How do I know if my son as ADHD?

[Nik's Mom]

Hi,
I have 2 autistic sons in special ed. My 7 year old ds has no attention span. It's always been a problem for him. My sons teacher has been great with him. She has tried a lot of different techniques to get him to improve his attention span, but nothing seems to work. We are at the end of our rope. At this point, we are concerned that he is just falling further behind in school.

Tomorrow I plan on seeing the pediatrician to get her opinion. But I want to hear from parents first. How do I know if my son has ADHD? He figids and has trouble sitting still. He will not pay attention in class. He loves movies, but he can't sit still for that either. The only thing that works are books and video games. But he needs to start paying attention in school.

Any advice? I don't want to just put ds on medication without knowing some facts.

Thanks!

 

[bookwormde]

My first question for parents when they ask this question is, does he never have an attention span for when there is something visual (like a TV show) or something is his special areas of interest, can he attend to that for significant periods of time (often excessive). If he really can not attend to anything for more than a very short periods of time then that is an indication that he is ADHD (assuming he has hyperactivity on an ongoing basis, not an anxiety based fidgets and restlessness or ASD theatrical presentation). Be aware that sitting still is not a requirement for “attending” unless he completely becomes disengaged from the activity by the required movement. If he can attend to some things then he is probably not ADHD (at least in the most classical sense) and typical accommodations and clinical supports are not appropriate (except in the most challenging cases and then only until the environment and supports are in place for his EF needs)

What did his auditory processing evaluation conclude and recommend. If the teaching style, curriculum and classroom have not been adapted adequately for his EF needs then you should not expect that he would be able to “pay attention”.

The fact that they have “tried things to extend his attention span” really throws up a red flag, since unless the groups designing these “things” really are Autism specialists who are up on the most modern information, what typically happens is it just generates additional anxiety and quickly makes thing worse. I guess to offer an intelligent thought on this I would need a few examples on what they have “tried”

Bookwormde

 

[KirstenB]

Our older dd who's 11 was dx'd when she was in 3rd grade. That teacher wouldn't leave it alone. She was very persistent in sending home notes about dd's inability to focus in class. I thought kids with attention issues were always hyper, which dd isn't.

After we did the testing, the child psychiatrist was going over the results with me. At that point, I actually started believing dd had a problem. I remarked to the doctor, "you know even when we're doing something fun, like going to Busch Gardens can take forever for dd. I tell her to go upstairs, and get dressed, and 20 minutes later she's still in her jammies." The doctor said that was a perfect example of a kid with attention issues---do they still have trouble, even when they have a really strong incentive to focus?

 

[Nik's Mom]

Thanks for responding. bookwormde, the autism specialist for the school district has observed him. And his teacher has a masters with an emphasis in autism and is working on her phd now. She has tried a long list of things, which I will be handing over to the doctor. Just a couple of examples are a reward system and the use of a weighed vest. The vest worked for a short period last year, but now ds refuses to wear it. Ds also has his own para to work with him, but even then he loses focus.

It's hard in our case because ds is autistic, so some of these symptoms are classic for that. But the attention span is so bad. He can't even get dressed without getting distracted. It seems like the older he gets, the worse the attention gets. Even things that ds enjoys (video games, books) will only keep his attention for a short time. He loves movies too, but he can't sit still for them.

KirstenB, ds LOVES WDW, but even that doesn't motivate him. It's so sad to see him struggle.

 

[bookwormde]

Reward systems are not a way to help with EF differentials, if the “Autism specialist” recommended this his/her training is way out of date, the vest may help with sensory needs and reduce anxiety, which can make EF issues less “out front”. None of these are the typical first line EF supports or part of the typical auditory processing recommendations. What level of visual support cues does he have for things like getting dressed and for his work at school? He may very well have for lack of a better term a little ADHD but until his EF differentials are fully understood and supported it is very difficult to tell where one ends and the other begins, and since the ways to deal with each one is very different and sometimes contraindicated for the other sorting this out is very important. Again I suggest starting with the auditory processing evaluation (and if he has not had a good one done in the last 2 years have it done again by someone experienced in Autism spectrum children).

