School report: Day Three or "Fourth grade math may be the death of this family"

MOMMY: Daughter reportedly had a good day at school. Both my "flies on the wall" had encouraging things to say about schoolwork and her eating. It just all went south after she got home. I'm telling you, this fourth grade math ...

Actually what happened was she completed her "morning work" assignment -- division problems during class. So that was a good thing. Unfortunately she did them all incorrectly. So she needed to rework them tonight. I think the real issue for us is just trying to explain to her where she went wrong. And then once she gets it, going through the steps. Again, I have found that if I leave her side during these assignments they don't get done correctly. I just need to be there keeping her on track. I would love it if we could get to the point where that wasn't necessary. Not because I don't want to sit with her, but because I know it can't be good for her confidence. Not to mention the fact that I can't be with her when she takes her tests.

There's another little issue we're having around here: anxiety, drama, fighting with her sister and her best friend. She has been very tightly wound for the last month or so. I really can't blame it all on the meds ... as it started before she began the medication. In general, she's more anxiety-prone than the average kid. But the drama seems to be increasing lately. I really want to get to the bottom of that issue with her.

School report: Day One

MOMMY: No real changes reported by teacher yesterday, except that Daughter appeared "moody" and a bit difficult throughout the day. I believe this may have had more to do with being up too late at a Super Bowl party the night before than anything else. The pediatrician made a point of saying not to judge the impact of the medication on one day. We all have good days and bad. We're looking for trends over the next couple of weeks. That makes a lot of sense.

I will say that Daughter said she thought it was easier to concentrate on her classwork. And I noticed a marked difference in doing homework last night. She worked through the math problems with much less drama than before -- in fact, no drama. For whatever that is worth.

I just want to document this daily so that I can look back and see the trends.

First day at school on ADHD meds

MOMMY: Daughter is at school right now. Day three on Concerta. This is the big test. How will she do today? And will she have any anxiety because she thinks she should be doing better, but maybe she doesn't? Will she feel the anxiety that I feel? Why can't I be there with her? Oh, to be a fly on the wall in that classroom today. I am so very fortunate that she has a teacher who is so caring and concerned about her wellbeing and also great at communicating with me. She'll give me a good play-by-play of the day. It's only 9:42 a.m., and I've already gotten one e-mail. And as for my other worry--how she'll do at lunch--I have that covered as well. See, Daughter's best friend's mother is an aide at the school. She eats lunch with the kids every day. So she'll be watching and giving me a full report. So while *I* can't be a fly on the wall, I have two flies on the wall who will report back to me. Still ... this day is killing me. I don't like turning my child over to others when I feel like she needs me.

Concerta vs. Daytrana: Mommy's perspective

MOMMY: If you read Daughter's post last night, you know we had a considerably better first day on Concerta. Whew ... what a relief to both of us. What a curiosity as well. Why would two drugs based on the exact same ingredient (methylphenidate) have such vastly different effects on her?

The only thing I can figure is that the Daytrana Patch is not metabolized through the stomach and is absorbed straight into the system, thus giving her a stronger bolt of the drug. The Concerta though, which is an extended-release pill, is designed to be released slowly from the stomach. I'd think the patch would release slowly as well. But there must be something about the metabilization through the stomach that changed the way it is absorbed into her system. That's just doctor/scientist mommy talking. (And by the way, she's actually taking a few more milligrams of the Concerta than the Daytrana, so it can't be that she was getting more of the methylphenidate through Daytrana...)

Anyway, all I can say is that the two drugs had the complete opposite effect on her. The Daytrana Patch zinged her up like she was literally on speed, and that rapid heart beat and breathing scared us to death. Plus she was so wired she didn't sleep all night. But with the Concerta, she was really rather subdued all day (the desired effect). And she fell asleep easily. Good. Good, but weird.

