Sunday, 30 August 2015

Letter to Psychologist - 31/08/2015

2009 we enrolled him into a preschool – our main objective was to socialise him more to assist with the delayed speech – he turned 4 in March and by June we already knew we had a problem.

He was struggling to communicate with the other kids – as his speech was behind their, his ability to play, participate and interact with the other kids was difficult. He would get annoyed because not only could they not understand what he was trying to say, but he was frustrated that he himself couldn’t find the right words to communicate effectively so that the teachers and kids could understand him. He would feel left out and as a result he would act up and do things he knew were naughty just to get the attention he was seeking. In his mind, negative attention was better than no attention. He would physically lash out and soon became the child all the other children would not play with to avoid getting hurt
We tried everything we could think of – another 18 months and things weren’t really looking up. In 2011, the year he turned 6 he entered kindergarten. Within the first month the school called me in and said they could see there were issues and that they would like us to have him tested and investigations done.

Firstly we enrolled him in speech therapy weekly to assist with learning letters and words and sounds so that he didn’t fall behind in class. We had his hearing tested – perfect. We had his eye sight tested, perfect. He had bloods taken to see if he perhaps had an imbalance of something, nothing wrong, all levels perfect.
He started off year 1 at the bottom level for everything, He was placed with a teacher who ran a special reading program for children who were struggling – she had had much success with children with reading difficulties.  Unfortunately this teacher disliked James from the very first day. She took a hard approach of negative comments and chastising for his inability to achieve the levels she needed him to. His entire day was spent listening to this adult woman throwing negativity at him for 6 hours a day.  Very quickly we started noticing our happy little boy, disappearing.  We were later to learn that this teacher was going through chemotherapy and was using James as her outlet for her frustrations of feeling ill at work.

It was at this point that our speech therapies suggested we take James to a developmental paediatrician to have him assessed for other possible issues that could potentially be rectified. One assessment later and we were advised that our son was very much on the ADHD spectrum. Although extremely against medication, I decided to do what the doctor felt was best for our son. 2 days later and it felt like our little boy had been given back to us.
It’s now been 3 years since that initial diagnosis and we’ve had much success with Concerta, but we do feel that things are very slowly slipping away from us once again. As James gets older we’re finding the areas of struggles are becoming broader but his reactions seem to remain constant. What I mean is that besides the constant struggles to have him eat and sleep, his mood swings seem to have become more prominent and noticeable.

We find his emotions are being driven more by his mood than by impulse. He lives most of his life in a state of movement – in that he is mostly unable to relax, slow down, eat or sleep and then there are days where he hardly moves at all. We are seeing so much more of the explosive angry reactions that he used to have, mood shifts without warning and such extremely contrasting moods, we’re often left baffled as to what just happened.  We used to joke that he could go from sad to happy in 2 seconds flat, but it seems he is doing more of the average mood to angry then to sad in 2 seconds flat.
He is struggling with homework. Despite sitting with him every single day and going through his homework (spelling and maths) he just cannot seem to do this on his own. His handwriting is illegible at the best of times.  When I sit with him and ‘do’ the work ‘with’ him he has no problem completing the work – his struggles come in mostly when he has to self-regulate getting through the work – he simply cannot. If I leave him to it, he ends up in tears and totally shuts down

This past weekend he had a short assignment to complete on the Great Barrier reef and his choice of 1 animal found there. We endured hours of him coming back to us stating that he simply didn’t know what to do or where to find the information. We persisted because we felt this was his ploy to getting back to playing games on his PC. He tried every trick up his sleeve to get out of doing the project – positive coaching, much direction and suggestion – eventually I had to sit with him ad do the work with him, which he managed to get through then without any hassle. I won’t always be able to help him like this with his work – he needs to learn to do this sort of work on his own.
A few hours prior to this, I decided that his bedroom, the ever present elephant in the room, needed to be cleaned out because I was worried there may be national hazard to health growing in there.  I had him empty out his entire closet of all the storage boxes (which separates all his toys) line then down the passage and the begin sorting out toys into their correct boxes.  Previously this sort of job would have taken him all day and we would have endured several meltdowns and crying but yesterday he managed to complete the entire exercise within an hour and a half – perfectly.

We are struggling with how sometimes he can do a job or task so easily and then the next time it becomes the mountain we can’t get over.
He is having similar issues at school – some days he has great learning days but lately, most days are not. Socially he has major issues with mixing with peers and making friends as well as playing games without having a meltdown.  I guess for the most part, school feel as we do, that we are consistently trying to help him help himself but there are days when he just seems disinterested in doing so for himself and it is extremely frustrating. We are all making accommodations for his ‘issues’ but it’s beginning to feel a bit like “give him a hand and he’ll take an arm”

At school I have initiated a few things to assist him, such as fidgets for when he can’t sit still, a bean bag ‘time out zone’ for when he quite simply just needs 5 minutes of quiet time when he is struggling with the loud noise that is school.  The teacher also regularly utilises him to run messages to the office to give him not only a break from the work, but an excuse to work off some of the excess energy. I have provided list upon list to the teacher regarding how best to handle him in the classroom and on the playground.
Honestly we’ve all reached a point of exhaustion that none of us seems to be able to break the surface of with James.

James is such an amazing kid. He is extremely creative and loves to draw. Very slowly we’ve been working on his tolerance of music because I know how calming It can be listening to music which I think he can benefit from. He is excessively loving and caring and would defend with his life, family and friends that he felt he could protect. He is quite emotional and feels empathy deeply.  He dislikes disappointment, his own and others to such an extent that he will punish himself without thought for making someone feel that way.  I’ve found the best way to tackle any and all situations, the good and bad ones, in a positive manner. Rather than focusing on what he has done wrong, we try to think about and work on what he could do right next time. Shouting, blame and punishment simply result in him shutting down which then takes hours to wean him out of.
I have found that given the opportunity, James will talk about anything and everything. He will ‘milk’ any situation for attention.  A stubbed toe will result in him telling people his leg is about to fall off. An incident that occurred last week will suddenly play on his mind that he will then force himself to cry about how that situation upset him, simply to get the attention of teachers. We don’t allow for this at home at all and as such a lot of what happens at school only happens at school. On Friday last week he was rubbing a leaf on his face during recess which he then ‘milked’ for a trip to sick bay with an ice pack during lesson time. When I asked him about it, he immediately jumped on the defensive stating that he had told them the itchy face was not from the leaves and that he didn’t want to go to sick bay for the ice pack, despite him actually doing this. It’s almost as if he uses hindsight (his mother’s voice of reason) to try and talk himself out of trouble.

I read recently that ADHD kids are prone to telling lies because it’s their immediate reaction to being asked a question as their brain hasn’t had enough time to process the correct answer.  I pointed this out to him and now whenever I ask him something and I know his response was a lie, I remind him to take a few seconds to think about his answer and thus far it’s been 100% effective. Problem is I can’t always be around him to remind him to do this and as a result the fibbing still continues when I’m not around.
Our house feels like it is being overrun by lists. He has lists on his door, on the fridge behind the front door etc. These visual cues seem to work for a few days but realistically I’ve wasted time putting them together and sticking them up. It went from me reminding him to do xyz to reminding him to check off his list – it really hasn’t made any difference to his ability to get anything completed on time or properly.