bookwormde

 

[Nik's Mom]

Reward systems are not a way to help with EF differentials, if the “Autism specialist” recommended this his/her training is way out of date, the vest may help with sensory needs and reduce anxiety, which can make EF issues less “out front”. None of these are the typical first line EF supports or part of the typical auditory processing recommendations. What level of visual support cues does he have for things like getting dressed and for his work at school? He may very well have for lack of a better term a little ADHD but until his EF differentials are fully understood and supported it is very difficult to tell where one ends and the other begins, and since the ways to deal with each one is very different and sometimes contraindicated for the other sorting this out is very important. Again I suggest starting with the auditory processing evaluation (and if he has not had a good one done in the last 2 years have it done again by someone experienced in Autism spectrum children).

bookwormde

Ds has his next IEP in 2 weeks, so I will definitely ask about the auditory processing evaluation. Maybe I'm doing more harm than good then. I was the one who requested a reward system. We use reward systems at home with both boys and have found that it helps. I just thought it would help at school too, but it didn't. Then they used something called a penny board, which I had never heard of. Well that didn't work either.

Anyway, thanks for the suggestions. I need to do more research. I just don't want to medicate my son unless I'm sure he needs it.

 

[bookwormde]

EF is by far the least well-understood components of ASD and is just beginning to be addressed in any effective way in the clinical literature, so often it is not dealt with effectively. You are doing the correct thing by asking questions and continuing to learn, hopefully the rest of the IEP is doing the same, good luck with the meeting.

bookwormde

 

[Ctsplaysinrain]

visual (like a TV show) or something is his special areas of interest, can he attend to that for significant periods of time (often excessive).

I want to disagree with this statement. My younger son has severe ADHD, he's 12, diagnosed at 4, primarily hyperactive with a Giant H but he does have combined type. On things that interest him, like books and video games, hyper-focusing has ALWAYS been a part of it.. In fact, he tends not to eat or sleep because of hyper-focusing.

To the original poster, I believe if you go to the CHADD site, there may be some info there that can help you.

 

[KirstenB]

Nik's Mom, I've been trying to figure out forever who's in the photo in your thingy. Apparently, I can't read, because if I could, I'd see it's Keith Moon. Anyway, I love the Who, and had most of their albums way back in the day!!! Roger Daltrey is like Paul McCartney---both look totally amazing--apparently lead singers get some kind of cosmic pass on aging!!

I did my tenth grade English paper on Tommy. This was when REO Speedwagon and Journey were huge. My presentation in front of the class didn't go as well as I'd envisioned...

Our younger dd Zoe has ASD, and although her attention span has improved, I can really relate to how hard it is to untangle ADD/ASD and figure out your next move. Our older dd just has ADD, so it's easier to separate things out.

 

[Nik's Mom]

Nik's Mom, I've been trying to figure out forever who's in the photo in your thingy. Apparently, I can't read, because if I could, I'd see it's Keith Moon. Anyway, I love the Who, and had most of their albums way back in the day!!! Roger Daltrey is like Paul McCartney---both look totally amazing--apparently lead singers get some kind of cosmic pass on aging!!

I did my tenth grade English paper on Tommy. This was when REO Speedwagon and Journey were huge. My presentation in front of the class didn't go as well as I'd envisioned...

Our younger dd Zoe has ASD, and although her attention span has improved, I can really relate to how hard it is to untangle ADD/ASD and figure out your next move. Our older dd just has ADD, so it's easier to separate things out.

Hi fellow Who fan! There are a lot of us kicking around the Dis!

Thanks for all of the suggestions, everyone. I appreciate you sharing with me.

 

[bookwormde]

Ctsplaysinrain,

CHADD has only limited credibility with a most people in the ASD community due to the outdated information, lack of experience with EF and autism and their close ties to the pharmaceutical industry. They do have a loyal following though.

bookwormde

 

[BeckyScott]

I do remember during oldest DS's eval several years ago, I was asked about his ability to concentrate on things he enjoys. I replied that he could do video games for lengthy periods of time. Matter of fact, he will play them for hours on end if we let him, and is determined to "win" and will stay with it until then. I was told that video games don't count. I'm trying to remember the exact reason they told me, but somehow the visual craziness input of video games, something like that, there is enough activity in them, they don't count. I will say, he tends to do the games that are more "active" (Tony Hawk, anything with driving cars fast) than ones that are strategy-based and require figuring out a complicated plot-line (like Zelda maybe, that sort of thing).

