What a difference a day makes ...

In my last post, I was so concerned about Daughter's mental heath and felt like we were making no progress at all. And then Friday happened. On Friday, she seemed to turn the ship around. Several wonderful things happened on Friday. First of all, may I shout from the roof tops that Daughter got a C+ on her math test! We have been living in the land of "Fs" for a couple of months now, so this is nothing short of miraculous. There are a couple of factors that might have contributed: one, her teacher started allowing her to take math tests in the library. Daughter gets so frustrated by distractions in the room during tests, and this especially hurts her during math. She has literally cried about the "loud" sound of other children writing and erasing ... if that doesn't sound like ADHD, I don't know what does. Her teacher first let her try testing at a table at the back of the room and she liked that better. But when she allowed Daughter to test in the library, she really hit the jack pot. The library is Daughter's "happy place." Everything about the library suits her. So that was a great move.

Also, we had a really great homework session on Thursday evening. And her Friday morning tutoring also went well. Both of these I attribute to her attitude. I wish I knew what it was that turned her attitude around. But sadly, I do not. If I knew what button to push, trust me -- I would push it every time. BUT ... is it a coincidence that we started the new, increased dosage of Concerta on Thursday morning and had these improvements? It's a little too soon to know for sure, but I'm going with it for now.

Friday was also Daughter's 4th Grade Spelling Bee. Daughter is a fantastic speller and has qualified for the Spelling Bee every year since second grade. She finished 9th out of 18 kids, which was a disappointment to her (last year she was 3rd). But we were very proud of her. Also, she turned her disappointment around rather quickly and didn't dwell on it all day -- didn't let it derail her math test, for example, so I think that is a real victory.

Since my husband and I were at the school for the Spelling Bee, we scheduled her annual speech IEP for the same day. She does not qualify for an educational IEP, only speech, but this year the IEP meeting was really different because of the new ADHD diagnosis. I found it to be a really positive experience. The OT who recently evaluated her joined us, as well as the speech teacher, her regular classroom teacher, and the process coordinator for the school. There was a great deal of brainstorming among the group on things we could do to improve Daughter's functioning at school. I'll talk about some of these things in future posts.

Discouraged

MOMMY: I feel like I am failing her in so many ways, and I'm not sure what to do. She needs me to show her the way, and I honestly don't know the way.

After receiving the report from the OT, clearly her fine motor and gross motor skills are still a problem, but the school won't be able provide intervention in that area. This is the report we received:

Occupational Therapy Screening
2-10-09

[Daughter] was seen for an Occupational Therapy screening on 2-10-09 by [school district's OT], MS, OT/L. In the area of self help skills, she was able to manage buttons and snaps, but had difficulty engaging a zipper and was unable to tie. [She] is able to manage bathroom and lunchroom needs independently. [She] demonstrated weak proximal muscle strength while attempting the prone extension (superman) position. She was only able to hold this position for 10 seconds after practice, where the norm is >30 seconds.

She was unable to balance in the Rhomberg position (one foot in front of the other) with her eyes closed. She was able to cross midline during Brain Gym activities and reports she has no tactile aversions.

In the area of fine/visual motor, [she] demonstrates a thumb wrap grasp using her right hand during writing tasks. She is able to copy from the board using adequate sizing and spacing. Finger individuation and serial opposition are within normal limits. She had difficulty visual tracking in diagonal planes.

Recommendations:
-Hand strengthening exercises with theraputty
-proximal strengthening using superman position to improve posture and
attention
-allow [her] to chew gum during class if needed to help with attention
-try a disc seat at desk to allow for movement without disruption
-balloon volleyball, or any other eye hand coordination exercises to
improve visual tracking

Meanwhile her grades are not getting any better, it doesn't seem like the medication is helping and she shows increased signs of anxiety at home and at school. We go back to her pediatrician this Wednesday, so we'll see what he has to say about all this and go from there I suppose.

Occupational therapy?

MOMMY: A note from the teacher today:

She did finish her morning work but I had to have her check over it. It seems that the mornings are still her most difficult time with focusing. That may be something to mention to her pediatrician. We do really well from about 10:00 to 1:00 and then you can tell her mind is starting to wander. She is doing so much better with staying in her seat though. I rarely have to redirect her anymore!!!! YEAH!! I am seeing positive progress though. I don't notice any signs of depression etc that sometimes goes along with it.

Daughter is being evaluated by an occupational therapist at school today. I asked the school if there was any way that an occupational therapist might be able to help teach her some skills for impulse control in the classroom, and we also wanted to have her fine-motor skills evaluated. Her writing is very sloppy and that really seems to be affecting her math accuracy (as she gets her numbers out of place when adding columns). I'm not sure what, if anything, the school can do to help. But we're checking into it. It's obvious just watching her that she holds the pencil all wrong -- in fact she had a real power struggle with her third-grade teacher over that issue and never has "gotten it" regarding how to hold that pencil.

Daughter received occupational and physical therapy when she was 5. Her gross-motor skills were about two years behind at that time, and we did the therapy through the hospital and the school until she caught up. She still has poor muscle tone and strength ... and the mommy-playing-doctor-therapist in me is wondering if this isn't all connected to the ADHD issue. At the time we went through that before, her fine-motor skills tested right on schedule. I just wonder if she hasn't been progressing as she should in that area.

Week in review

MOMMY: A big thank you to Suzymom for your encouragement to Daughter on her post. Your comment is similar to what I told Daughter when we discussed this. My gut feeling is that she is feeling some pressure to be different or feel different, and she is really confused about what she is supposed to be experiencing right now. The reports from her teacher indicate that she had a very successful week at school, particularly in the three areas we are trying to encourage her most (completing morning work, staying in her seat at the appropriate times, and concentrating her best during math).

Daughter told me she feels that she's doing better only because she is trying harder, and not because of the medication. She also feels very frustrated about her difficulty in concentrating, which she doesn't yet feel is getting easier. I think it's a combination of the two: her working so hard and the medication giving her a boost.

I told her that we'll talk to the doctor about it at our follow-up visit, and he may very well increase her dose now that she's tolerating the lowest dose so well. We'll just continue to see how this develops ...

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 Two

Mommy: Today let me copy and paste an e-mail from the teacher:

"She had a much better day today. She was very positive during math.
She even said at one point, 'Wow this is easy once you learn it.' I think
we'll see lots of great changes in the future."

If you know Daughter's struggle with math and her attitude toward it ... well, this is huge. HUGE.

So, that is the good news. The bad news is she forgot to bring home her math homework. You win some; you lose some.

I am trying to figure out how to help her organize herself without actually doing it for her (ie, put the homework in the backpack myself). I made her a very simple end-of-the-day checklist for school, but she is not using it consistently. We even have a reward system right now, and part of her reward is based on using the checklist each day. We're not there yet, but I'm not ready to give up on it.

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.

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.