One of the challenges associated with ADHD and ADD is “executive functioning”. I have talked about this before. This like so many other things is a confusing element to ADHD but one that I feel is really important to be aware of and necessary to understand the challenges of your child holistically. In fact, many experts in the field of ADHD/ADD are starting to suggest that ADHD be re-conceptualized as an “executive disorder” and deemphasize the focus on hyperactivity and attention. Problems with executive functioning are not limited, however, to only those with ADHD or ADD. Executive dysfunction sometimes is the only problem and sometimes is part of a larger problem.

The easiest way to think of executive functioning is that it is the administrative or managerial part of the human brain. Executive functioning has to do with organization, planning, self-control, and time management, for instance. Like anything else, any individual with executive functioning issues will have areas of strength and areas of weakness within the broad spectrum of executive functioning.
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One of the things I struggle with as a parent of a child with neurological issues is really grasping everything.  There are times when I feel that I have a handle on things and there are times that I worry about all kinds of issues.  Does he have other psychological and behavioral issues?  Is he suffering from clinical anxiety, does he have ODD, what is immaturity, bad behavior and what is executive functioning deficits?  Sometimes I think I might go mad with all of the questions running around my head!

One term that I have heard fairly often and frequently worry about is ODD, Oppositional Defiant Disorder.  Many parents have not heard about this disorder but it apparently is one of the most common psychiatric problems in children affecting around 5% of the child population.  It also affects a high percentage of children with ADHD … around 30 to 40% of those with ADHD also have ODD. In fact it is exceptionally rare for a child to only have ODD; ODD is commonly associated with ADHD and depression/anxiety.  Oh that lovely comorbidity thing again!!

So what is ODD?  One of the best descriptions I have heard of ODD is by Jim Chandler, MD, FRCPC.  (http://jamesdauntchandler.tripod.com/).  According to Chandler, “ODD is a psychiatric disorder that is really just the far end of the stubbornness spectrum.  The line that divides being just difficult and stubborn from ODD is a set of diagnostic criteria.”

The criteria for ODD are:

A pattern of negativistic, hostile and defiant behavior lasting at least six months during which four or more of the following are present:

• Often loses temper
• Often argues with adults
• Often actively defies or refuses to comply with adults’ requests or rules
• Often deliberately annoys people
• Often blames others for his or her mistakes or misbehavior
• Is often touchy or easily annoyed by others
• Is often angry and resentful
• Is often spiteful and vindictive

The disturbance in behavior causes clinically significant impairment in social, academic, or occupational functioning.

Now why do I worry about this so much and why am I confused?  I think any parent of child with ADHD probably struggles with getting their child to cooperate with homework, chores and the other necessities of life.  Our son often throws fits and refuses to cooperate.  This is pretty much a daily occurrence.  Are they outrageous, knock down fits?  No.  He occasionally has an outrageous fit but not often.  But why does he throw these everyday fits:

• Is it because some times he gets his way?
• Is it because of executive functioning deficits which cause a low threshold for frustration?
• Is it a side effect of the medication?
• Is it a transition issue?
• Is it because he is exhausted from school?
• Is it signs of ODD?

I think this is the most difficult part of our son’s neurological challenges – not knowing the answers to everyday occurrences.  Am I doing something wrong?  Am I doing something right?  What should I be doing?  And the internal battle of questions rages on and on in my head non-stop.

I decided to do some research into ODD for today’s blog post because it is an area I have been concerned about but have not really had the time to research.  What I found to be the key criteria for ODD is spitefulness and vindictiveness.  This coupled with a blaming others for his or her mistakes or misbehavior are key signs of ODD.  According to Chandler, “the destructiveness and disagreeableness are purposeful.  They like to see you get mad.”  It is this description that turned on the lightbulb for me.  Our son often refuses to cooperate but he is not spiteful or vindictive. He is “oppositional” mostly because he does not want to do what I am asking not because he wants to see me get mad.