James’s currency seems to be electronics and games.  We have a no technology rule from Monday to Thursday in our house – not even the TV gets turned on. This doesn’t mean that he abides by this. Often we will find him sneaking into our room at night to retrieve my phone or the ipad which we’ve tried to keep away from him. On a Friday afternoon after school he knows that if he gets through his chores, he can then play computer games until I get home from work. (about 2 hours) In this situation, all chores are done with no hassle – why can’t he be like this all the time?!
We allow our boys 6 hours of technology time for the entire weekend – this includes computer games, TV/DVD watching/ phone time. They have to keep a time card of the time they spend, which we were hoping would assist not only with their time management but would also limit their technology use.  Our major difficulty with James is that unless someone is actively checking on his usage, he will simply play all day and then act like he had no idea he had gone over time. He always has an excuse. Our other matter is that we have a 14 year old who uses his computer for homework and assignments on weekends (he is inattentive ADHD) and at present we are regulating their technology use equally because of their constant comparison of time usage between themselves which is causing major arguments between them.

Tuesday, 25 August 2015

random thoughts

ADHD is like:

A radio that isn't quite tuned into a station. You're mostly hearing static but every now and then something audible comes through.

or

Having 10 web browsers open on your PC, each with a video playing at top volume - trying to listen to and understand each one at the same time.

Questions from kids with ADHD:
What if I can never be fixed properly?
Why can't I just be normal?

When I look at my son I am proud - The strides he has made to overcome his ADHD leave me in awe of his determination and strong will.

I'm trying to teach him to celebrate his differences, to revel in them and be proud of them because they are what make him, to me at least, the most special little boy in the world. And I wouldn't change a single thing about him.

He has taught me how to be a kinder, better, more gentle mother and human being.

Despite the challenges we face each day, we face them together as a family, full of love and respect for each other.

10 things kids with ADHD wish teachers knew
1. The struggle is real - They are trying hard not to be different from their classmates and friends. It takes a lot of work to look like they don't have any problems at school.
2. Things are a lot more complex to them than you imagine - What's intuitive to you is a long and difficult thought process that they often don't have time for.
3. They worry, A LOT! They are constantly worried that they look different, that they will forget their homework, that they might say something wrong, or that they'll get into trouble.  They probably worry about every minute that they are at school. Sometimes that makes them tell wild stories to try to get out of school.
4. They feel stupid when they can't accomplish what their peers can.  They're not stupid, but they sure feel like it when things are hard for them and simple for others.
5. They are emotionally sensitive. They might seem like a cry baby but they feel things deeply.
6. They are literal kids. They cannot tell when their friends are teasing They take everything people say and do at face value.  They often feel like their friends are being mean to them.
7. They're smart! When given the time to fully process or a way to show what they know that doesn't involve completing a worksheet, they can shine.  Give them the opportunity to suprise you.
8. They're not lazy! There is a lot more going on in their mind than most people.  Plus, they struggle with planning, processing and organisation.  That can slow them down or make them not want to do the work.  And, their ADHD brain is interest-based - they can focus better on the assignment when it interests them.
9. Their weaknesses often make them feel like a failure.  You can help them a lot just by believing in them and encouraging them.
10. They don't intend to make you angry.  They want to do well.  They deserve love and respect, just like their peers.

Luke - Inattentive ADHD is a different shade on the same rainbow.

Things that are hard for me to admit:
1. sometimes I feel alone - Isolation is real. When people see what we are dealing with, we get 'politely avoided' - I don't hold it against them, but damn life gets lonely.
2. I feel left out - I appreciate hearing about your frequent family vacations.  We have had 1 family vacation since we became a family more than 14 years ago. Please don't mistake our lack of vacations with the lack of desire to have them.  Its just difficult for us, on way too many levels to explain to people who quite frankly don't want to know about it.
3. Money is always an issue - let me tell you, paediatritian visits and monthly meds are not cheap - add to that the cost of the quarterly tests to track improvement, and getting assistance for these costs - its minimal, don't let anyone tell you otherwise. Lets not forget speech therapy, occupational therapy and psychologist costs - WEEKLY!
4. I take your opinions into consideration, but I know best - Only time and effort can bring real solutions and I have logged in plenty of both.  Sometimes its better to keep the opinions to a minimum and just offer a helping hand.
5. I'd love to teach your children tolerance - While some special needs individuals do not have the ability to demand tolerance, their loved ones do. If your child teases or bullies our children, expect to hear from me.  I'm used to fighting for my children and will not hesitate to speak up.
6. I hate when you assume our child will grow out of it, so stop asking - we're in this for the long-haul - if you're not willing to stick around and support, there is the door - I don't have the time nor the energy to make sure you're OK with all of this.
7. I'm tired - be considerate when discussing your poor nights sleep - I'm on years of sleep deprivation and as a result, often feel the physical and mental repercussions.
8. I don't have all the answers - I'm still learning, every-single-day! Every day bring new challenges. I research and ask as many questions as I can, but usually a new question follows a solution. Be patient with my family and I, we're doing the best we can.
9. I'm well aware of my child's short comings - and don't appreciate you pointing them out.
10. I need support - I may not always say it, but I need it and if it sounds like I need help, I probably do.  Offer to do the 'hard work', those tasks that may require you to feel uncomfortable or lose sleep, but they are the things I will not forget.  Sometimes it feels like I live in a constant state of chaos - help me get away.  Nobody can withstand this type of existence without feeling a little frayed.  Stepping in for any amount of time makes a world of difference.
11. I notice when you stop asking about my children - My child may not be the best in his class or year but he still has accomplishments and achievements.  Acknowledge the effort my child makes to do what most children take for granted.
12. I need to vent - I am thankful for the opportunity to raise these beautiful children but its a stressful job.  It can be depressing for you to hear but this is my reality and I can't escape it.  Please allow me a place to talk honestly and unload. And I want to do the same for you.
13. Going out in public is hard - I am on guard in public places.  I hear whispers, I see the stares, but I also know I have the right to public space. I do take others into consideration when situations become difficult, so please do the same.

Special needs parenting changes the heart and mind.
Parents like me can be the most empathetic and patient people you will ever encounter. 
And although I often face a great deal of difficulty with a smile, I'm sometimes hurting somewhere inside.  The guilt of not knowing or doing enough is constant, I often feel like things will never get better and yearn for friendships that will withstand.
Please know that I only wish to change the world for the better for children like mine. I want others to see the true gift of a child with special needs.





Letter to Paed - 26/08/2015 - A minute of your time please

Hi Natalie,

I'm really sorry to bother you but I really do feel it is important to share this with you.  I am feeling a little disheartened today.
 