My DS is Combined type, although I think he swings more Inattentive. Oh, look, a squirrel!

 

[Nik's Mom]

EF is by far the least well-understood components of ASD and is just beginning to be addressed in any effective way in the clinical literature, so often it is not dealt with effectively. You are doing the correct thing by asking questions and continuing to learn, hopefully the rest of the IEP is doing the same, good luck with the meeting.

bookwormde

Ok, we had our doctor appointment yesterday and I'm so frustrated. The doctor knows very little about autism, which isn't surprising. She was really no help at all. So now I'm thinking of looking for a child psychiatrist. At this point, with the IEP just two weeks away, I'm going to have to create my own strategy without knowing if ds really has ADHD. Bookwormde, can you explain EF furthur?

Thanks!

 

[bookwormde]

I would stay away from psychiatrist since they use a disease model (this is how they are taught) as by percentage are the least likely to be trained in the current information on autism (unless you get one that is highly recommended ASD, HFA and Aspergers).

If you can find a developmental pediatrician that has good experience in all areas of ASD that would be my first recommendation, if not a neurologist with the same experience would be second.

EF (executive function) is all about how the brain receives, organizes processes and outputs information. NT brains bring in information linearly (on piece at a time) and discriminate what is important and organize it in memory in this fashion (which is very good for written and speech communication since that is the way it is laid out). People with ASD brains bring information in a non-linear form (the simplest example is visual/picture form). They do not discriminate at the point of input and memory, but instead store all of it (if it comes in a linear for they typically must convert it into some non-linear context (again in its simplest for a picture or movie) and store it in a non-liner form. This is why linear input (reading and speech) is so “ineffective” unless extra time is allowed for this conversion and a visual framework is supplied so it does not have to be built from scratch.

Once the information is stored it is processed and in a non linear fashion also (again not 1 step at a time) but in chunks (pictures or movies is the easiest representation although this does not truly reflect much of what goes on since the individual does not actually see images in a significant portion of the processing they just “know” the answer).

The combination of these 2 differences is what gives ASD individuals their exceptional problem solving and inventive capabilities in complex areas that have eluded NTs since they have discriminated to the point where assumptions have removed possible scenarios and the tedium of linear analysis is too great to handle the complexity.

Here are the 2 “rubs” of the ASD mind. First every indicating is that it takes 20+ IQ points more to effectively “Run it”. Second is that the areas of the brain where this non linear processing takes place seems to coincide to some extent with the area that NTs use for processing social skills (which if you consider its complexity and that it is at the base level done with little conscious thought and it tends to be non linear) so The EF differential tend to be inversly proportional to the social skills innate and natural non intellectual learning and processing abilities.

With a dedicated area of the brain not available for social skills, falls back on having to be dome completely intellectually, and it is funny that it also has to be done is a linear fashion (which is much slower thereby there still being an out a sync and fatigue issue even with those with be best adaptive intellectual social skills).

Another thing to remember is that all output for NTs is filtered through the social portion of the brain in an almost instantaneous manner and moderated to varying extents by it.

For ASD individual the output either comes out unfiltered or goes through the intellectually developed social skills portion of the brain which created delays and during times of stress is overloaded and output comes out unfiltered.

There is also some supposition which is just starting to be discussed that some of the reasons the sensory issue ay be higher than expected (even beyond what would be expects for actual differential on signal intensity) is that in some fashion sensory input is dampened by the same social portions of the brain as in some fashion from prior expectations and experience.

I know this was long but is about as simplistic a way as it can be explained, and from what I have been able to find out probably not more than 500 clinicians in the world really understand it in any depth. There are certainly lots of other fine nuance involved but the above is a gross overview.

bookwormde