We still dealt with her tummy hurting and difficulty eating, but she did eat more yesterday than she did last Saturday. I even took her out for ice cream, and she ate the whole sundae and said it really tasted wonderful - even though she had been afraid it would be difficult to eat (she hadn't been able to get down more than two bites of ice cream the week before). The appetite-suppressant issue is going to be a big one for us. Her doctor will take her off of the drug if she loses weight for more than two months because of her current size, so I am actively working on this issue. Here is what I'm working on:

1) I have to see that this helps her and that the good outweighs the bad or I'll take it off her it myself, but anyway ...
2) We're eating a very hearty, nutritious breakfast before taking the pill so that at least breakfast is not affected by the drug.
3) I'm trying to get in really nutritious snacks -- yesterday she did a great job snacking on raw veggies and ranch throughout the day, even though she did a rather poor job with lunch and dinner. I'm even going to send some snacks to school, and I think the teacher will be cooperative about letting her have these at recess. She loves cashews, so I think they should make an easy and nutritious, calorie-dense snack for school.
4) We're having Ensure shakes before bed at night. She really enjoyed one last night. So that worked pretty well.

We'll just figure this out as we go! But I sure do feel more hopeful today

And to answer your question yesterday, Good Fountain, yes, it's one pill a day. Thank you so much for reading and caring.

Ready for Concerta

MOMMY: Daughter has done a fantastic job swallowing pills all week. We even tried something different this morning, as the Concerta pills are a good deal larger than the Zyrteks. So I gave her one ibuprofen pill. I know it's not generally wise to just randomly give ibuprofen, but one pill wasn't going to hurt her--and I needed to know if she could do it. The last thing I need tomorrow when I give her the Concerta is to have her gagging and freaking out over it. It went down fine, so we both feel good about it now. Pill swallowing officially learned! If nothing else, I'm glad we have conquered that little life milestone. (One thing we did learn, for anyone looking for advice on how to do this, is that the pills go down much easier with juice than they do with water. Juice and a dollar. That's my magic formula for pill swallowing.)

Regarding tomorrow, I'm pretty nervous (now, how to keep Daughter from reading this post for the next 48 hours or so?) If the Concerta does to her what the Daytrana did to her, we are so done with medicine. I'll be looking for non-medical options to deal with this. On the other hand, I've had a lot of time to work with her one-on-one this week with homework and studying because we've been cooped up with snow/ice days, and I've really seen how very much she needs help. I desperately want this to help, but I desperately want it to help without any ill side effects. Are those mutually exclusive desires?

ADHD and self-esteem

MOMMY: What Daughter wrote last night makes me sad. And it's the number one reason I am driven to help her in whatever way I can. I've watched her since second grade adopt this feeling of failure about school, even as she's continued to make mostly A's and B's. This child is way too smart, way too bright and creative to feel like giving up. Last night we worked on her math homework. Six division problems took way too long, maybe an hour. I understand why she is frustrated. More than half our time was spent just redirecting her attention. Sit down, pick the pencil back up, wait you're not even working on the right problem anymore, no we're not going to watch the Wizard of Oz right now, I said sit down ... She broke into tears about 10 times. Just trying to do six simple division problems. I've learned that I pretty much have to sit with her and walk her through the math homework or it doesn't get done even half way correctly. It isn't that she doesn't know how. It's that she gets off track in the middle of every problem. It makes me sad.

An unpleasant new task

MOMMY: This ADHD medicine business means Daughter and I must deal with a little issue we have been putting off: learning to swallow pills. UGH. We're scheduled to start the new medication next weekend (I could try it now but refuse to do until a weekend when I can watch her like a hawk for two days before I send her off to school "medicated.") So we have this week to learn this dreaded pill-swallowing business.

Pediatrician suggested we practice with Tic-Tacs. Counselor suggested hiding them in applesauce. I just picked up her Zyrtek (allergy medicine) in pill form rather than chewable and offered her a dollar for each one she could get down this week. For real! Don't worry, I'll only let her have one a day. It didn't work yesterday, but this morning that pill went right down.

Am I terrible? Any other moms out there with other tips for teaching kids to swallow pills? I've told Daughter that at 10 it's time she learn anyway.

