Yes, it’s the Lizardqueen — three months after the last post. This past three months (that’s the fall semester in school-speak) has been an incredible challenge, keeping everything in balance and NOT insane.
I could never imagine how the kiddo’s ADHD diagnosis and treatment of play therapy and medication would take over my work and home life from his initial evaluation in early September to his recent ADHD follow-up this past Monday.
As mentioned back in September, the kiddo’s preschool teacher and preschool director gave me a letter (“Uh oh”), informing me that something wasn’t normal about the kiddo’s behavior. Based on their many-years’ experience educating pre-K and early 5-year olds, they suggested that I get him evaluated for ADHD.
My first reaction: fear. And then: more fear, mixed in with guilt. But, thanks to my own experience as a teacher, not once did I feel anger towards the kiddo’s preschool staff.
Instead, I felt grateful.
With that letter in hand, I called the kiddo’s pediatrician, who gave me a referral to a local psychotherapist who specialized in evaluating behavioral disorders like ADHD.
The whole month of September was a whirlwind of trips to the pediatrician and the psychotherapist, filling out evaluation forms from all the adult stakeholders involved, and the start of play therapy as the kiddo’s initial prescription for stimulant medication was filled.
The kiddo has ADHD that combines all three forms: inattentive, hyperactive, and impulsive. He’s like a Curious George — intensely and actively curious in everything, and everything is so equally interesting that he can’t prioritize anything in his head long enough to think things through. Whatever catches his eye makes him move towards it, to check it out — no matter what’s appropriate or inappropriate at the time.
That’s fine on the weekends and weekday evenings (when it’s just me and him), but not so good in a pre-K4 class of 18 kids, where he’s learning phonics, writing his name, counting to 100, and keeping his hands to his own worksheets instead of his table mates’, all before 12pm.
Since he’s still 5, his pediatrician was wisely conservative in prescribing stimulant meds, which had to be special-ordered and didn’t arrive at the local pharmacy until the first week of October.
He first started on 2.5 ml (which is 50% of the usual minimum dose), twice a day, on short-acting methylphenidate (liquid form, since the kiddo has a tendency to not swallow pills).
I would dose him as soon as he woke up, got him ready for preschool, prep his breakfast, and then give him his breakfast 30 minutes after that first dose. I’d make sure that the kiddo had at least 200 calories before leaving the house, as his meds would kill his appetite so much that he wouldn’t eat the school lunch.
Of course, the kiddo was a finicky eater *before* his diagnosis, so that “not really eating lunch” part wasn’t so unusual.
The school would administer another dose at 12noon, and then another at 4pm (his last dose of the day).
That amount worked well for about three days, until the effectiveness seemed to go away after the third day, as the kiddo’s body adjusted to the meds. With approval from his pediatrician, his dose increased to 5 ml, twice a day.
Morning dose would be 5 ml at home, and the second 5 ml was split in two 2.5 ml doses, at 12pm and 4pm. That dosing schedule and two play therapy sessions seemed to work well for the kiddo, getting him through October.
Until it didn’t. November was the month of 5 ml and then another 5 ml, at noon. The school couldn’t give a second 5 ml at 4pm, since the label on the med bottle didn’t allow for it. So I began to pick up the kiddo around 4pm, just as the 12pm dose would be wearing off.
The kiddo’s martial arts class on Mondays and Wednesdays — which starts at 6pm — has been an adventure, to say the least. Let’s just say he won’t be belt testing anytime soon.
Meanwhile, between scheduling appointments with the pediatrician, the preschool, and the psychotherapist, my grading schedule had gone to the toilet, often with me being 2-3 weeks behind on essay grading.
This was a semester of me apologizing to my six classes on a regular basis and expressing much gratitude for my students’ patience. I am so grateful that I teach at a community college, where my students are often adults with kids and jobs and, thus, can empathize with my challenges of being a single mom to a newly diagnosed ADHD preschool boy.
I’m officially a faculty adviser for the campus English honor society (it’s called Sigma Kappa Delta), but I was effectively AWOL for the whole semester, often apologizing to what few active SKD members were left.
Did I feel a little guilty? Yep. Did that make me prioritize SKD over the kiddo? Nope.
In November, the kiddo’s ADHD follow-up was good: no weight loss, ECG testing normal, typical stimulant med side effects (a bit of a fast heartbeat, some stomach upset, a little dizziness) within normal tolerance, and — over time — the kiddo got used to it, as they were only temporary as the meds settled into his system. He seems to be giving up his naps but still sleeps at night, so that’s good.
But then, sometime in early December, the 5 ml before breakfast didn’t seem to be working, per his teacher. So December ended up being this: 7.5 ml at home before breakfast (to get him through the academic rigour of morning curriculum), 5 ml at school after lunch (to get him through the early afternoon), and 2.5 ml at 4pm at home (to get him through early evening and any homework to do).
However, a big change is coming, as the kiddo’s preschool will discontinue disbursing meds beginning January 2. At the kiddo’s December 24 follow-up, I stated that.
In response, his pediatrician prescribed an extended-release 10 mg capsule (capsule so that I can open it up over a teaspoon of applesauce for the kiddo to swallow) of another kind of ADHD stimulant, dexmethylphenidate, aka Focalin XR, to be given once –and only once — first thing in the morning. If needed, I can give him two capsules in the morning.
I haven’t started the kiddo on the new meds and dosing schedule, as he’s on Christmas break until January 2, so we’ll see how that goes once he’s back in the classroom. While on break, I’ve lessened his dosage to 2.5ml, once to twice a day, as a form of low-level maintenance.
(No, I don’t just stop it cold turkey, as common sense tells me that stimulant withdrawal symptoms would probably be worse than the worst of caffeine-withdrawal symptoms. Ouch.)
He *has* lost a pound from November to December, so the good doctor suggested that I give Pediasure to the kiddo, twice a day, in addition to his breakfast and dinner. What’s funny is that the kiddo hates the taste of Pediasure SO MUCH that just the threat of me giving it to him makes the usually slow-eating and finicky kiddo finish his breakfast and dinner.
So. Here we are, at the tail-end of December 2012, with the prospects of a New Year, a new semester, a new kind of ADHD meds, all in preparation for when the kiddo ends his time at preschool and gets ready for kindergarten, in what will likely feel to be only a few short months.
Here we go.