My 7-year-old will be attending 2nd grade this year. She's in an extended summer program right now, but we're having the same problem there that we had last school year. Every day she has a meltdown and we have to come pick her up from school. She can't go a single day, whether full day or half day, without melting down and needing to be picked up. She gets aggressive and destructive when she's melting down, not to mention disruptive to the whole class.
I don't even know what to do with her anymore. She refuses to try to read, refuses work, and is doing everything to refuse and avoid any amount of anything she doesn't want to do. She says school is boring.
I can't keep doing this every day. I'll lose my job, and I feel like I'm losing my sanity. How can we turn this around so that she can stay in school all day and, hopefully, even thrive in school?
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mrl12
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Hi. You did not say what treatment and accommodations she is receiving, so I will start at the beginning. The management of ADHD is a three legged stool. 1. Mediation. 2. Accommodations at school (IEP or section 504 Plan). 3. Lifestyle modification at home (like reward charts, checklists, specific enforced bedtimes, and specific daily schedule). Some would add counseling to this list, but it's never been needed for us (my son keeps getting discharged with counselor saying he doesn't need to be there). For us, the most challenging by far was the accommodations at school. If you have not yet started that process, please do so immediately. You make a written request to the committee for special education who must by law complete a full evaluation within 60 days of the written request. I can send a sample letter if you don't feel comfortable writing it yourself. Depending upon the results, your daughter may qualify for an IEP (individualized education plan) or she WILL qualify for a 504 plan (section 504 of the Rehabilitation Act of 197...) by virtue of the medical diagnosis of ADHD. If all of these things are in place, write back and I'll provide more advice. If they are not, please get these things in place. It will change your daughter's life significantly for the better. Be well.
My daughter currently has a 504 that was written while we were mostly learning from home during remote schooling. Most of the things that worked for her then weren't in the 504, they were things I came up with to allow more flexibility and to try to keep her engaged. And she was actually learning at that point! She wasn't paying much attention to her live classes online, but she was interested and engaged in activities I put together for her and she would complete her assignments. She tested out of her supplementary math class (regrettably) and went up a couple of reading levels. When she returned to in-person schooling, the sh!t hit the fan and she pretty much tapped out. We were having to pick her up daily.
I had been trying to get the school to do other evaluations but it wasn't until her disruptive and aggressive behavior in school that they finally agreed to schedule a full gamut of testing: psychiatric (at the school's request), psychological, functional behavior assessment, OT evaluation, and she's scheduled for her learning evaluation tomorrow. The reports found her to be high likelihood for just about everything they tested for (ASD, ODD, conduct disorder, ADHD, bipolar, etc.) Her OT evaluation determined her to have questionable processing for visual, touch, and movement experiences. I suspect she may be on the spectrum. We had an ASD evaluation over the winter, but that was a one-hour online appointment and the doctor deemed her not to have ASD on account of her being able to hold a conversation and maintain eye contact. I never felt confident in that assessment.
We're still waiting on the report for the psychiatric evaluation, and once she's done with the learning evaluation, her school case manager will schedule a meeting to go over everything and see how they can help her at school. She goes to a summer program now and has a special ed teacher who tries all kinds of methods to try to engage her, but my daughter gets bored and kicks into fight or flight--she either runs out of the room and around the school or becomes combative and aggressive.
She also sees a psychologist every other week. But we're scheduled weekly now that we've hit our deductible. They do play-based therapy, but I don't see any progress yet. It's been about 5 sessions, but I know it doesn't happen overnight.
She's prescribed Methylphenidate long-acting but we've had a heck of a time getting her to take her meds. She can't swallow pills and she doesn't like the taste or texture of it. Her doctor just told us about a patch version but it's on back-order at the pharmacy. So she's basically unmedicated right now.
I know we're in the middle of it all right now, so part of this is just waiting it out. We have the patch coming, the meeting coming up, and the psychology sessions are ongoing. Maybe I just need patience, but I'm so worried about school coming up in a little over a month and her still not being able to make it through even a few hours. She'll be starting 2nd grade at a kindergarten level of reading and math, only because she regressed so much when she went back to in-person.
