My little girl is newly diagnosed with ADHD though I’m not that shocked. The past year of school has been incredibly challenging: hitting the teacher, explosive emotions, easily frustrated, highly impulsive. This school year started and after she headbutted the floor, I decided to consult a doctor. The assessment completed by the school was shocking. I knew she had been struggling but was blown away by how bad they said it was. She has the same type of behaviors at home too, of course. Today we started her on Focalin XR and I’m not really sure what to expect. I’ve read things where parents say that how much meds helped their kiddo. Was it an overnight difference? Did you have to work up to a dose? My girl is tiny, 37 lbs, so I’m not sure that there is much to go up on with the dosing. Any side effects? Or rebound symptoms? Does the med seem to last all day?
Do you think an IEP or 504 should be started immediately? She doesn’t really need extra time with tests since she is in kindergarten, but are there other things that little kids can benefit from? She already gets counseling sessions at school.
Any other tips? I’m a PEDS nurse but my background is critical care so I don’t have a lot of experience with ADHD. I am open to anything that will help her. We are going to see a child psychiatrist tomorrow. Any help is truly appreciated
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Pedsnursemama
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Sounds familiar 😵💫 I can't speak to that medication, but you can search for posts about it here. I think learning plans take time to write, so it may be useful to get that started, and there are other benefits besides time.
The most helpful things for us, outside of medication, have been the neuropsych battery testing, OT, and play therapy.
When trying out meds, you have to be on the lookout for a lot of things. Try keeping a journal to track it all each day and look for patterns:- what do you observe in your child (mood, behavior, focus, impulsivity level, etc.)
- food intake (is it going down or staying the same)
- ask your child how she feels every morning and afternoon (general mood, headaches, stomach aches, sad/happy, was she able to focus on the lesson/teacher, etc)
- if the teacher is open to it, ask for feedback from them too
Finding the right medication and dosage is definitely a lot of trial and error. You may go through several different meds and various dosages before finding the right one.
If your child only has ADHD, then she will qualify for a 504 plan. Get a letter from the Dr and send it to the school to start the process.
If you think your child might have additional learning disabilities (dyslexia, dysgraphia, etc.), then you need to request that the school test her for learning disabilities.
For either process you can find example letters online:
Additionally, you can search for "common classroom accommodations for ADHD" to find several lists. Each year, I print these out and have my kids go through them to mark the items they think will help them the most. I also go through them and mark the ones I think will help them. I often send these lists (unmarked) to the teacher prior to the 504 mtg to help them come up with their own list.
If your child has some other learning disability, you can find similar checklists. For things like: dyslexia, dysgraphia, auditory processing disorder, eye tracking problems, anxiety, etc.
Once you've found a medication + dosage that works for your child, be sure to check in with them at least every 3 months about how they are feeling. As their bodies grow the dosage will usually need to go up.
Involve your child in all of this as much as possible. She will need to learn to advocate for herself and these are the beginning steps in that process (awareness, choices, etc). By middle school, she will be a participant in her own 504/IEP meeting. By college, she needs to advocate all by herself.
My kids are now in 7th + 8th grade. One just has ADHD. The other has ADHD, dyslexia, dysgraphia, auditory processing disorder, and anxiety.
A journal is a great idea. Yesterday was my first full day with her on the med. she ate normally and even fell asleep in the car when we drove back from the doctor (it was a little far).
I’ll definitely check out the lists and see what works for her. Thanks so much
Hi there! I’m an SLP in the schools and in my experience it’s nice to set up a team plan such as an IEP and/or 504 plan for consistency for the student, teacher and home. Don’t be shy to share what has worked/hasn’t worked for you at home. Visual really have helped and a consistent schedule and expectations. Sometimes movement breaks recognizing any patterns to notice before she gets to the hitting stage (if any) and providing a sensory/movement support prior to getting escalated/disregulated? Lean into what she excels at, make things feel like a game, provide constant and high reinforment for good behavior, especially in the beginning. These are all just ideas!! And truly you know your girl best, so don’t be shy to collaborate with the school. It sounds like if they are offering support through an IEP/504 they truly what what’s best for her and what to provide her with supports to be successful at school. Hope this helps!
Teachers pay teachers have a tone of visual supports for visual schedules, incentives for good work/behavior, here are some examples:
ADDitude magazine has a lot of articles and templates about the IEP/504 process. Your school district or state dept of ed might have resources as well. Something I’ve learned is that most of us don’t ask for enough with the 504/IEP process because we don’t even know what to ask for. For a little kid you could ask for water breaks, snack breaks, movement breaks, fidgets. There are wiggly chairs too. A high energy kid can be given heavy lifting or pushing projects, like going and getting the AV cart or pushing a library cart with books. A good one is for the teacher to “check for understanding” which means just checking in with the kid regularly to bring their attention back and make sure they didn’t miss anything. Preferential seating, one on one check ins and check outs with the teacher. Also, chunking down big or complex projects - “clean up your materials” can be proven down into manageable tasks. You can request positive reinforcement!
We loved OT for our kid, the occupational therapist can have great ideas for stuff to put in the learning plan. Someone mentioned sensory issues. You can also have your kid evaluated for speech therapy. Pragmatic speech which is necessary for expressing your thoughts and feelings and for self advocacy can be a lagging skill for our kids. Ask, ask, ask everyone you know for ideas.
Schools sometimes drop the ball on this, but the learning plan should have measurable goals, a timeline for progress and checking in to see if those goals are being met.
OT helped my kid, but our new school days OT and speech are only for kids with iep. I work in special education, so I can give a plethora of other accommodations depending on the kid, but there’s so many that it would be a textbook for list, so I like to know kids before suggesting many accommodations.