The trial-and-error phase begins

MOMMY: Once daughter's psychologist diagnosed ADHD, the next stop was the pediatrician. My husband and I both agreed we would consider medication for her if it would help. If there's a medication out there that can help help straighten out those chemicals in her brain and bring her mind back into focus, why wouldn't we? After watching her anxiety for the last two years in school (headaches, stomach aches, insomnia, etc.) and seeing it spiral out of control this year -- hearing her cry about not understanding why she can't pay attention. Why would we deny her anything that would help?

I told her one day that her brain was kind of like my eyes. They just don't focus very well. And I need to wear my contacts or glasses to make things clear. And we were going to see if medication would do the same for her brain. She seemed to like that analogy. Score one for Mommy!

We talked to the doctor about all the medication options and decided to try "the patch." It's called Daytrana. There were two reasons we decided to go with this option. The first is that the doctor said of all the stimulant medications, Daytrana seemed to be the least likely to have the appetite-suppressant side effect (which is our biggest concern for her, as she is only in the 10th percentile for her weight as it is). The second is that it comes in patch form, and she hasn't yet learned to swallow a pill.

It seemed like a good plan. Several people (doctor, counselor, teacher) warned me that finding the right medication can be a trial-and-error process--what works for one child can be all wrong for the next child. I dreaded that process for her. The last thing I want my little girl to be is a medical guinea pig. So I was hoping we'd get it right the first time.

No such luck. She wants to write about what happened.

"I think she might have ADHD"

MOMMY: When my daughter's counselor said to me, "I think she might have ADHD," I can't say that I was surprised. About three months ago I began to suspect it myself. Had the counselor made the suggestion prior to the time I started figuring it out on my own, or especially if she had come to that conclusion a year and a half ago when we first began taking her to counseling, I'm sure my reaction would have been, "Forget you. We are sooooo out of here."

ADHD? For a child who get mostly A's, with the occasional B in math? ADHD? For a child who never gets in trouble at school? ADHD for my little girl who can read a 200-page book in a single day and sit and write her stories at the computer for two hours at a time? ADHD for the better-behaved of my two children??? It just wouldn't have made any sense.

But fast-forward to December 31, 2008 when we were sitting in the counselor's office, and there were other things to consider. Now that she was in fourth grade. Her A's were turning into B's, and her B's were turning into Cs. Lately she was bringing home math, science and social studies tests that had F's on them. My daughter getting F's? Even her once-a-week math tutoring wasn't helping.

Her teacher was reporting an increasing amount of wandering around in class. Distraction, trouble focusing, fidgeting. She was getting F's on tests because she wasn't paying attention. And we were noticing it at home as well. Truth be told, she's always done these things, but they were starting to catch up with her. And her natural smarts weren't gonna cut it in the classroom anymore.

And then there's the issue of her not sitting still. She never has sat still, this child. She's like a little Energizer Bunny. It's an oddity the family has always worried about, but honestly no one ever thought ADHD. She has this habit that drives us all crazy, bless her heart. She runs around our coffee table in the living room. Around and around and around. One she even developed this little cyst on her foot--I can't remember what it was called. But I remember that the doctor had thought she was a dancer, because it's a repetitive motion injury. She got it from pushing off her foot in that one spot running around the coffee table all the time. She always tells us that the running helps her imagination. "I'm using my imagination," she would say.

Over the years, I've tried to figure out all this movement. I've asked the doctor if she could have Restless Leg Syndrome or growing pains. But I never once considered ADHD. Not until the signs started adding up together three months ago. And now I've learned that 4th grade is actually the most common age for girls to be diagnosed, because it's often the grade in school where girls can no longer compensate anymore. The schoolwork gets harder and they are expected to sit still for longer amounts of time.

In our case, I believe the symptoms started showing up in second grade. And we've been on a two-year journey trying to figure out why school was getting increasingly difficult for her (even as she kept her grades up). Now that we know why, we deal with how ... how to deal with it. And where ... where do we go from here.