At a time when I know in my heart we should absolutely be focusing on the positive things James IS achieving on his own and at school compared to what he wasn't previously - the amount of negativity OOZING out of school at the moment is so difficult to bypass to those positive thoughts.

At home we honestly feel like we are doing everything that we can to assist with his needs.  At school they feel that they are trying everything to assist with his needs.  James I can see is trying really hard when he remembers that he needs to put in effort, but honestly it really just feels like we're fighting this battle and it doesn't feel like we're going to get a win anytime soon - which I know every single person involved really needs right now.

I do so much reading and research that I'm beginning to feel like I live in this ADHD bubble world on my own.  The problem here is that no matter how much we help or put things into place - ADHD is horrible and it will never go away, not for 1 second - life as we (James and family and school etc) know it will always feel so hard. We're ALL exhausted and the cracks really are starting to show.
I have read so many things in regards to different medications, elimination diets, behaviour modification, assistive aids, useful prompts (the list goes on and on) and I realize how enormous this entire situation is.

All we want for our son is for him to feel normal and to feel like he fits in with his peers in class and social situations and activities. I guess we're concerned at how slow the progress is to assisting him to get to this point - all we see are the same issues yet he continues to get older.

Having Luke in high school we are VERY aware of the workload and expectations of them when they enter high school and we're extremely concerned that James simply will never reach this point of readiness at the pace he is moving now. I know these things cannot be rushed and he will achieve as his brain obtains the capability to achieve but we're questioning whether or not we're doing enough, or if what we are doing is the right course of action.

I know this appointment with the psychologist may very well be what we all need. As much as we want to send James in for speech therapy and occupational therapy and any assistance we can get him into, the reality is we know that all of this is useless and a waste of time and money if James doesn't want to help himself.  We need some way of sparking, not his interest but his need to help himself grow and achieve and get better at managing the issues he is dealing with - we just aren't sure how to do this.

I apologise for the offload but it doesn't really feel like we get the time to really talk about our concerns about James when we do meet up. My last email mentioned how we really felt he had SPD issues that were affecting him and the topic felt to be brushed aside when I mentioned it on our last visit.

You mentioned wanting to get James re-assessed but I'm not really sure what the plan of action or time line around this is. If we could possibly come up with a very clear plan of action on how to get the re-assessment done and all our concerns addressed and if need be, assessed, that would be very much appreciated.

We put our trust in you to help our son - which you have done.  We just feel that there are way more questions than answers at this point in time that we'd like to address. I'm really not good at softening the blow of my words in an email, so I do apologise if any of this feels like its aimed at you - this is ABSOLUTELY not my intention. We're just feeling lost and need clear direction again.

We really do appreciate your time - thank you for listening.
Kind regards

Report from School 14/08/2015

 
I am sending you this information to provide you with the school’s perspective on some of our concerns about James Keevy to further assist in your management of him. I have collated information from my personal experiences with James along with observations from his class teacher and the
Deputy Principal to provide you with insight into his behaviours in the school setting.




 
 
Background:
James has attended St Ives North Public School since Kindergarten and is currently in Year 4. In Kindergarten, the school received Flexible Behaviour Support for James for his violent behaviours towards his peers and teachers (biting, punching and kicking). In Year One, James had intervention from the Itinerant Support Teacher (Behaviour) for poor peer relationships, anger, task refusal and non-compliance.

James’s Year Two and Year Three teacher, Victoria Mamas, attests that James was initially extremely reticent in Year 2 to involve himself in class activities and peer interactions. He did not respond to positive reinforcement, even refusing to accept rewards and certificates. Victoria noted a significant improvement with his behaviour during the two years that she taught him and believes that this is related to the large amount of attention that she gave him whilst in her class. Victoria stated that James was significantly more demanding of her time, for his emotional needs, than the other students in her class. Whilst James cried often and his anger and distress continued to be easily triggered, Victoria did note that he developed friendships, demonstrated an eagerness to please his teacher and appeared to enjoy school.

Victoria’s predominant concerns with James during her time with him were related to her observations of him appearing to hear imaginary voices and other stimuli and reacting to these with inappropriate behaviours, such as laughing hysterically for no apparent reason.

James’s behaviour and ability to cope at school has deteriorated significantly this year and the following interventions have been implemented to support him. James’s current teacher, Amanda Tunks, has instigated an individualised behaviour management program for him in the classroom, based on the provision of positive reinforcement for expected behaviours. His mother, Colleen Keevy, has provided ‘fidget toys’ as a calming strategy to be utilised when his anxiety levels are heightened and James has a designated calming space in the classroom where he can choose to move to if required. James has been placed on a highly supervised and structured playground schedule to ensure that he has adult supervision at lunch time. He also has regular school counsellor support.
School teacher observations – Information provided by Miss Amanda Tunks (12/08/15):
 
 
James can be a friendly boy who likes to contribute to classroom discussions. He loves to read books during class and is creative and excels artistically. James receives computer time, if he completes his work, and he is responding well to this positive reward system.

James frequently complains about feeling sick at school, he often appears tired and has dark rings under his eyes. James exhibits a very strong reaction to even slight injuries. He has been observed by a teacher to deliberately scratch himself, possibly to gain the attention of said teacher. He also has hit himself several times when frustrated.

At times James has his clothes on back the front or inside out and hides his face under the hood of his jumper during class and play time. On Monday 27/07/15, James wore two layers of clothes to school and then placed his sports uniform over the two layers. The clothes consisted of jeans, a long sleeved t-shirt, full school uniform and sport uniform. James said he had slept in the jeans and long sleeved t-shirt the night before.

Academically, James struggles to understand simple instructions, attempt or complete work and he becomes fixated on completing certain questions or activities. This results in him becoming anxious and unable to progress with his work. James ‘shuts down’ when he is asked to do something in class that he does not want to do or when things don’t go his way and he then refuses to participate. It is difficult to reach James during these periods and he appears either ‘blank’ and nonresponsive or overly distressed. James displays extreme mood swings and can quickly switch from laughing hysterically to crying uncontrollably and at times cries nonstop for extended periods and is unable to calm down. One example of this was when James arrived at

school on 07/08/15 crying and visibly distressed. He stated that he was upset about an accident that he had the previous night at Hornsby shopping centre and was inconsolable.

James has immense difficulty interacting with his peers. He has been violent towards them by pushing, punching and kicking them. James has also been observed being verbally abusive to peers, especially on the playground. He has been observed distracting his classmates by touching students, throwing items at them and licking them. James is able to take responsibility for his actions and show remorse, yet often does not appear able to understand why his behaviours are inappropriate. He finds it difficult to show empathy and is predominantly negative in his perceptions of himself and others.
Deputy Principal observations – Information provided by Mrs Naomi Ierace (10/08/15):
 
 
James has been spending a number of play sessions in the Deputy’s office as an optional "time out" strategy, where he chooses to go there during play time rather than be in the playground. This strategy was created last term in response to James having regular (daily, sometimes twice-three times a day) altercations, both verbal and physical in the playground with his peers. These altercations were usually related to a hand ball game.