To read Jim Chandler full pamphlet on Oppositional Defiant Disorder, please go to http://jamesdauntchandler.tripod.com/ODD_CD/oddcdpamphlet.pdf.  It is a straightforward description with examples that I found to be tremendously enlightening.  Most other sources of information that I found online stuck with the Diagnostic and Statistical Manual of Mental Disorders definition as an ongoing pattern of disobedient, hostile and defiant behavior toward authority figures which goes beyond the bounds of normal childhood behavior.  Most sources of information are very clinical with very few examples.

So I am happy to say that our son’s stubbornness does not seem to fit within the range of Oppositional Defiant Disorder.  Yeah!  Cross that off the list, for now (J).  So now I need to worry if it is a side effect of the medication ….. sigh.

This post can be found at: http://jozikids.co.za/blog/2009/11/27/adhd-and-the-holidays/

ADHD and the holidays

By Angel Swemmer, a  mom to a teenage-almost-adult ADHDer and what I write is purely my opinion on things I feel strongly about, based on my experience as an ADHDer parent. Author of the blog Angelsmind

Are you dreading the holidays?

Does the thought of spending time with friends and family scare the bejeebers out of you?

Well, if your ADHDer is anything like mine, then he (or she) is a handful at the best of times and I don’t blame you.

Like me, you probably also have- or have had- a dilemma with friends and family battling to deal with your ADHDer, or struggling to understand that ADHD is a disability.  And if you medicate your ADHDer then you’ve probably also had flak for doing so. Maybe your parents or family members “…don’t believe in ADHD…” and don’t agree with how you are treating the condition. Perhaps you even have close family and friends whom you haven’t even told about your child’s ADHD- for whatever reason…

The holidays make all this a lot more difficult than usual.

As it is, a simple Sunday lunch with the family can be a nightmare for ADHDers and their parents. In the holidays- even if you do not actually go away- you will most likely be spending a lot of time with close friends and family over the silly-season, so you can multiply the nightmare comparison by a factor of 10, at least.

You’d think an ADHDer would thrive in this season of noise and colour and excitement, but what it really does is make them needier when it comes to their demand for immediate gratification- and it makes them come across as even more hyper and disruptive than usual. ADHDers battle socially. They don’t read social cues and they cannot read body language. The bright lights, colours, crowds and the pressure to meet holiday deadlines and interact socially, quickly sends an ADHDer’s brain into overload. And this is when they become difficult to handle even for people who love and understand him.

One of the first things that fall by the wayside when Christmas holidays start is the daily routine. You sleep late, eat later, eat “junk”, shop, gallivant, visit friends and family, and in some families you no longer medicate* your ADHDer.

Read the rest of the article here: http://jozikids.co.za/blog/2009/11/27/adhd-and-the-holidays/

The Wonderfulness of Me

If you took all of the things that were special about me,

You could put them all together and call it AD/HD.

No better, no worse, just different that’s me,

I’m really not crazy, please try and see.

Like a talented wizard in a world full of “Muggles”,

It’s no wonder all you see is frustration and struggles.

As I daydream and drift, you think no one’s there,

But nothing could be further from the truth, believe me, I swear.

I see your impatience as my mind starts to wander

But, you don’t know the depth of the thoughts that I ponder.

For creative thinkers, get lost in deep thought, which leads to the illusion that they cannot be taught.

I know trying to reach me can give you the blues, but I wish for just once, you could walk in my shoes.

To see things through my eyes, you would be amazed, at the speed and sheer volume my thoughts seem to blaze.

I’m not lazy or stupid, if only you knew, how truly difficult it is to limit myself and think like you do.

But, I can see things that you’ll never see,its like second nature, because I am me.

With lightning fast reflexes, I can switch gears,

To be firm and inflexible is the worst of my fears.

I’m calm in a crisis and know just what to do,

For I’m in great company, Mozart, Edison and Churchill to name just a few.

So show me some patience, as I’m patient with you.

Just a little tolerance, it’s long overdue.

Please try and understand me, along with my AD/HD, It’s a very big part of the wonderfulness of me.

Credit to author: Robert Tudisco

I found this poem on a blog called Angel’s Mind, a mother of a young adult boy with ADHD.  Here is Angel’s link http://www.angelsmind.co.za/2009/12/04/a-new-adhd-poem/.