Thank you for listing pragmatic speech. I’m going to request that when we are stable in our school. OP should first email teacher and principal and specifically ask for an iep evaluation. Some kids don’t make the cut, but it doesn’t hurt. Worst they can say is no. We asked for a one on one paraprofessional for my stepkid and it didn’t work out. They said no on a daily check in.
She had a speech delay as a little kid and they closed out her speech therapy and IEP in May of 2022. She was only at school for the speech therapy and it was 1.5 hrs twice a week so behavioral issues weren’t really noticed.
I’m interested in OT, especially because she gets frustrated if she doesn’t have the dexterity to do something which leads to meltdowns. I’ll ask the school if that is something she qualifies for
You could ask her doctor since kids can qualify for medically based OT. Especially since she melts down about it.Might be easier to get medical since, school based take up to 60 days once the school receives a written request from a parent.
My stepkid is in 9th grade and had outbursts in k-1 like that the school diagnosis said autism. There were weekly room clears. We knew it was wrong and went to doctors who said adhd with dmdd. The school put her on an iep and it took some time (because we tried other things first), but from spring break 1st grade until 5th grade she was put into a special education class. She learned lots of coping strategies. They did struggle in 6th and 7th due to Covid and transitioning to multiple classes, but they did well last year in 8th grade. They going their group of kids and got in the swing of things.my stepkid never takes adhd meds (mom hates the idea), but they do take anxiety meds that help tremendously.
My bio daughter is 9. she was diagnosed at7, and takes a stimulant. We paused because she got tics as a side effect, but the meds did help with other adhd behaviors (which were a lot milder than my stepkid, more like blurting and moving). We chose to get her on a 504, since iep was not necessary. She is allowed extra time in the bathroom (I never knew her constipation was adhd), fidgets more than other kids and a few other small things.
As for stimulants, the half-life is so short it does show within a day, but many docs want you to try for a week or two to see if the day was a fluke.
Hi there— I’m mama to a 5 yr old boy recently diagnosed as ADHD. We have a 504 plan but he is not on meds (though that might change, of course). His main challenge is impulsivity (which includes hitting). There are definitely things that can help kindergarteners, like where they sit, having fidgets toys, and just helping them figure out alternative behaviors (the psychiatrist can help with this too). Our son sees a psychologist who’s been very helpful both for him and for us. What’s also helped our son is previewing things so he knows what to expect. Which is not to say that everything’s hunky dory. Definitely still a work in progress. Good luck to you all!
Hi Pedsnursemama! I understand. I’m also a nurse, but CCRN(Adult) and I have a 7 yr old son who has ADHD (combined type). He was diagnosed as a 5 yr old, but we sought a second, third, and fourth opinion while we wait to see the developmental pediatrician. This was during and right after COVID so there was a very long wait.
Anyway, I’m glad that you are getting the help that you need now. My husband is also in healthcare and we are so hesitant about starting meds on a developing brain. After we have exhausted all other options, our last resort for help manage the undesired and unacceptable behaviors at home and at school (he was already in kindergarten at last winter), we started him on a non-stimulant drug for his ADHD (Guanfacine or Tenex: used off-label for ADHD, and can be crushed or dissolved since my son cannot swallow pills yet) during Christmas break. He was tired for about a week or so and I gradually titrated the dose up according to tolerance (I checked his BP and HR regularly before administering the med every 12 hrs). He got tired for about a week every time I increased the dose and as expected BP was going down also. I kept a log to make sure his BP and HR stayed safe. However, his behaviors improved significantly. Not saying that there are no more issues with behavior, but good enough that his weekly behavior therapy was eventually weaned to off. He did so well at school also. This summer, he was seen by his pediatrician for his wellness visit and his (primary care) pediatrician inquired why he is not on a stimulant med (first line for ADHD), and we voiced our concerns (side effects especially of losing appetite: my son is 7 yrs old and 43 lbs soaking wet). He (pediatrician) said that it is worth a try after he showed my my son’s growth chart. And that if there are side effects, then that is not the right medication for my son. Bingo! We saw his developmental pediatrician who prescribed the Guanfacine (non-stimulant med) and asked if my son can have a stimulant med now. He did not want to mess with the Guanfacine (took some time to titrate to achieve desired results), so he added on a stimulant that is safe to be taken with the Guanfacine. He prescribed Dyanavel XR (liquid form and to be taken in the morning only). He is doing much better. Hang in there. There is hope. Make sure you take care of yourself, so you can be the best Mama for your daughter. He is behaving so well at school, too. My son still struggles with transitions, but he is doing so much better. As for school, please request for an evaluation by the school psychologist. That’s how the school determines if she will qualify for an IEP or not. My son has an IEP. It has helped him significantly. I hope this helps.
I’m Peds and have 2 kids who both have adhd & autism, 1 with an intellectual disability. I would definitely ask for a 504 evaluation. I would also consider having your pediatrician refer her for a speech evaluation to a speech therapist outside of school. I’m wondering if she still has some mild communication difficulties that are magnified when she’s stressed out and these are contributing to the meltdowns. It’s very hard having your beloved child struggling, particularly with a developmental disorder that shows up in behaviors. If your child has a medical illness, everyone rushes to help and feels sympathetic. When your child looks to everyone else like they’re “misbehaving”, people don’t understand and assume you’re not “raising them right,” etc. It can be bewildering and isolating. You’re not alone, as you can see from other parents here. Big hugs incoming—-hoping you can feel things improve a bit as you move forward with the medication and school supports.
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