During these sessions, James interacts easily with the Deputy. When he brings a friend, James is observed to play calmly and has very positive social interactions when he is 1:1 with them. James behaves very differently depending on the mood that he is in when he presents to the Deputy. He vacillates between being chatty, friendly and excited to share his experiences of the day to being sullen and unresponsive.

James’s behaviours of concern occur predominantly in the playground or in the classroom in response to learning activities that James finds difficult.

Playground Concerns

James lashes out verbally and physically in response to perceived or real disagreements with his peer group. He punches, kicks and swears at other students. James has difficulty maintaining friendships because of this.

James can be highly resistant to understanding another person’s perspective. He has been observed being distraught and abusive when some of his friends chose to play handball on a four square court instead of a six square court where he wanted to play. The histrionics can last for up

to half an hour and can lead to kicking, punching and fighting with other students depending on when, how and which staff intervene.

Classroom Concerns

James has been sent to the deputy during class time as a result of becoming unreasonable and argumentative in class. His teacher has a quiet area for James in the classroom and he uses "fidget toys" to give him something to do with his hands if needed.

Once, during a maths lesson, James came to the deputy’s office extremely agitated and virtually incoherent. He was upset and described seeing "numbers everywhere". He appeared to be actually seeing imaginary stimuli and was repeating the word "numbers" over and over.
School counsellor observations:


James happily comes to counselling sessions and often refers himself if he is feeling distressed or worried about something. He has a vivid imagination and can be highly descriptive when talking. James has a number of good friends who I have also spoken with and they are reliable and very supportive of James. I have observed them playing very well together on a variety of activities in a 1:1 or small group situation. James is a very good handball player and this is his favourite activity. During these games, James shows very high levels of focus and agility. James is always very polite and well-behaved during our sessions.

James has difficulties with his emotional regulation and is easily triggered into high levels of distress. He has been brought to the counsellor’s office on two occasions recently because he could not stop crying and was unable to speak about the incident that had instigated his distress. In these instances, distraction was the only means to calm James and he promptly stopped crying when sufficiently interested in another activity, immediately ceasing his rumination about the recent event. The concerning incidents appear predominantly to originate in the playground at recess or lunch from altercations in a handball game.

James is very verbal and enthusiastic when speaking, though at times he exhibits difficulty when participating in a conversation. He switches between topics and at times contradicts himself within the one sentence, such as initially stating that a student dislikes him but then attesting that he is a supportive and reliable friend. James talks about his "imaginary world" and his "real world", where he believes he is able to switch between the two realms. James describes Yetis (characters from a computer game that he plays) as being in his bedroom at night and leaving ice blocks under his pillow and around his room. He states that the Yetis are "imaginary", yet the ice blocks are "real".



James has persistent deficits in his social interactions with peers. He finds it difficult to understand or comprehend another child’s perspective when analysing an incident and is frequently unable to consider alternative options than those which he has selected. James has a low self-esteem at times and describes himself negatively unless prompted to talk about his strengths. Once he has been directed to focus on his good qualities, he is able to do this unless distressed. When James is feeling low, he is more likely to describe other students, including his close friends, as disliking him.

James is highly sensitive to noise. He reports that he "falls out of the world" when his surroundings are loud. He attests that earplugs or earmuffs would not be helpful because he "hears everything perfectly when they are on, even with my hands over my ears". I have also observed James exhibiting behaviours that indicate that he is also overly sensitive to touch. On two occasions, when walking with James to his classroom, he was accidentally lightly brushed by a student walking past and he jumped, appeared very shocked and made a shout and then elbowed the student in retaliation.
 

My response:
Well let me begin by saying that a lot of what has been highlighted in this report is new to myself as well.
I am truly surprised that most of this hasn't come up in any of our many conversations. No mention of perhaps meeting to discuss any of this either.
 
I can honestly say that I have been left floored and speechless. I have no words to express the disappoint I'm feeling at this very moment.
 
I will liaise with Dr Silove moving forward and will inform St Ives North of what our next steps will be to ensure James's educational needs, as well as social and emotional needs/support are met appropriately.
 
kind regards
Colleen
 
Dr Silove's response:
Dear Vashti
 
Thank you very much for this report – much of this information is new to me and very relevant , so I will arrange a meeting with James’s parents to discuss how we can best support him moving forwards.
Do you have an recent academic testing on James ie a WIAT or similar assessment. Is it possible to let me know what academic support/intervention/scaffolding/adjustments James is receiving or requiring at school?
Many Thanks Natalie
 
After a phone call with Dr Silove:
HI Colleen
 
To summarise our phone call :
The information from the school is new and unexpected
It is distressing to hear of this in a report and not first hand after all the interaction you have had
My take on it is that James is feeling insecure, unable to manage his emotions, unhappy and as a result externalising this. Its hard at this stage to know exactly what the cause is, but we will assess further
Vashti will be back at school next Thursday and give me more info regarding his academic and intervention support at school
In the meantime, you will ring Tim Wahlin Clinical Psychologist and get an appointment as soon as possible for James and yourselves
Once you have an appointment you will let e know and I will do a referral.
Otherwise you will try arrange for someone to be with James in the morning when he leaves for school and at home in the afternoon when he gets back from school.
Already you are trying strategies to get him off more easily to school in the morning and it is working.
We will stay in touch telephonically
Regards Natalie
 
 

Letter to teacher - 20/08/2015 - What James wants you to know

James has a condition called Attention Deficit (Hyperactivity) Disorder. It is a real medical condition that doctors define as impairment to his executive functions (cognitive management system – which includes lacking the abilities to handle frustration, start and complete tasks, recall and follow multi-step directions, stay on track, plan, organise, and self-monitor) in his brain. That means that learning is hard for him. The part of his brain that manages these skills is like an orchestra conductor who tells all the musicians how to play together and on time to make beautiful music. His conductor has trouble communicating with the musicians, so he needs your help.


He is not crazy, lazy, bad, or stupid. In fact, his IQ score is most likely above average, and many people with ADHD are also gifted. But because his brain is wired differently than that of regular students, he sometimes feels stupid or bad. Sometimes it’s hard for him to admit that he needs help. Sometimes it’s easier and less humiliating to act like he understands or to act angry to distract you from finding out that he is having trouble and so that the other kids in the class don't know that he is struggling. He needs to know that you won’t make fun of him and shame him when he asks for help.

Another challenging thing about having ADHD is that one day he can do something really well but the next day, he can't. Please don’t make him feel bad by saying, "I know you can do this if you really try, you did it yesterday." Instead, show him how to get started just as if he were learning it for the very first time.

Because you cannot see his ADHD, you might have trouble remembering that he needs your help. When you look at him, pretend that he is a blind student and think about how you would feel about helping.