Thanks for the additional info. First the meds. Swallowing difficulties are not uncommon. The pills tend to float in liquid which is tough for some kids. Try putting the pills if her favorite flavor pudding. For my son, the pills are taken with chocolate pudding.
As for testing, the school is REQUIRED by federal law (IDEA) to complete the "full gamut" of tests at your written request. They did NOT get to choose or wait until she's disruptive.
As for counseling, try switching to a psychiatrist (medical doctor) rather than psychologist (PhD). Your insurance should cover it. If it does not, reach out and I will help you get it covered. Even Medicaid covers it. There is NO private insurance which does not. Please be proactive. Do not wait for the school to step up. You know your daughter and her needs and they are REQUIRED to give her what she needs but will not if you are not proactive. MOST IMPORTANT. though is get her on her meds regularly. All ADHD kids fight it, but in my house NOTHING is more important. There is no TV, no devices, no friends, no nothing if my son doesn't take the meds his doctor has prescribed. Good luck. Reach out for help. I can help you.
My son (6y/o) is undiagnosed but I am and I recognise in him the signs. I just want to say I know what you are going through. He is almost the same behaviour. Some of it due to me spacing out and not focusing on managing him. Am gonna try harder now.
We went through this big time. The school refusal was terrifying and miserable and caused a ton of conflict in our home. But it was also the red flag we needed to start getting help for our daughter. She was actually around 7 when it happened same as your kid. Our daughter’s therapist says behavior is communication - she’s trying to tell you something. And it sounds to me like you are listening and taking action - you are doing all the right things. The period before you get the diagnosis is the worst. While you are in it, I recommend acknowledging your daughter’s feelings (you seem angry/scared) as opposed to trying to calm her down immediately and just pouring love into her whenever you can. Positive reinforcement is so powerful. Once you have the diagnosis it will also open up different modes of treatment. You don’t say anything about occupational therapy but OT could be a good option - it sounds like there’s some sensory stuff (like the pill swallowing) and OT’s can help with emotional regulation. We had more success with OT when my daughter was too young to really get anything out of talking to a therapist. I’m confused if the meds are being prescribed by a psychiatrist? You should be working with a psychiatrist. If you have a complicated diagnosis (and who doesn’t?) a psychiatrist is essential. It’s fantastic your doctor prescribed the patch. That’s the kind of problem solving you want on your team. Forcing someone with sensory/gagging issues to swallow something can really backfire. When the report comes back, you should push for an IEP rather than a 504. It’s complicated, but an IEP qualifies you for services rather than accommodations. And since your kid’s grades dropped, she’s a good candidate. ADDitude magazine has some good resources for understanding this. I’m also not clear if the evaluation includes testing for ASD? That would be a good thing to know and would provide clarity. For us, it turned out that anxiety was the biggest factor and ADHD was secondary. So whatever comes back in the report will be really helpful as you figure out what your kiddo needs. Once you get the report back, start learning which meds are correct and get your team in place, things will get better. There’s a ton of trial and error when you get into that phase - which is also super stressful - but where you are at is really the darkest hour before the dawn. Basically, it sounds like you are doing all the right things - just remember to love on your kid and yourself right now. Also, while we were in the middle of school refusal but before we started to really make any headway on actually solving some of our problems, we were able to work with our school counselor to set up a check list with rewards that our daughter could earn by going to school. And he helped us change some patterns in how our mornings were set up that made it easier until we could get the right medication. One last thing - the transition back to school from remote while the pandemic ongoing is really hard! So remember to celebrate your and your kid’s courage through all of this. Lmk if you have any questions - it does sound very similar to our experience.
We went through a similar situation and I l know how miserable it is—hang in there! Things got better when the school made the appropriate accommodation. I talked to her classroom teacher many many times to figure out what wasn’t working. I was lucky that he was willing to work with us and a lot of it was goal setting—we were ok if she didn’t finish an assignment or needed a reduced HW load—and finding the triggers. Good luck.