One of the areas where I constantly struggle is helping our son find his areas of talents or what I like to call, his essence. Our children are like my husband and I. We are good at a lot of things but not outstanding at any one thing. We are good athletics, we enjoy music, we like books and politics, we enjoy giving back to the community and so forth. We are not the next Rembrandt, Tchaikovsky, Michael Jordan or Mother Teresa. Nothing is glaringly obvious.

Couple this with the fact that most of the time and effort with our son is currently focused on academics. He is absolutely exhausted when he comes home from school. He works hard, thank goodness, and cooperates with his teachers and, new this year, he actually LIKES school. I have so much to be thankful about. But some days when he gets home from school, he looks like he has been through a war.

We value play time and are mindful of balancing work with play time. But we have over an hour of homework each night and it is very difficult to fit everything in. He does play sports on Saturdays and seems to enjoy it but it is not clear to us that sports is his THING either.

Why do I worry about this so much? Our primary goal with our son with everything we are doing is to develop is self confidence and his self esteem. That is starting to develop academically because we are able to send him to a school when he can learn differently than the mainstream and be successful. I want him so much to experience success in something outside of school that he truly loves.

Getting him to try new things is not easy. He gets anxious and worried about new activities. Often when we start up a new sports season, he has trouble with the first few weeks of the activity – it is a transitioning issue.

Maybe this worry is more about me than him? I just want so badly for something to come easily to him that he truly truly loves … given that he has to work so hard in the other areas of his life.

So this blog post is not a Karen offering a suggestion blog post – it is one where I am reaching out to you for help. Do you have any suggestions or thoughts?

• How do we fit in the time for him to explore his interests?
• When is the right time to pursue drum lessons or karate or whatever else?
• Is maintaining a balance between play time and work time enough for laying the groundwork for future interests?
• Do I need to just chill out and believe that with self-confidence and academic “success”, he will figure it all out?

Would love to hear from you regarding how you enable the “essence” of your child to shine through all of the struggles!!!

MEET CHARLIE OUR GUINEA PIG

As many of you know, having a child with ADHD or working memory issues creates a challenge when trying to get them to take responsibility for multi-instruction tasks. We have had a difficult time getting our son to be independent and to take on responsibility. Some of this is probably our fault. He works so hard with his learning disabilities and ADD that we probably baby him too much otherwise. However, he was begging – BEGGING for a guinea pig. Even though we really did not have ANY desire to have another pet in the house (we have a Havanese dog and a Beta fish), we decided to use the opportunity to teach responsibility and to increase his independence.

At the pet store, we made a very hard deal with my son. He had to take responsibility for caring for the guinea pig with my help. If he did not, then we were going to give the guinea pig away and he was going to have to pay us back for the cost out of his allowance. We emphasized the deal several times and made him repeat it back to us several times before we even bought the guinea pig. So we bought the guinea pig and named him Charlie.
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According to discussions I have had with many doctors and therapists, no one should have to suffer through terrible side effects of ADHD medication. There are many medications to choose from and each one reacts differently to an individual’s body chemistry.

Putting your child on medication for ADHD or ADD is not an easy decision or one that should take lightly. I, however, have seen firsthand the power of what the medication can do for a child. It can have absolutely amazing results. I said on a recent post, “It’s almost like his brain is a lock and medicine is the key.” Unfortunately, however, medication is not effective for everyone. Some experts say that medication is not effective for some 20-30% of the ADHD population.

My family had many discussions with doctors and therapists before we decided to put our son on medication. Two critical pieces of advice that we were told over and over again are advice that I feel everyone considering medication for their child should know. First, each child responds individually to each medication and that it will probably take time and experimentation to find the right medication for your child. Secondly, it is absolutely not necessary to tolerate side effects which last for more than a few days.

There are many choices of ADHD medication both stimulant and non-stimulant based. If a child is having side effects from the medication which continue for more than a few days, consult your doctor and try another medication. Do not tolerate side effects – this is what we were told by both our doctor and the many therapists we spoke with which was about ten therapists – all extremely experienced with ADHD.
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This blog post can be found at “A Mom’s View of ADHD” http://adhdmomma.blogspot.com/2009/04/get-facts-or-shut-up.html.