It is hard to tell by looking at him sometimes if you have his attention because he doesn’t always make eye contact or sit upright, but he is usually listening to what you are saying. If you’re not sure, ask him what you just said, rather than asking him if he is paying attention. If he responds correctly, he is paying attention. If he cannot repeat information back to you, gain his attention before you present it again.

It is a challenge for James to learn passively for extended periods of time. Sometimes all he needs is repetition, once you have his attention, to learn. The more senses you involve, the more engaged he will be. Don’t just tell him what to do, show him how, and then have him show you that he understands.

He has a lot of trouble controlling his behaviour sometimes. Being inside his head is like having several radio stations all playing at the same time, so it’s hard to just listen to one. It’s very stressful and frustrating, and so sometimes when you ask him to do something and he responds in a negative way, it’s because he can't handle any more stress.

Sometimes he doesn’t pay attention because he is distracted. Sometimes, he needs a distraction. A totally still environment can cause his ears and eyes to strain to find out where the distractions went. If he has something subtle to occupy him — two coins to rub together or a pair of earphones to muffle sounds or to listen to music with — he is neither distracted nor seeking out the distractions. He is relaxed and alert.

You can help him by pretending that you’re his coach. Good coaches get the best performance from their players by encouraging them, rewarding them, and praising them immediately, especially in front of others. Punishment for things that he’s not very good at only makes him feel worse about himself. And please don’t embarrass him in front of the class. Please talk to him privately about issues. He sometimes has trouble making and keeping friends and responding appropriately to social interactions. Please coach him on how he can do things better. Show him in detail; model it for him. He doesn’t tend to learn well if he is just told how to do something. And give him praise and encouragement when he tries. ADHD children often have little sense of how they're perceived by their peers, and will commit social blunders without realising it. Help him by discussing what went wrong, why it happened, and what he could (not should) do differently next time. Be as sensitive with him as you would be with a close adult friend -- too much negative feedback can hurt his self-esteem.

To help him remember the rules, please post them somewhere where he can constantly see them. He’ll need your help to know when he is breaking a rule and reminders and warnings to follow the rules. He needs practice to follow the rules. Let him know right away if he is breaking a rule, and let him know what he should be doing instead.

He’ll need your help to learn and practice:

 organisation skills (things like writing assignments, planning them out, completing them, and getting them back to you when they're due)

 note taking

 study skills and

 Test taking strategies.

When you mark his work, please look for areas that he is struggling with and show him how he can do better.

It’s hard for him to remember lots of instructions when you give them all at once. Please give him one instruction at a time. For assignments, it really helps if he has written instructions, so he doesn’t have to remember everything.

Ask yourself – are you teaching him or interrogating him? What he has learned in school is not always apparent, even to James. He needs you to help him show what he has learned. When he has to answer a question, make the answer be a goal that he will want to reach and will be proud of when he succeeds. But if you tell James that he isn’t trying hard enough or not cooperating, his motivation and mindset become that of a prisoner locked in an interrogation room. Being interrogated does not motivate James, but discourages him from wanting to try. He needs to feel like you’re guiding him toward finding the answers.

The medication that he is taking helps him to focus and calms his hyperactivity. But as he grows, his medication may need to be adjusted. You can help by letting us, his parents know if you notice that his medication is not working as well as it did.

Even with the help of medication, he still feels the need to move. Movement helps him to learn. Sometimes it helps if he can stand while you’re teaching. Sometimes he needs to work off the energy because it feels like he’s got high-voltage electrical currents running up and down his arms and legs. Why not develop a private signal that lets you know that he needs a break from sitting still. He could run something to the office for you, hand out or collect papers, or wipe off the board. Or you could involve the whole class in a stretch break, and no one would know that it’s really just to help him.

His attention span is tied to his energy levels. He knows he is supposed to get school tasks done while he is sitting at a table. But how is he supposed to go forward if his brain is always in neutral? If he cannot move while he thinks, his engine will stall. If a shutdown occurs, let him stand, move, or shift gears before returning to the target subject. Sometimes a movement break — a few jumping jacks — can jump-start his progress. This works better for him than trying to buckle down and not being able to move around until a task is completely done.

Do not take away recess, lunch or sports as punishments. He desperately needs physical activity several times a day to work off the excess energy that he has and relieve the stress of having to sit still for so long. Without this time to "blow off steam," he is more likely to have increased hyperactivity and impulsive behaviour.

The other thing that helps is if he has something to do with my hands. Clay, a stress ball, or even an elastic band helps his body get rid of the extra energy.

Finding a good seat in your classroom is important. He may need to sit at the front of the room, so that he isn’t distracted by the other students and sitting closer to you when he may need help. Or he may do better at the back of the room so that he is not always turning around to see what's going on behind him. Being at the back also takes away his "audience" and allows him to stand up if he needs to without distracting the other students. He also needs to sit somewhere away from other distractions like windows and pencil sharpeners and other students who are struggling. And it helps if he can sit beside a student who can help him when you’re too busy because when he needs help, it’s hard for him to wait.

If you see that he has lost his focus, please give him a private signal to get him back or walk by his desk and touch his shoulder. Or say something like, "Now this is very important, so please pay attention." Please don’t ever humiliate him by using sarcasm or sayings like "Earth to James."

Please remember that he wants to succeed. He is not acting this way to annoy you or to be disrespectful. His brain works differently, but it does work and he can tell when adults don’t like him. If you are on his side, he will know it and will work harder than if you are just putting up with him.

James can be sensitive to small noises and sensations like the hum of fluorescent lights, the temperature of the room, the tags inside his clothes or the sound of the kid behind him as he writes. Sometimes, he just can’t concentrate because these small things are so distracting. It helps if he has a quiet place to go to if he feels the need or if you see that he is having trouble concentrating, but please give him the choice to go there. Do not force him to go there because it will only humiliate him in front of his friends. If you offer this "quiet place" to the whole class, it helps him to accept the option without feeling separated out.

He has trouble making transitions from one task to another especially if he isn’t doing something that he enjoys. Sometimes he can hyperfocus, (the tendency to focus very intently on things that do interest them. At times, the focus is so strong that they become oblivious to the world around them) and it’s hard for him to stop and change tasks. You can help him by giving him advance notice that we will be starting something new in a few minutes. It gives him the time that he needs to work on putting the brakes on in his mind. Changing from doing something active to doing seatwork (coming in from recess or gym) is especially hard for him. Help James by slowing him down gradually and rewarding him when he settles quickly.

Handwriting is difficult for James. Please let him print if he wants to. Using a computer is even better, because he can think faster than he can write and a computer will help get his thoughts down without having to worry about mistakes and organization, which can be corrected later.

Letter to school - 24/08/2015 - Step 1

Afternoon all,
 
I hope this email finds you well - there is a bit of a bug going around at the moment.
 
We are trying to address the areas where James has difficulty.
 
After several incidents on the [playground around the game of handball, we thought it would be good to perhaps address James's lack of social skills. That's not to say he doesn't have any, we just feel that perhaps he misses a lot of the social cues from his peers and people he deals with on a daily basis.
 
