I Heart Fish Oil

It's nice when things go right.

You might recall we have been dealing with Noah's hyperactivity and impulse control issues. We have instituted a behavior modification technique or two that are working really well at home, and also at school when the teacher takes the time to... you know, USE them.

I also think the diet changes have helped. We put him on daily doses of fish oil that people have had lots of success with, even though we are going through a gargantuan bottle designed for heart health instead of brain focus. The other day I thought about it and asked Michael... "Is it just me, or has Noah been more... you know... reasonable lately? More average? More calm?"

Who knew you could get all excited about your kid being "average"?

Michael had to admit it was true. Noah is able to stay in his chair for homework and meals more often (although we have allowed him to stand beside his chair if need be as long as he doesn't leave the table), he is working to control his anger and "use his words" and he is coming home from school with "green cards" a LOT more often, which means he had a good day.

It's nice to see things get easier rather than more chaotic for once.

I bow down before the awesomeness of the bottle of gummy fish oil.

Something Fishy: Omega-3s for ADHD

I've been doing a good deal of research into ADHD and some of the alternative therapies that are used to treat it. There are of course lots of ideas and home remedies for those who are looking for alternatives to amphetamines and also side-by-side therapies which sometimes allow folks to lessen the amount of medication they give their kids.

There are some, like St. John's Wort, which when tested, have proven to not be beneficial in any way, but I was happy to come across a couple therapies that really seem to be making significant positive changes in the lives of many ADHD kids and adults, and have some research to back them up!

One of those is removing foods which contain certain dyes and preservatives from the child's diet. Another is adding magnesium and zinc. I haven't looked into either of those too much, but have done quite a lot of studying into fish oils which contain EPA and DHA Omega-3 fatty acids. These have been shown to reduce the risk of coronary heart disease.

Well, it seems it was found that kids with ADHD seem to have a severe deficiency in these fatty acids compared to the average kid. So, folks tried giving ADHD kids supplements and were thrilled to see that it helped them with focus and impulse control (but not so much with the hyperactivity).

I looked deeper into the issue and found lots of ADHD moms saying (in forums) that they had read somewhere and agreed that a 7:1 ratio of EPA to DHA in the oil was ideal and you want to give the kid about 1000mg of EPA a day.

While I was only able to find Moms who seemed to support this ratio and no scientific evidence of it being the best, it seems that many of the companies making fish oil for kids adhere to this ratio as opposed to the nearly opposite ratio for heart health.

It takes anywhere from 7 days to three months to see results but folks who stick with it seem thrilled with the results. Enough so that they are willing to keep forking over the bucks to buy the supplements with just the right ratio.

So, we decided to give this a try. We had gone out and bought a couple bottles of chewable gummy supplements before realizing that there is an ideal ratio to take. So, since this is a process of building up the acids in your body, we figure what he is getting won't hurt and that we will go through what we have before buying the ones with the correct ratio.

Michael and I have decided to start taking it too, since we are not eating any fish on a regular basis.

I, personally have had an odd heart arrhythmia since I was a teen, have had occasional painful joints for years, and the hubs has suggested that some of my odd quirks could be signs of (often genetic) ADHD. Well, it seems the three things Omega-3 are good for? Well, it's heart health (lowering your cholesterol!), inflammation of joints and ADHD!! YAY for me!

If you are interested in which brands fall into the ADHD therapeutic ratio, let me know and I can point you towards a list (if I can find it again.... sigh...).

I have to say that Noah came home with a note from the teacher mentioning his positive attitude today, which just thrilled me to no end. Could be coincidence but I will take it!

Did I Never Explain This to Him?

We have been working on Noah's behavior issues with a new method that I described in an earlier post. It's a kind of ladder chart, with levels the child can climb up or slide down. Each level has a privilege that he either gains or loses depending on which direction he is going.

So far, its worked really well. As soon as we instituted the new ladder/1-2-3 method, he went to the top and stayed there for days, displaying a great attitude, being kind to his brother, having good meals.