 
I keep reading over and over articles, blog posts, etc. claiming that teaching ADHD kids consequences will “cure” their ADHD. Anyone who spreads this rubbish can’t possibly have ADHD, know someone with ADHD, or be a medical professional of any sort. They are just yet another conspiracy-theorist anxious to fuel the flames. They do get me in a tizzy but not the one they were hoping for. I get downright angry. If they were educated on the subject whereof they take great liberty to speak, they would know this belief is pure trash.

As a parent of an ADHD child, we hear it all: behavior problems are just bad parenting; if you punish them they will comply; every child can sit still and focus if they try hard enough; ADHD medications/stimulants just drug a child into submission; blah…blah…blah.

We knew there was something going on with Luke because

* we know we are good parents,
* we punished taking away privileges until he literally had no toys and had to earn them back a few at a time and he still couldn’t follow directions (or earn his toys back)
* he wanted desperately to follow directions and please his elders and was very sad a lot of the time because he couldn’t no matter how hard he tried
* he is the sweetest, most kind-hearted little boy around but he was constantly in trouble.

Now, I know perfectly well that my son’s ADHD is very real and not something that he can control on his own (at least not at 6 years old — I certainly hope he will learn to compensate and cope when he is older). He can’t just tell himself to calm down and sit still and pay attention and have it be so. For that is the definition of ADHD! An ADHD individual cannot control their impulses — something different is happening in their brain.

TO READ THE REST OF THIS POST, PLEASE GO TO http://adhdmomma.blogspot.com/2009/04/get-facts-or-shut-up.html.

This blog post can be found at “A Mom’s View of ADHD” http://adhdmomma.blogspot.com/2009/05/ugh-more-meds.html

 
Last week, Luke had his second checkup with the Behavioral & Developmental M.D. at the Olson Huff Center since being diagnosed with ADHD there Nov. 2008. At the first checkup in March, his Concerta dosage was increased and the doctor was concerned because he had lost 4 pounds. I was, of course, nervous about going in again. I knew if he had lost any more weight, the doctor would change his medication. I agree that he has to grow. But I was also nervous as to the outcome because both his teacher and I had begun to realize the Concerta was loosing effectiveness again (that’s how he got the increased dose the last time). I just don’t approach the unknown very willingly.

So he was weighed and measured and his blood pressure was taken. Then we waited for our turn with his doctor. I saw what his weight and height were at the time measured, but I didn’t remember what they were in March so I was on the edge of my seat when we finally got in with the doctor. Fortunately, he looked at his weight first. It was exactly the same as two months ago, down to the tenth of a pound: 47.7 pounds (he had been 52 pounds when diagnosed in Nov.). He actually grew 1.5 inches too. Yeah, he was growing!

When I mentioned that the Concerta was beginning to loose effectiveness again, I got the dreaded “this may be as good as it gets” spiel. Frankly, I am fine with his current behavior. It can be frustrating at times, but we have dealt with it for a few years and can deal with it again. What is bothersome is how much trouble and learning prevention ADHD causes at school. When his meds are working he does so great and I really want that greatness for him.

So Dr. S told me about Tenex. Tenex is a hypertension medication that is often prescribed to ADHD individuals when stimulants aren’t tolerated or don’t work well. It is not yet FDA-approved for children and for treating ADHD but that is going to happen later this year. It affects a certain chemical in the brain causing a “slow-down.” I didn’t like the idea of giving him two medications every day and I didn’t like the idea of giving him a medication for high blood pressure when his blood pressure is a-okay. But Dr. S explained that it helps with hyperactivity and impulsivity, the two ADHD symptoms that Luke was again struggling with. He said we could try it for a few days to 1) see if he could take it without severe drowsiness or other side effects and 2) see if it would help with the re-emerging symptoms. If so, great. We’ll continue to take it. If not, he’ll tell me how to wean him off of it (you cannot stop this medicine abruptly).

TO READ THE REST OF THIS BLOG POST, PLEASE GO TO http://adhdmomma.blogspot.com/2009/05/ugh-more-meds.html.