To perhaps work on the peer-to-peer matter, we were thinking of perhaps trying to socialise James with some of the other kids in the class on a one-on-one basis.
 
Amanda, this is perhaps where you would be most knowledgeable.
Are you perhaps able to name 2 or 3 kids in the class that you feel James may get along better with or who you think may share similar interests to James. 
 
I will then privately approach the parents via email to explain our intentions and set up a play date at our home that not only has a time limit but has some structured and planned activities for the time to enable James to become more familiar with social interaction with peers where he may be more aware of social cues i.e. learn what is appropriate behaviour and what isn't, how these behaviours may affect other kids.
 
James does already have play dates but with kids he has known for a very long time who know of his character/behaviour and wouldn't necessarily pull him up for saying/doing anything incorrectly.

In terms of how James interacts with adults in his life. Mrs Taylor is well aware that we (I.e at home) do not tolerate rudeness or disrespect from James, towards adults in particular. We have always maintained that he will listen and be respectful when speaking with adults. This lesson obviously seems to have been misplaced.
 
We are now constantly reminding him to "check your reaction" or to "think about your response" when he is communicating with an adult.  Also when he reverts back to bursting into tears, we remind him to "think about how you are responding" We then give him 30 seconds to pull himself together and then ask the question again. We also remind him to "lower your voice" when he starts getting loud and over the top.
 
James will, like any other child takes advantage of an opportunity to tell stories.  A lot of what was contained in the report from last week, we feel, was only shared at school because he was given an avenue/opportunity to do so.  James is a great story teller but when we can tell that his stories are getting over the top or that he is purposefully mixing stories and reality (sometimes with fibs or white lies) we shut that down immediately. 

A lot of what he had said at school had never been said at home because we do not give him centre stage to construct imaginary stories to use as reasons to explain his actions.  Of course we do encourage imagination etc, but there is obviously a time and place for everything.

As you are aware, my husband and I both work full time and it is impossible for us to be around for when James leaves for school in the morning. We were considering putting him into before school care however with his troubles with his social skills, we do not want to create another area within the school where he is having issues and getting into trouble until we feel that he has gained some control over his actions.
 
What we will be trialing from tomorrow morning and every Tuesday and Thursday morning is that he will be going over to our neighbour's house at 8am when his brother leaves for school. James will then travel to school with our neighbours and their children (they are also in SINPS)

We would like to monitor how he goes at school on those mornings. With less time to get himself into mischief, think negative thoughts or even have to catch the bus which as you know is not a pleasant experience for him at the moment, we are hoping that he may arrive at school in better spirits. Amanda, if you could please let me know via the communication book how he goes on Tuesday and Thursday mornings, that will be very helpful and appreciated.

Dr Silove and Vashti - I have left a voice mail on the clinical psychologist's mobile (referred by Dr Silove) in regards to making an appointment to see him with James - I will let you know as soon as I hear back from him.

I apologise for the volume of emails coming through at the moment but as you can appreciate, a lot of what is happening needs to be addressed and fixed immediately - this will be a lot more successful if both home and school are aware and on board.

If there is anything you can suggest that we do at home that you have found is working at school, please do let us know

Have a lovely week - keep dry if you can!
Kind regards
Colleen

Letter to School - 11/08/2015 - Bullying on the bus

Evening all,

It is with a heavy heart that I send this email this evening.
We have just had a visit from a neighbour who came over to have a chat with us about what has been going on for the last few mornings with James.
 
This morning in particular, James went over to the neighbours as they were leaving their house to drop their girls off at SINPS and asked for a lift. When my neighbour asked if he had missed the bus his reply was "no, I just don't want to be bullied on the bus any more" Further probing into the situation, our neighbour discovered that James has become a target of some severe bullying on the bus whereby he would rather miss the bus and walk to school or find alternate means of getting to school.
 
This happened a few years ago when both our boys were catching the bus - it first began with both boys being bullied but Luke stood up for them and then the bullies would only target James - bullying included pockets being ripped off school shirts, lunch boxes being thrown from the moving bus windows, bag straps being cut off their school bags and a list of physical bullying.
 
I'm sure that you are as tolerant of bullying as we are and hopefully there will be some investigating into this matter to discover exactly what is going on on the bus.
I will be having a conversation with James in the morning about sitting up at the front of the bus again where the bus driver can see him.  James is apparently reluctant to name names and therefore I cannot tell you who is instigating this however he did mention it is a pack-mentality situation, one boy egging other boys to get involved in the bullying against our son.

My heart breaks thinking he has to deal with this even before he gets to school where he is already having a tough time.

The next part of their conversation this morning is really distressing. Apparently James seems to believe he is stupid and that everyone at school thinks he is stupid and that people are treating him as such. Now as adults I can fully appreciate that none of you would openly refer to my son as being stupid, but he clearly isn't feeling this way for no reason.  I have no idea why he is saying this as the word stupid is one we do not tolerate at home. Obviously something is happening on the play ground.
 
What I do think is we have a little boy who is struggling with communication and social interaction with peers and because of these struggles and the very clear difference between him and his peers, he is labelling this as being stupid.

To be honest we're in the dark - we have absolutely no idea how to manage such a situation and would really appreciate some guidance here. We would like to manage and hopefully fix this matter before heaven forbid our son decides that he can no longer tolerate this life and the hand he has been dealt.
 
Dr Silove - we've been double dosing the melatonin for the last 9 days  (7 of those days being school days) and I can honestly say we've had the worst 7 days of school this year. Now I'm not sure if its the melatonin that could be affecting his moods, but our child - in my opinion - is suffering some sort of depression and we are at a total loss of how to help him. Could you please let us know when we can schedule a visit to discuss all these matters?

Please help us to help him - we are absolutely petrified that if we don't help him now, that we're going to lose this beautiful happy little boy.
 
Appreciate your time - thank you.
Kind regards
Colleen

Dear Colleen and Anthony
 
It is stressing to hear that James has had to contend with these issues. I am pleased that he has found a way to communicate what’s happening to you and the adults around him so that action can be taken. I have no doubt that the school will follow up on the bullying and school related issues as they would have a no tolerance approach and the best way is to confront the issue up front with those concerned.
 
The other action is to empower James with dealing with these issues. We have identified the language, learning and ADHD. Managing this does require a team approach around James. As discussed the team consists of
James at the centre and yourselves and his brother
The school and his educators
Speech therapist
Counselling
Medical management
 
All need to work together collaboratively and have a very important role to play. It does take time, effort and a lot of co ordination, and expense on your part. The school teachers can do a lot of the language based work in conjunction with his literacy at school, but there remains a role for a speech therapist at this stage.
 
The school counsellor is able to assist with supports at school but James will require more intensive counselling around strategies relating to work and study strategies, executive function, peer socialisation, bullying and self esteem. A public service can be accessed either via the Hills Community Health centre or they will direct you to the most appropriate public health service. I am happy to recommend local private therapists which can be assisted via medicare support and The Better Access to Mental Health Plan.  Given your current concerns, I would suggest that this would be a priority.
 
