your research. But I’m not a scientist. I don’t understand what research papers say.

yeah I am sorry, I always throw that term around. For kids, evidence based anxiety therapy will focus on how the adults in their lives can make sure they are not reinforcing anxiety and that they are supporting the child in learning to tolerate anxiety. This takes the form of time-limited skills-based therapy - the best known is called SPACE. https://www.spacetreatment.net/

Non-evidence based therapies and interventions for kids are often very costly because they have no end point and no focused goals, and because they are not effective. That’s things like ill-defined 1:1 talk therapy with a child.

With respect to school interventions, almost all of the interventions people talk about here are expressly non-evidence based and are actually bad for anxiety because the focus on letting the child escape from anxiety. if there is a single hallmark of evidence-based treatment for anxiety, it is that avoidance perpetuates anxiety. So things like letting a child skip oral presentations, extended testing time, letting child skip school and then make up missed assignments … all are very counterproductive.

Anonymous wrote:

Anonymous wrote:It’s insane. We make a good living and our parents still cover the therapies for our adhd kid because they’re so expensive. I think about this all the time.

For what it’s worth, I’m not sure how much any of the therapy helps at a young age. Medication has been by far the most helpful thing. I would probably hold off on anxiety therapy until they’re older and can apply it. And OT we did for two years… it helps some but really for my child’s motor skill delays and adaptive skills that he was delayed in, not much for emotional regulation.

Medication can be great, but wait as long as you can and try to find a med that doesn’t exacerbate the anxiety.

Depends on how deregulated or how much they are suffering. Theres no reason to wait for meds if your child is struggling.

Anonymous wrote:What are the evidenced based therapies for anxiety? People always say do your research. But I’m not a scientist. I don’t understand what research papers say.

I just posted but according to our psychiatrist meds + therapy. (True for adults too)

Anonymous wrote:

Anonymous wrote:It’s insane. We make a good living and our parents still cover the therapies for our adhd kid because they’re so expensive. I think about this all the time.

For what it’s worth, I’m not sure how much any of the therapy helps at a young age. Medication has been by far the most helpful thing. I would probably hold off on anxiety therapy until they’re older and can apply it. And OT we did for two years… it helps some but really for my child’s motor skill delays and adaptive skills that he was delayed in, not much for emotional regulation.

Agree with you on the limited use for OT … for therapy though, actual evidence-based therapies for anxiety will not drag on. They are time limited and may be worth investing in. Evidence based therapies also focus on the parent not the kid.

The evidence is strongest for kids w/ generalized anxiety is therapy + meds. It is absolutely worth doing early because you can actually rewire the brain as the younger the are, the more plasticity there is.

OT is a mixed bag based on people I have talked to. We did it for three years and motor planning and coordination improved immensely, but it was extremely incremental and only the cumulative effects were noticeable over a long period of time. Our insurance covered it once we hit our deductible but if finances or time were an issue, this is one I might skip. I think lots of outside time in nature (climbing trees, playing in the dirt) over time would be a good (free!) substitute.

What are the evidenced based therapies for anxiety? People always say do your research. But I’m not a scientist. I don’t understand what research papers say.