I second everything the previous responders said! I have been where you are and I know how crushing it can feel. You are doing amazing! I know it might not feel like it - there is usually a big time gap between when you are doing all the hard, hard work and when you see the results of all that parenting work. But know that it will come.We did not push for an IEP until our daughter was in middle school, and I regret that. She was on a 504 that was essentially useless from third grade until middle school, and I wish I had advocated for evaluation sooner.
Just a couple things I would add to the advice you already got:
1. For kids whose ADHD includes severe emotional dysregulation (mine does and it sounds like yours does too), Methylphenidate is often not enough. My daughter started taking Lamictal (aka Lamotrigine) a couple years ago. It is considered a mood stabilizer. It was an absolute game-changer. As someone else said, getting to a good psychiatrist (not psychologist), preferably one who knows a lot about ADHD and kids, is going to make a big difference. We are now with a psychiatric nurse practitioner and he is AMAZING. If you find that option, I would look into it. NP's are very knowledgeable and can prescribe meds, but also tend to really take the time to get to know their patients, appointments are typically much longer and they want to know more about all aspects of functioning.
2. Hopefully this will not come up with your daughter, but I had to fight hard when it came to the "identification" part of my daughter's IEP evaluation process. If they find her to be eligible (based on what you said, I can't imagine they wouldn't), they will need to determine a "category of disability". Because my daughter's emotional dysregulation was the most disruptive of her challenges, they focused on that and wanted to place her under the category of Emotional Disability. I was very opposed to that because her emotional dysregulation is a symptom of her ADHD, and she has other educationally relevant needs due to ADHD that they had been ignoring for years because those symptoms aren't disruptive for them. It was a very tough situation and I was surprised that the school psychiatrist was so adamant. I am an OT and work in the same district in the special education program, so I am lucky that I know the system and the laws. I got them to agree to a primary disability of Other Health Impairment, which under law is where ADHD is supposed to fall. If you run in to any problem with them wanting to use Emotional Disability and you disagree, I would be happy to share some of the information and "arguments" I used to support my position.
All the best to you right now. I am glad you are asking for support through this group. There are so many people here with great information and advice.
Yes, I would love to see that information! I'm hoping for the best with our upcoming meetings. I would guess from the OT evaluation and the psychiatric report (which I finally received today) that she will qualify for the IEP. But as everything has been a battle with this school so far, I want to be prepared if they try to fight against that.
The center we go to for the psychology sessions also has a psychiatric nurse practitioner. I'll have to call them tomorrow to ask about getting an appointment to see them. I've been wondering if a mood stabilizer would be beneficial for my daughter, but I understand the process is to see how she reacts to the ADHD meds first. Still working on getting a form of medicine she will take.
I will also look into getting an advocacy lawyer to help with these meetings.
Here is the email I sent to the school before we had the meeting to discuss the IEP category of disability. It's long and has a lot of specifics to my daughter that may not apply to yours, but hopefully it will give you a sense of how I approached it.
As we have the evaluation continuation meeting coming up, I would like to share my thoughts on the disability categories we will be discussing related to possible eligibility for L. We touched on that conversation briefly, and I know you are planning to share more of your thoughts on why the SIED/Serious Emotional Disability category is the most appropriate.
I’ve done more research and thinking over the last couple of days, and feel strongly that OHI/Other Health Impairment is the more appropriate category. I’m hoping putting it down in writing will give you a chance to look it over before the meeting and help us make best use of time during the meeting.
It is my understanding that when there are multiple issues affecting a student’s educational experience, they should be considered from the perspective of which is most comprehensive of all aspects of the delays/disability that affect learning, including the question of if one category is actually a set of symptoms under another category. I believe this is the case with L. We all agree that there are significant social-emotional struggles that impact her at school. However, there is strong evidence that these symptoms are caused by her ADHD, not separate from it.
L’s ADHD has been clearly documented for several years. The health history written by the school nurse states that she has severe ADHD. We provided medical documentation of her diagnosis when she was first given a 504 plan years ago, and we are happy to provide that again if needed. I know that the medical diagnosis alone is not everything, however just looking at the DSM-5 criteria for ADHD, Inattentive Type is like reading a laundry list of L’s struggles:
Often fails to give close attention to details or makes careless mistakes in schoolwork, at work, or with other activities.