From the medical perspective I will try answer your more immediate questions and concerns  from your emails :
 
·         Stop the melatonin as it does not appear helpful and may be giving side effects. Should sleep be a major issue, please let me know and we can review.
·         Brain scans and Spect scans do not have a place in diagnosing or managing ADHD. The diagnosis is clinical and the management needs to be specific to addressing functional skills and the associated learning difficulties for James
·         I will be very happy to meet for a case conference at the school if they felt this would be helpful
 
I look forward to reviewing James together with yourselves in the near future
Regards NAtalie

Letter to Paed - 14/08/2015 - 7 types of ADD

Hi Dr,

I hope you are well.

I have just read the best piece of information on ADD that I've ever come across - it explains the types of ADD so well and how each one affects the brain and the best course of action for treatment.

After reading this, I strongly feel that we should investigate further (perhaps a brain scan) of James to find out how the ADD is affecting him and treat accordingly. We are having such a difficult time with him and honestly it feels like every day we have to change strategy and approach with him. With Luke it is so different because he clearly has inattentive ADD and what we are doing works perfectly for him.

I've sent a few emails requesting that we please make contact to discuss this as I do not want to leave this for another 6 months before his next check up is due.
Would you kindly please let me know when we can schedule a catch up to discuss approach/next steps or if you can point me in the right direction of where we can get all of our concerns and questions resolved.
 
Appreciate your time and assistance.
Kind regards
Colleen

Published on ADDitudeMag.com

The 7 Types of ADD – and How to Treat Each One

One ADHD expert says there are many types of ADHD. He explains them here, and offers his treatment plans for managing them.

by Daniel G. Amen, M.D., double-board certified psychiatrist / photos credited to Amen Clinics

“One Treatment Does Not Fit Everyone”

As the founder of six Amen Clinics, I bring a multidisciplinary approach to diagnosing and treating brain based disorders including attention deficit disorder and coexisting conditions. For over twenty years, I’ve used SPECT brain scans (along with other diagnostic techniques) to develop individual, targeted treatment plans for each patient. Early on, I discovered through brain SPECT patterns that attention deficit is not a single or a simple disorder. 

My ADD Is Not Your ADD

ADD, anxiety, depression, bipolar disorder, autism, and other conditions are not single or simple disorders. They all have multiple types. ADD affects many areas of the brain—the prefrontal cortex and cerebellum primarily, but also the anterior cingulate, the temporal lobes, the basal ganglia, and the limbic system. The 7 types of ADD that I studied are based around three neurotransmitters—dopamine, serotonin, and GABA.

Classic ADD

This is the easiest type to spot of the 7 types of ADD: Primary symptoms are inattentiveness, distractibility, hyperactivity, disorganization, and impulsivity. Scans of the brain show normal brain activity at rest, and decreased activity, especially in the prefrontal cortex, during a concentration task. People with this type of ADD have decreased blood flow in the prefrontal cortex, cerebellum, and the basal ganglia, the last of which helps produce the neurotransmitter dopamine.  

Treating Classic ADD

The goal here is to boost dopamine levels, which increases focus. I do it with either stimulating medications — Ritalin, Adderall, Vyvanse, Concerta — or stimulating supplements like rhodiola, green tea, ginseng, and the amino acid L-tyrosine. Getting lots of physical activity also helps increase dopamine, as does taking fish oil that is higher in EPA than DHA. 

Inattentive ADD

This type, as well as Classic ADD, have been described in The Diagnostic and Statistical Manual (DSM) of Mental Disorders since 1980. This type is associated with low activity in the prefrontal cortex and low dopamine levels. Symptoms are short attention span, distractibility, disorganization, procrastination. People with this type are not hyperactive or impulsive. They can be introverted and daydream a lot. Girls have this type as much as, or more than, boys.   

Treating Inattentive ADD

Inattentive ADD is usually responsive to treatment. It is often possible to change the course of a person's life if he or she is properly treated. The goal, as with Classic ADD, is to boost dopamine levels. I use the supplements like the amino acid L-tyrosine, which is a building block of dopamine. Take it on an empty stomach for maximum effect. I often prescribe a stimulant like Adderall, Vyvanse or Concerta. I put patients on a high-protein, lower-carbohydrate diet, and I have them exercise regularly. 

Over-Focused ADD

Patients with this type have all of the core ADD symptoms, plus great trouble shifting attention. They get stuck or locked into negative thought patterns or behaviors. There is a deficiency of serotonin and dopamine in the brain. When the brain is scanned, you see that there's too much activity in the area called the anterior cingulate gyrus, which is the brain's gear shifter. This overactivity makes it difficult to go from thought to thought, task to task, and to be flexible. 

Treating Over-Focused ADD

The goal is to boost serotonin and dopamine levels in the brain. Treatment is tricky. People with Over-Focused ADD get more anxious and worried on a stimulant medication. I use supplements first—L-tryptophan, 5-HTP, saffron, and inositol. If supplements don't help with symptoms, I prescribe Effexor, Pristique, or Cymbalta. I avoid a higher-protein diet with this type, which can make patients mean. Neurofeedback training is another helpful tool.  

Temporal Lobe ADD

Of the 7 types of ADD, this type has core ADD symptoms along with temporal lobe (TL) symptoms. The TL, located underneath your temple, is involved with memory, learning, mood stability, and visual processing of objects. People with this type have learning, memory, and behavioral problems, such as quick anger, aggression, and mild paranoia. When the brain is scanned, there are abnormalities in the temporal lobes and decreased activity in the prefrontal cortex. 

Treating Temporal Lobe ADD

I use the amino acid GABA (gamma-aminobutryic acid) to calm neuronal activity and inhibit nerve cells from overfiring or firing erratically. Taking magnesium—80 percent of the population are low in this mineral—helps with anxiety and irritability. Anticonvulsant medications are often prescribed to help with mood instability. For learning and memory problems, I use gingko or vinpocetine. 

Limbic ADD

This type looks like a combination of dysthymia or chronic low-level sadness and ADD. Symptoms are moodiness, low energy, frequent feelings of helplessness or excessive guilt, and chronic low self-esteem. It is not depression. This type is caused by too much activity in the limbic part of the brain (the mood control center) and decreased prefrontal cortex activity, whether concentrating on a task or at rest. 

Treating Limbic ADD

The supplements that work best for this type of ADD are DL-phenylalanine (DLPA), L-tryosine, and SAMe (s-adenosyl-methionine). Wellbutrin is my favorite medication for this type of ADD. Researchers think it works by increasing dopamine. Imipramine is another option for this type. Exercise, fish oil, and the right diet will help a person with Limbic ADD better manage symptoms. 