The little snag we have run into is that he pretty much STAYS at the top of the ladder with full privelges! He keeps earning the ability to move up but he is already at the top! He wants to know if he can go up above the highest rung and I keep having to say no.

I told him that I was really proud of him and that he has been a wonderful boy lately. He has been kind to his family, very helpful, has had a great positive attitude, and hasn't even HAD much anger to "talk through with words". I made sure he understood how proud we were of his efforts.

He responded with,

"You mean... ...this is how... ...ummm..

...I am... ...ummmm...

...supposed to act?"

Easy As One, Two, Three

So, we have dived head first into Behavior Modification techniques for ADHD, although without going to a specialist. I have read (or skimmed) quite a few books and web pages and forums looking for tips and techniques that work best for other parents in the same boat.

What I never realized with ADHD (and a reason that I balk at the diagnosis) is that these kids apparently come with a lot of anger issues and behavioral problems. I thought it was just happy hyperactivity or gaze-out-the-window-dreaminess. I worried he might instead be bi-polar or something because I was seeing depression and mania, aggression and sudden anger. But apparently, these are common occurrences with ADHD.

We found something that is working pretty well for us so far. Even though I am one to loathe stickers, charts, and behavior games of all kinds.

We settled on a version of a tactic that worked so well with his (fabulous) kindergarten teacher last year. It's a kind of ladder chart with steps from 1-10. I came up (with his help) with 10 privileges that he has in our house, and each step adds one or removes one from what he is allowed to do. With each offense, rule broken, etc, he moves down a notch, and with each good behavior, he moves up.

He comes home each day with a red, yellow, or green card telling us how his behavior was that day and he goes up one with green, down with red, and stays level with yellow. If he walks out of the house on time in the morning without trouble, and on time, he moves up. If he shows kindness to his brother he moves up, etc. (As long as its NOT done so that he CAN move up!)

I gave him the option of choosing which level he should begin the method on, and of course he chose level 10 - Full Privileges! And I have to say he has spent most all of his time up at the very top of the ladder since we have begun it. But then most chart methods start off fabulous and go south eventually, so we shall see.

We also initiated a "counting" process based on the 1-2-3 Magic discipline approach by Dr. Thomas Phelan. Very simplistically, you say "That's one" when anger, backtalk or disobeying occurs. "That's two" when it occurs again immediately afterward. On "three" they get a time out, but for us, we move him down a rung on the ladder and he loses a priviledge. Less time outs for us, and now we use them only for hitting, extreme rudeness and for cooling down from a rage.

This method is nice for ADHD kids because it gives two warnings instead of the one he was always failing to heed or sometimes even notice. Gives him more than one chance to realize what is about to happen and get himself under control and make a shift. And while we did make rules, you can count any kind of undesirable behavior.

So...


Noah: Can I go play with the water hose before dinner?

Me: No, we are just about to eat and I don't want you to get all wet and muddy.

Noah: Oh Pleeeeeeze!!????

Me: I said no, honey.

Noah: WHY NOT!?

(and instead of saying "I just gave you the reason why not!" or "because I said so", I now can simply say "that's one" and keep chopping vegetables.)

Me: That's One.

Noah: I won't get wet, I SWEAR!!!

Me: That's two.

Noah: grrrrr.... FINE!


No arguing, no raised voices, no letting him get a rise out of me, no explaining myself more than once or justifying my reasons. Counting tells him that whatever he just did is not appropriate. No fuss, no muss.

Pray it lasts.

Becoming Convinced

I have scoured those questionnaires before, trying to evaluate whether my eldest has ADHD or is he just rambunctious, or do his parents practice lazy parenting, or is there some other issue? All those questions are so subjective...

Does he have trouble enjoying leisure activities quietly?

Does he talk excessively?

Does he have trouble waiting for his turn?

I mean, geez, he is a five year old boy!! And he's my first child, so its hard to compare him to your average Joe Kindergarten, if you don't know what average kindergartners generally act like, you know? What is talking excessively for a five year old? How much trouble do five year old's generally have waiting their turn? Michael and I find ourselves answering some of these questions differently on different days.

