Psychiatrist in Atlanta for suspected “ring of fire” adhd

[atay]

hi all. Our daughter is 10 and has adhd and severe anxiety and most likely depression. All of the posts I read about aggression are interesting because her aggression is internally focused. She has so much compassion and grace for others (and empathy!) All of the negative talk and even rage are internally focused. I really believe the root of it is a severely low frustration tolerance. This leads her to a very negative self image- everyone else is smarter, better, prettier, etc. She expects perfection from herself (tho admits that’s impossible) so she gives up or won’t even try anything— sports, mindfulness, positive self talk tricks, etc. She talks about how much emotional pain she’s in, and that if she weren’t here she wouldn’t have to experience the pain. It’s gutting to hear…

we have her in therapy and she had a psychiatrist- we are doing everything we can! But many suggestions for help like diet/exercise don’t work with her because of her low frustration tolerance. Physical exertion or eating something that’s not her favorite feel like a punishment to her. Obviously “we must hate her to force her to eat something that doesn’t taste great” or make her play sports. (She claims sports might cause an injury and she is extremely fearful of physical pain- again, low frustration tolerance).

So ultimately what I’m asking for is a recommendation for a psychiatrist and/or therapist in Atlanta who can really help get to the root of this anxiety and low frustration tolerance. For now we are on low doses of guanfacine and Zoloft. I’m at a total loss as to what to do next and the hard part is current psychiatrist seems baffled as well

[Hidden]

I am sorry I can’t recommend anyone.

However when I read about your daughter it’s a bit like I used to be as a teen (although I didn’t have aggression nor self harm or anything like that).

Now as an adult I think I may have dyspraxia (coordination disorder which now my son has been diagnosed with). Basically I always was shit at any sport, throwing, catching, running, anything really. A person who is ‘normal’ with coordination and learning sports can’t understand how it feels to be shit at any given sport. You just feel like an odd ball.

Maybe she is not so great with balance, coordination etc. But of course I don’t know her so I can only guess and give my example why it was anxiety inductive for me when I was a teen😄

So I don’t blame your daughter that she is inventing ‘excuses’ why she won’t be doing sports.

To give you an example at PE at school we needed to do aerobics and I was hopeless at this so I would make up stuff like that I have something in my eye and to go to a school nurse and avoid.

And yes, when a young girl doesn’t exercise enough the mood will be even lower because it’s movement and exercise that creates endorphins and brings balance to various neurotransmitters and also helps with healthy weight and looks!

I’d say think out of the box for her, maybe she would be okay starting yoga but at home with the online instructor. Or maybe you have places where you 2 can go on long fast pace walks. Or maybe she would be okay on a training bike or a rowing machine at home.

As a young adult I found that I loved wall climbing. I did a course, I bought my gear- rope, harness, shoes, chalk bag and I had a partner who I met at the course. We were meeting weekly for an indoors wall climbing session. It was fun.

I mean, it’s worth trying with her various things. Because Zoloft won’t work if she won’t start being active in one way or the other.

I was on Zoloft for 6 months as a young adult and it really helped me but I remember psychiatrist was saying that I need to start ‘doing’ things because otherwise it won’t work.

I still dislike exercising and any team sports now as a middle aged woman😄I am slim but it’s because I do intermittent fasting and I do try to walk a lot. We do skiing as a family and I am so unfit that I have to take pain killers every day to get through a week of holidays on my snowboard. Well what can I say, I developed my strategies…😉

[katcald]

Following. I don’t have any advice but this sounds a lot like my daughter.

[T8T8T8]

I'm so sorry. We're in the same boat and it's brutal. I encourage you to investigate Rejection Sensitive Dysphoria (RSD). It's very common in those with ADHD and it sounds like that may be what you're dealing with. Here is a link to some information if you are interested. Good luck and hang in there. 🌻

additudemag.com/rejection-s...

[atay]

thanks, all. I have read a lot about RSD and she definitely has that… but I still feel like the root of almost all of her challenges stem from 1) low frustration tolerance and 2) black and white thinking

She shies away from anything and everything because of her low frustration tolerance and the black and white thinking spiral into such negative self talk/beliefs.

I’m not sure which way to go with medication to focus on those two specific things. First- they lead to severe anxiety, which we are attempting to treat with Zoloft. But we have to stop the intense outbursts when she gets so frustrated and feels ashamed because she thinks she’s not smart enough- she tries to hurt herself.

Psychiatrist wants to treat anxiety and then try stimulants to help with low frustration… but I am so worried stimulants will make the anxiety worse. When the psychiatrist seems stumped… it makes me want a better/more experienced one. I know our daughter isn’t the only one with these struggles

[MaudQ]

Have you considered that she might have autism? It can go unnoticed in girls and women. Black and white thinking and low frustration tolerance would track with ASD.