Often has trouble holding attention on tasks or play activities.
Often does not seem to listen when spoken to directly.
Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (e.g., loses focus, side-tracked).
Often has trouble organizing tasks and activities.
Often avoids, dislikes, or is reluctant to do tasks that require mental effort over a long period of time (such as schoolwork or homework).
Often loses things necessary for tasks and activities (e.g. school materials, pencils, books, tools, wallets, keys, paperwork, eyeglasses, mobile telephones).
Is often easily distracted
Is often forgetful in daily activities.
There is no doubt that L has ADHD, so it seems the question of ED vs OHI is which is primary, affects her school performance more, and if one is actually the cause of the other. A couple of thoughts here:
In the eval report, there are several instances of L’s struggle to perform academically that are clearly related to attention issues:
Under Educational, it was observed that she started tasks but did not continue, such as writing down the "Do Now" problem but not completing it, and needing a reminder to start the math lesson, complying, but then not being actively engaged.
Under Social-Emotional, Mrs. M stated that when L has trouble grasping math concepts, she uses writing, coloring, and doodling as a “coping skill”, and that L complies when Mrs. M is right there to guide her but goes off-task as soon as she walks away.
Mr. B stated that L struggles to work independently.
L’s “coping skills” of drawing, doodling, coloring were mentioned a few times and I think need to be re-thought. I completely understand and agreed with the idea when she was having emotional struggles and seemed to need calming activities. But I think she is now using them not only to cope with strong feelings, but quite often as a way to avoid mental tasks that are difficult and confusing. A classic component of ADHD is seeking activities that are creatively rewarding and offer an immediate “hit” of satisfaction and avoiding tasks that are less intrinsically motivating/interesting and do not result in immediate rewards.
L checks the boxes for every item in the third section of the OHI determination form under limited alertness:
Inability to manage and maintain attention - a common thread to all the information provided by her teachers is her inability to independently sustain attention to school work
Inability to organize or attend - her struggles with organizing herself, her belongings, including schoolwork, and organize and sequence tasks to completion is well documented and on-going,
Inability to prioritize environmental stimuli - this is a huge struggle for L. The form goes on to say, “including a heightened alertness to environmental stimuli that results in limited alertness with respect to the educational environment.” I believe one of the ways this plays out with L is an over-alertness to the social stimuli at school - she is acutely aware of which students are present, their affects, where they are sitting, who is answering and who isn’t, who is on track and who isn’t, who gets answers right most, etc. That over-attention to social stimuli interferes with her ability to direct her focus to academic tasks. It also fuels many of her social-emotional struggles because she has a heightened alertness to those things, she has a hard time just letting it go, so instead of moving on and focusing on the next learning task, her brain is still stuck on thinking about some social issue.
Emotional dysregulation, and delay in social skill development, is a very common, and often severe, symptom of ADHD. Here is just one study that addresses this. I know as a school psychologist, J, you’re well versed on this, but wanted to include some research-based evidence to my thinking, and for others on the team that may not be as familiar with ADHD and emotional symptoms. I can provide more if anyone wants it.
Excerpt from the abstract: “It has long been recognized that many individuals with ADHD also have difficulties with emotion regulation... The authors examine the current literature using both quantitative and qualitative methods. Three key findings emerge. First, emotion dysregulation is prevalent in ADHD throughout the lifespan and is a major contributor to impairment. Second, emotion dysregulation in ADHD may arise from deficits in orienting towards, recognizing and/or allocating attention to emotional stimuli; these deficits that implicate dysfunction within a striato-amygdalo-medial prefrontal cortical network.” They go on to say “There is growing consensus that the emotional dysregulation, including social skills impairment, and behaviors that could appear as anxiety and/or depression, is a symptom of the same brain differences/disability that causes the more readily-known symptoms of difficulty with attention and focus.”
In looking at Special Education Law and guidance, I found this in the CDE Guidelines for Determining Eligibility for Special Education for Students with Serious Emotional Disability
Pg 34: “It should be noted that other disabilities may result in the lack of social skills that could otherwise be systematically taught to the student. The lack of social skills alone or as the result of another disabling condition does not make a student eligible under this category.”
