A Difficult Decision

What thoughts and feelings does the phrase ADHD evoke in your mind? Hyperactive? Unfocused? Child who is not disciplined enough? Over medication? Misdiagnosis?

Yeah...me too. Which is why I am having such a hard time dealing with Nathan's recent diagnosis of ADHD. We had been having issues with his behavior and inability to focus for some time now. As early as Kindergarten, the teachers had trouble getting him to focus on a task, and to sit still for any appreciable amount of time. We dismissed it as a function of his age and his creativity since he was doing well academically and was even placed in the gifted and talented pool for 1st and 2nd grade.

The most challenging part for us was dealing with the discipline issues he was having at school. From all accounts, he was never defiant or willfully disobedient, but he was constantly getting in trouble for not keeping his hands to himself, playing at inappropriate times and generally not having any impulse control. It was difficult because the child we had at home did not behave this way. This is not to say that we have a model child who never acted out or threw a fit. It does mean that we had a healthy boy who enjoyed imaginative play, and would forget himself in the moment. We were constantly reining him in as he became increasingly hyper with the ever present reminder to CALM DOWN!!

Early this school year, his teacher mentioned in passing that Nathan had real difficulty sitting in his desk and following what was going on in class. For the first time I had the thought that maybe there was more to his behavior than I first thought. When he was younger, I figured it was just hard for a small child to sit still and not fidget all day long in school. But he was now entering the realm of elementary school where he would be expected to sit still and pay attention. For the first semester of school, his grades varied wildly. He still made As and Bs, but he would have a 97 one six weeks, and then it would drop to 82 the next.

He continued to have issues with his behavior, and I appealed to the expert on all things education in my life, Mama. I figured that earning her doctorate in education qualified her to give advice on this subject, so I called her. It wasn't the first call, but it was the first time that I was really seeking guidance. She suggested several things to try and help him focus better, but the one that we really did was puzzles. I bought several puzzles and we began to put them together. Nathan had no problem sitting for an hour doing a puzzle, but it was not without much bouncing up and down in his chair and getting up to stand while he worked.

We tried positive reinforcement for good days at school, and did our best to react appropriately to the bad days. It didn't seem to matter what we did, Nathan's behavior and attention to his academic work did not change. We called his teachers for a conference in February, just to get a feel for where he was socially and academically and to see if they had any suggestions. The conference was very enlightening, and his teachers clearly had a passion for teaching and for seeing each child do their best. They had many good things to say about him, including the fact that he was always polite and that he never lied. Even when faced with punishment, he would not lie about doing something wrong. More than anything else, that made me proud because it made me feel like the really important things we are teaching him are actually sinking in.

In spite of their praise for his manners and intellect, they both expressed concern at his inability to focus and to sit still. Both had tried changing the location of his seat and the people sitting near him. We saw that his desk was in the back of the room next to the teacher's desk. She said she finally put him there so he could stand up or kneel in his chair while he was working and not distract the other students. What we found was that both teachers had tried alternative techniques to allow him to work in a way that made him more comfortable, but it still was not working. They were still having the constantly redirect him to his work or to what was going on in class.
Trevor and I made the decision to take him to the pediatrician to have him tested for ADHD. We did it with trepidation, because of personal family experience with a cousin who was misdiagnosed with ADHD, treated for several years with no success, then correctly diagnosed as bipolar. We were understandably concerned about misdiagnosis. What if he was really just acting like a normal almost 8 year old? He was certainly able to focus for hours when he was creating something with his Legos.

Our pediatrician carefully examined him, and then ordered blood work to rule out any metabolic problems like diabetes, thyroid issues or hypoglycemia. The blood work came back completely normal, and we were asked to fill out a form designed to measure the different qualities of ADHD. We had one and so did his teachers. We filled them out, and brought them back to the MD yesterday for evaluation. She reviewed them, and then graphed the data for us so we could see where Nathan fell in terms of exhibiting the signs of ADHD. The higher the score, the more likely the child had ADHD.

Not surprisingly, Nathan scored very low on cognitive ability and on response to authority. Those scores were well within the normal range for a boy his age. But with the behaviors related to hyperactivity and attention deficit, he was clearly within the range of ADHD diagnosis.

Can I just say that I was devastated? I really though that we were going to walk out of there with some suggestions for behavior modification, and we would just keep on keeping on. But when she pulled out the prescription pad and started writing it out for a ADHD drug, I seriously wanted to cry. Were we about to become a statistic? One of the many parents whose child was misdiagnosed and improperly medicated? How could we be sure? Were we doing the right thing?

So many things ran through my head, and as I sat there with tears welling in my eyes, I had to give myself a good mental shake and say, "You're being ridiculous! She didn't just say that Nathan has cancer or an incurable disease! She carefully and thoughtfully diagnosed him with ADHD! GET A GRIP!" That calmed me a little bit as well as a quick prayer sent heavenward, reminding me that God is in control.

We asked some questions about dosage, side effects and length of use and then it was over. She instructed us to call her if he had any of several symptoms she mentioned, and that she wanted him to try the medication for 30 days. At the end of that time, she wanted to re-evaluate him.

So, here I am at the end of day 1. I thought about him all day long, and was thankful that he has teachers who understood my concern and kept me informed all day about how he was doing by email. There was not a dramatic difference in his behavior, but the MD said that it would take some time for Nathan to settle into the medication. Relieved that he did not experience any adverse side effects today, I feel a little better about giving it to him tomorrow.

Every time that I called a friend or family member to tell them what was going on, I felt like I needed to explain myself. It was like I was trying to convince myself that we had done the right thing, and was pleading that we not be judged. With all the kids who are labeled hyperactive and medicated for just being children, we were afraid that we would be judged as bad parents for even considering medication for Nathan.

The bottom line is that I trust his pediatrician, and I trust his teachers. Giving him medication is scary for me, but I know that we still have the authority as his parents to stop it at any time if we feel it is having an adverse effect on his mental or physical well-being. The fact of the matter is that we know Nathan better than anyone besides God, and we really feel like we are doing what is best for him right now. We are loving, committed parents, equally involved in his life and we are not substituting medication for good parenting and biblical discipline.

So, we'll see what happens now. Our family is supported by an army of prayer warriors, and I know that no matter how dimly I see the future, God is working all things for our good.

And the path that be my portion,
May be through flame or flood
But His presence goes before me,
And I'm covered by His blood.
Many things about tomorrow,
I don't seem to understand
But I know Who holds tomorrow,
And I know Who holds my hand.

"I Know Who Holds Tomorrow"--Ira Stanphill