[atay in reply to MaudQ]

our psychiatrist recently brought that up as a possibility. It has never been on our radar because of how well she communicates- especially her awesome interaction with adults- eye contact and in general just a great little conversationalist.

Would autism still be on the docket given that?

I don’t know much about autism, but would treatment options and/or medication differ?

Thank you for your help/comment!

[MaudQ in reply to atay]

My daughter’s ASD was missed for years because she was academically gifted, articulate and didn’t display any of the stereotypical symptoms of autism. What happened was that as she and her peers got older, it became clear that there was a social-emotional gap. Being inflexible when you’re 5 is normal, less so when you’re 10. We were able to find a psychologist to test for autism who took our insurance so we were very lucky. I would definitely do more research and get a second opinion before getting the test because it can be expensive and a big project. I wish we had done it years ago, though. Our daughter missed years of support and therapy that could have made her life so much better. There isn’t a medication for autism, but it makes it easier to get an IEP and the therapy is different than for ADHD. There’s a whole world of support for autism and it helps so much to have the framework to understand what your kid is going through. Lmk is you have more questions or want me to send you any resources.

[MarchMommy in reply to MaudQ]

Same with mine. She's 7 with adhd but many of her behaviors are very ASD level 1. But she's also a great conversationalist and hit every developmental milestone. I actually am getting a psychological eval done next week so we can refine and rule out a bit better. They do go together often...especially at the higher functioning level.

[Knitting20projects in reply to MaudQ]

THIS. Similar journey for our son (12, academically gifted), ultimately diagnosed this year. Suddenly seeing so many behaviors through an autism lens makes everything clearer.

[Knitting20projects]

I would really consider an autism evaluation or at minimum a speech therapist who has training in pragmatic communication to evaluate her social communication skills. Girls with autism are a huge undiagnosed population and commonly have anxiety, depression, & ADHD. They can also be intellectually gifted. They can also have less obvious restricted interests compared to boys with autism (who might love dinosaurs, trains, vacuum cleaners, etc). Girls often love something their peers also go through a phase about—-horses, unicorns, so theirs might not be clear to families as a restricted interest. Does she have strong friendships? Does she struggle to adapt to change in routine or plans? Does she have difficulty having a back & forth conversation & tend to monologue or “information dump”? I also wonder if either treating her ADHD first (maximizing treatment) would decrease the anxiety that poor executive functioning invariably causes. I also know that low dose Zoloft usually doesn’t treat anxiety adequately. Most people with severe anxiety need higher range doses of SSRIs, as opposed to the depression treatment doses, & SSRIs can temporarily increase anxiety as you increase the dosage. So there may be a challenging time before she reaches goal dose. I would really look for a psychologist experienced in autism diagnosis and get her an appointment.

[atay]

we briefly mentioned this to our therapist and her response was that if it’s autism, it’d be so high functioning that it wouldn’t change what we are doing, which is working in trying to build up her frustration tolerance.

So far this summer, things are good. It’s forcing school work that sends her into a tizzy, and I’m so afraid one of these tizzies will end dangerously one day.

[Knitting20projects in reply to atay]

Hmmmm. I’m wondering if a psychologist would say the same thing. I’m not at all saying you don’t have a good therapist. I’m just thinking that many kids with “high functioning autism” need lots of help—-social skills support, help with perspective taking, learning to ask for help when needed, having a plan b when their plan a fails, “reading the room” socially, planning, organizing, dealing with time blindness. I would at least consider having someone experienced in what used to be called Asperger’s see her. Our son with HF ASD struggles to have insight into his emotions, etc, on a level that’s useful with a regular therapy approach, even though he’s very intelligent, making straight A’s, and at least 5 professionals missed ASD completely in him. I say this as someone who thought his eye contact was great. It actually wasn’t when a skilled psychologist did a formal evaluation. The other reason getting an ASD diagnosis might help? She ultimately might understand herself and identify with an identity that maybe helps her feel more comfortable in her own skin.

[BLC89]

Hello away,I'm so sorry you and your family are going thru this. I wanted to add a couple of thoughts.

The therapist response that nothing would change is incorrect. Your understanding of your daughter would expand and that can change everything. So the treatments remain the same but the people using them are different. Information changes your perspective. I would get a second or third opinion or start researching girls and HF ASD and see what rings true.

Secondly I'm wondering if she likes animals. Animals are so pure in their joy and love for you it penetrates. Maybe there is equine therapy near you? You could explain that the kindness she feels for the animals is the same as she deserves from everyone, especially herself. Ask her what the animals think of her. They love her, they think she's wondeful, they can't be wrong can they? It's another avenue that may penatrate.

If it ASD there's a lot to learn and tons of support for you and your daughter.

If it ADHD + anxiety on overdrive stay curious, patient and open to new methods. And take care of yourself, if you are depleted everyone is worse off. I wish you the best and a speedy understanding of what's going on with your girl.

Hang in there,

BLC89