I checked out a few ADHD books from the library to read more about the diagnosis, the drug controversies, and to see whether he might have something else entirely, or is he just FIVE!? Something in the book lead me to a website, that lead to another, and I stumbled on this pack of CDs training folks to better parent kids with ADHD. I would not buy these CDs (they cost $350!), but they had a list of symptoms there that were quiet different than your average list. More specific. Less subjective. While a fraction of the list of symptoms over there did not apply to Noah, most all of them were like a blueprint totally describing my child! This is my boy:

Do you know why your child:
Has a big heart, but sabotages friendships?

Controls others, is bossy and needs to enforce “fairness”?

Relates well to adults and younger children, but struggles with peers?

Melts down over changes, disappointments and little things?

Is disorganized, forgetful and impulsive?

Appears unmotivated and underperforms academically?

Constantly makes noises?

Plays video games for hours, but can’t focus on work for 10 minutes?

Is afraid of being alone or the dark, and insists you lie down at bedtime?

Procrastinates with homework, but hyper-focuses on personal projects?

Needs you to be close or have your undivided attention?

Appears not to be listening, but remembers what you say weeks later?

Says, “I’m bored!” or "I'm stupid" often?

Eats the same food routinely?

Gets angry or impatient when you talk too much or lecture?

Can be extremely funny, but also pensive and moody?

Oh my god... If this was the Connor's Scale for ADHD, my son would score nearly 100% And these are not the usual symptoms you hear about. He CANNOT be alone, even in the bathroom, he calls himself "stupid" when angry, he CONSTANTLY makes verbal noises (although doesn't move his body so much) and the thing about getting along with older and younger folks but not kids his age is true as well. In fact, all of the above are true. I removed the 2.5 or so that did not apply.

Then, the other night, I got a call from his teacher. She is feeling overwhelmed with him, and says he is barely learning anything and is disrupting the classroom. I know everyone has their strengths and weaknesses, but she doesn't seem to be able to cope with and wrangle him as well as his kindergarten teacher does (although I know he is testing her limits these first couple weeks).

When asked whether she felt he might have ADHD or not, she said she wasn't a doctor but that she had a mother of a boy she had taught a couple years ago come up to her recently, crying, saying she had finally put her son on medication and it made all the difference. So, it seems while she is not willing to give us a "yes, I think he has it", she is fine with suggesting medicating him.

I feel on the fence... I don't want to drug my kid unnecessarily, giving him amphetamines throughout his entire childhood, but I also don't want to deprive him of his ability to listen and learn (and allow others to learn) through most of his formative years, while I sit back and wonder if meds are the right thing or not.

For now, we are going to begin a new behavior modification regimen, and probably go see a behavior modification specialist that was recommended to us.

You know... sit on the fence a little longer trying to see which side is greener.

First Opinion

A couple weeks back, Michael and I went in with Noah to see a psychiatrist to find out if he felt Noah might have ADHD.

He was a relatively young man who came out and greeted us with a walking cane. He spoke softly and greeted Noah warmly and lead us slowly back down a long hall to his office. Oddly, I was reminded of the scene in Willy Wonka where the kids and their parents get led into the Chocolate Factory for their big tour and Mr. Wonka's cane gets stuck in the ground... he begins to teeter forward and ends up doing a quick somersault and rebounds with lots of energy.

The soft spoken psychiatrist did not do that. He just kept walking slowly down the very long hall.

He asked us a lot of the usual questions, and had a few for Noah as well. He asked Noah to draw a picture for him of a house, a person and a tree.

Then, he had Noah perform a few physical tasks. He had him sit in a chair with his feet on the floor and his hands on his knees (I guess to see if he could sit still while we stared at him) and then he asked him to stand up, put his arms out, open his mouth and stick out his tongue as far as he could and stand there.

Noah made a little sound and the doctor said quietly, "Notice the grunt?" and "See how his toes flex?"

He did make a grunt, but it seemed to me he flexed his toes (in his sandals) to keep his balance.

The doctor wiggled Noah's arms and told him to keep them floppy. I believe he was looking for tense muscles.