To sum up my thinking on this, I believe the symptoms of emotional disability are actually part of L's ADHD, not separate from them. If it were only those symptoms that are impacting her education, then I could see validity for the SIED category. But clearly, they are only part of the picture. Her difficulty directing and maintaining attention, knowing how to organize her thoughts and work, how to sequence tasks, etc, has been impacting her learning for a long time, and needs to be supported and addressed if she qualifies for services. Therefore, OHI seems like the appropriate category.
Looking forward to seeing you and discussing further tomorrow.
Feel free to ask me any questions. This process was very, very hard, and that's with me being a seasoned special education professional myself. I can't imagine how scary it might be for someone who hasn't had to go through it before. I'm happy to provide any insight or suggestions that might be of help.
Thanks for all of your help and support. Yesterday was a low point for me. I felt completely useless and helpless. It's so hard to see your kid suffer and struggle.
We received our psychiatric report today and she took her learning assessment today, as well--the last evaluation of a long list of evaluations she's received over the past month and a half. I'm not sure what to do with all the information we have yet, but it confirms and validates the things I've been telling her school all year.
I will be calling the psychiatric nurse practitioner at our mental health center to try to schedule an appointment. And I'll contact an occupational therapist for her sensory processing. I will also contact a child advocacy lawyer to help us through these upcoming identification meetings. We'll keep trying different forms of medications in hopes one will take.
Sounds like you are doing all the right things. It can be very hard but also very rewarding when you see your child succeed and know that it was because of your efforts and the time you put in. I have come to see the ADHD brain as a super power capable of amazing things when managed properly. I sometimes think.of ADHD like the Hulk which, when properly controlled, is a super hero, but can also be a monster. You are doing all right things to get the Hulk under control. I like to remember what a gift ADHD can be (once we get these kids through a school system which doesn't value their gifts). Remember that your child is in the excellent company of Thomas Edison, Albert Einstein, the Wright Brothers and, some say DaVinci and Ben Franklin, all with ADHD. Of course we all know of Michael Phelps and Simone Biles. Hang in there. With your help, your daughter, too, can succeed with her super, amazing ADHD brain!!!
I hate that this is such a common refrain though: "get these kids through a school system which doesn't value their gifts." I told my daughter something to this effect this evening. It's such an unfair thought to have to convince our kids to just "get through" a system that is intended to teach them but instead sucks the joy out of kids.
I've actually been considering pulling her out of public school. There are a few Montessori and Friends schools nearby as well as a special ed type of school that says it teaches in a sensory type of environment. I can't help but wonder if an IEP will ever be enough to not only get our kids through the school system but ignite a love of learning. I hope I'm wrong, because I know alternative options aren't available for everyone and every kids deserves to learn, and to love to learn.
Hi. We did switch my son to private school last year. An independent school not affiliated with any religion or national program. It has been a new world! It has been wonderful and my son has been summa cum laude since starting there. We keep waiting for the other show to drop but it never has. They follow his 504 plan (though, it is unnecessary there since they just teach him) though they don't have to, but as a private school, they want to keep us happy (and keep the tuition coming) so they do it. If this is an option for you, I say do it.
Also, one more quick thing... You may enjoy reading a book called "The Edison Gene." It's available on Amazon. However, it's basically a long winded academic who fills a book explaining that the American school system is designed for farmers and is not equipped from its inception to teach ADHD brains (like Edison). I liked it (but I read EVERYTHING!).
OH goodness, that is so hard, I'm sorry you are dealing with that. I would suggest counseling for her and see what is behind her anger and rage. Probably counsel for you too. But when you give in and get her, she wins. Maybe have her sit in office all day to see that it is better being in class. Has she been to a pediatric psychologist to see what could help? Maybe some magnesium to calm her down and B vitamins to heal her nerves till you see what the Dr says. Hang in there, do what you can and don't give up, dear.
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Ideas for upcoming IEP meeting (specifically refusing to do non preferred homework at school)
School
Issues with the school
Starting middle school with Adhd
18 yrs Refusing medication