After we all sat together again, across the desk, the psychiatrist declared Noah as having moderate ADHD. He suggested we go talk to a behavioral therapist before considering drug therapy.

Back home, we digested the news for a few days.

Neither of us are completely convinced about the diagnosis, though we are not in denial, either. It was just a very quick appointment, much of it spent talking about insurance and such. We both agree that there is a very good chance this IS what Noah's problems amount to, but it could also be attributed to "typical boy behavior" that has stronger tendencies than many other boys. It could also be attributed to first time parents not making the best parenting choices and realizing too late that other tactics and more consistency are called for.

So, I think we may take him to the behavioral therapist and see what he/she thinks as well. He also begins first grade soon, and will be with another teacher. It would be interesting to see what her opinion is. ADHD or lack of maturity and self control.

Don't think I am saying "my child does not have ADHD". He probably does. But I don't think these things should be jumped into lightly, nor should you allow one person to put a lifetime label on your child.

We are taking the information, the opinions and evidence we have so far, putting it in our pocket, and moving forward.

If It Walks Like a Duck

I went to a seminar the other night offered by Noah’s school. It was an invitation-only event for the parents of kids with “identifiable problems”. We certainly have a problem, I am not sure how identifiable it is.

For those of you in need of a catch-up, Noah’s kindergarten teacher thinks he should be tested for ADHD. We took the Connors Test for ADHD (One of many tests available, in which the parents answer questions and the teacher answers a different set of questions and it is scored). The teacher gave him a very high score and we here at home gave him a low one.

But then, the issues we have at home are different. At school it is hyperactivity and distracting other students. At home it is sudden bursts of anger, negative talk about himself, and sudden bursts of furious rudeness when a moment before he was a cheerful boy.

I got to spend a good 20 minutes talking with a therapist from the school system. The topic was supposed to be what to expect from therapy and how to find a therapist that is right for your child. We did talk about that, but also about his symptoms. We talked about his issues at school and when I said, “he just doesn’t exhibit that behavior at home”, she sighed and said that THAT phrase is one of the things you hear over and over again from the parents of a child that is later diagnosed as ADHD.

In the second session, which was actually about ADHD with a specialist, I brought up the idea that it could instead be early signs of bi-polar disorder as that would explain the mood swings and occasional depression we see at home as well as the bursts of creativity at home and the hyperactivity at school. They asked if I had B-P disorder in my family.

No.

Does my husband?

No.

Does anyone in my family have ADD? Yes, my brother and his son. Does anyone on my husband’s side have it? I thought I had heard that Michael's brother did, too.

Apparently both disorders are highly genetic.

I had a long talk with my brother yesterday who described to me what ADD feels like (he does not have the H=hyperactive) and also explained that his son, who was diagnosed around Noah’s age, was experiencing low self-esteem and depression symptoms, too. In fact, they concerned the psychiatrist more than the ADD did.

Hmmm…

But still I persist in my doubts about Noah having ADHD. He does exhibit a few of the behaviors. But there is a good deal of symptoms he doesn’t exhibit. And a lot of the ones he does show COULD be chalked up to “being a boy” and lack of maturity. He is one of the youngest in his class.

But, geeez...
* The teacher believes he probably has it.
* The doctor who never met him but heard all about him agrees it’s likely he has it.
* “He doesn’t exhibit these symptoms at home” is a common thing said by parents of ADHD kids.
* My nephew had personality changes and low self esteem before diagnosis (which resolved after he finally went on medication after trying other methods for awhile).

* It is genetically passed on and seems to be in both our lines.

I guess I have moved from being on this side of the fence to being officially on the fence.

We got a referral for a great child psychiatrist who (thank heavens) is in our insurance network. He has been given accolades by his peers for being one of the best in his field in the county, and has been described as a very conservative doctor, who does not pass out ADHD diagnoses as if they were candy, like some doctors do.

There is a part of me that is actually hoping he has ADHD. If so, I will have an explanation for some bewildering and difficult behavior and therapies to treat it. If he doesn't have it, we may be dealing with something far fishier and difficult to pin down, to parent, and treat.

Until then, three more weeks of school until the end of Kindergarten.