Ring of Fire ADD

Patients with this type don't have an underactive prefrontal cortex, as with Classic and Inattentive ADD. Their entire brain is overactive. There is too much activity across the cerebral cortex and many of the other parts of the brain. I call it "ADD plus." Symptoms include sensitivity to noise, light, touch; periods of mean, nasty behavior; unpredictable behavior; talking fast; anxiety and fearfulness. In brain scans, it looks like a ring of hyperactivity around the brain.  

Treating Ring of Fire ADD

Stimulants, by themselves, may make symptoms worse. I start out with an elimination diet, if I suspect an allergy is involved, and boost the neurotransmitters GABA and serotonin through supplements and medication, if necessary. I prescribe GABA, 5-HTP, and L-tyrosine supplements. If I prescribe medication, I start with one of the anticonvulsants. The blood pressure medicines guanfacine and clonidine may be helpful, calming overall hyperactivity.

Anxious ADD

People with this type have hallmark ADD symptoms, and they are anxious, tense, have physical stress symptoms like headaches and stomachaches, predict the worst, and freeze in anxiety-provoking situations, especially where they may be judged. When the brain is scanned, there is high activity in the basal ganglia, large structures deep in the brain that help produce dopamine.This is the opposite of most types of ADD, where there is low activity in that region.  

Treating Anxious ADD

The treatment goal is to promote relaxation and boost GABA and dopamine levels. ADD stimulants, taken alone, make patients more anxious. I first use a range of "calming" supplements—L-theanine, relora, magnesium, and holy basil. Depending on the patient, I prescribe the tricyclic antidepressants imipramine or desipramine to lower anxiety. Neurofeedback also works to decrease symptoms of anxiety, especially to calm the prefrontal cortex.  

Letter to Pincipal - 24/06/2015 - School Report

Hi Mrs Taylor,

I hope you are well.
We've all had a bit of a tough evening in regards to James's school report coming home today - to say I'm disappointed in what was written as well as how he was measured in terms of work ethic and social interactions is an understatement.
 
I've pulled out James's school reports from Year 1 all the way through and honestly it feels like he has taken several back steps with Amanda Tunks teaching him this year.
 
I'm sure she is a wonderful new teacher, but as far as I'm concerned she is young, naive and inexperienced when it comes to dealing with children with special needs and James's report is evident of this.
 
I've sent James's reports back to school tomorrow for you to compare - reading his reports while he was under Vicky Mamas compared to when he was being taught by Jacqui Fine and now Amanda Tunks is very chalk and cheese.

James's results last year and the year before under Vicky Mamas clearly indicates that not only was she a competent teacher who identified what James needed, but that James trusted her to let down his guard and show off what he really is capable of achieving. Year 4 semester 1 report is very clearly indicating that not only is Amanda not clear on what James needs, but that he doesn't feel comfortable with her or trust her.  Tonight he has made it clear he doesn't feel like he can approach her and I believe the 'screaming incident' that took place a few weeks ago has really made James wary of her.

I do believe we are on a better path to giving James what he needs but I am genuinely saddened that Amanda's lack of understanding and ability to deal with James has been negatively reflected on James's report that is after all about James and not Amanda.

For nearly 2 years James has been expressing himself beautifully through HSIE and Creative Arts where is is evident from his report that this avenue of expression has been shut down for James.

I also note a massive regression in terms of social skills scoring on the back of his report and I wonder if Amanda for one minute stopped to consider that perhaps James being bullied by Aaron would have an effect on his confidence socially - marking him down for a situation that is out of his control hardly seems fair, especially given that we (at home) have been massively focusing on teaching him social resilience over the last few months given the situation with Aaron and I see he has been marked down for social resilience - I'm speechless to be honest.

As far as him being marked down drastically on independent learning skills well, I disagree whole heatedly and refuse to comment any further given that I believe Amanda's inability to cater for James's needs in the classroom are directly proportional to her assessment of his ability.

I understand that moving class half way through a year is impossible and also that moving schools is my prerogative as I was informed by Ms Ierace when I came to the school a few weeks back in regards to the 'screaming incident', so I'm going to be very frank and bottom line with you on this.  

I strongly feel that James's needs have not been catered to by the school despite my numerous attempts to work with the teacher in question however because we have successfully navigated the school with a previous child and do strongly feel good things for the school, I am willing to hold off on seeking further advice from the DOE in regards to everything that has been happening and hold off moving schools at this point.and will give Amanda Tunks the benefit of the doubt and believe that she now understands better what James needs and is being educated in terms of ADHD needs children and will provide a better classroom learning environment for James next term.

James took the drop in the results on his report very much to heart, I'm not sure if/how this may affect his time at school tomorrow/interaction with Amanda Tunks.
Please understand that despite me being a protective parent with a child who clearly needs assistance that he potentially hasn't been getting, I am also a very logical person who understands limitations in regards to the DOE and finances etc - I'm not expecting special treatment of James, I'm simply asking for understanding that he functions differently and asking for adaptation where possible to enable him to function at his optimum and make achievements like every other child.

I really do appreciate your time and assistance - thank you.
Kind regards
Colleen

Letter to Paed - 01/06/2015 - SPD

Hi Dr,
 
I hope you are well.
 
I apologise for troubling you with this matter, but I was hoping to get your thoughts on this, that we could hopefully discuss on our next catch up with James.
 
As I mentioned at our last meeting, the difference we see with James on the 27mg doesn’t seem to be as noticeable in regards to school work, behaviour and homework as before.  In fact, over the last month we’ve been seeing a lot of the ‘lash-out’ style behaviour from James and it seems to be an issue with his inability to focus or stay focused.  Obviously when he isn’t on the medication we can see the significant hyperactive change in his behaviour, but essentially our reasons for medicating were to assist him with his education and socialisation with peers.
 
We had a major incident at school last week Tuesday when a lady who is new to teaching, got annoyed with James.  An incident occurred on the playground where another boy was hitting and punching James in the head because he’d been caught out by James in a game of handball. James tried to ask this child to leave him alone, but after repeatedly having to deal with being hit, James’s frustration took over and he ended up kicking this other boy. 
Of course when this other boy reported James for kicking him, James shut down (he doesn’t like or trust the teacher) She then proceeded to make a spectacle of James by sitting him up front of the class. James’s nervous ticks kicked in and he ended up tapping a ruler on the desk – this annoyed the teacher who then made him sit on the floor by the door of the classroom where he continued to take his finger against the door. 40 minutes later the teacher had had enough and sent him to the deputy principal’s office (whom he likes) where he managed to calm down and told her what had occurred.
In the phone call to discuss this incident, the teacher failed to mention that she had spent the better half of an hour yelling at James at the top of her voice (loud enough for children from the next classroom to peek through the windows to see what was going on)Several friends (parents of children in the class) also rang me to re0tell what their children had told them that evening. The part that particularly broke my heart was when he was telling me about the teacher making him sit on the floor by the door, his words were "then she made me sit on the floor by the door like a dog!"
The next morning I was in the school office at 8am wanting to speak with the principal who was unfortunately not in that day so I had to see the deputy principal. I was extremely angry that James had been treated in this manner and demanded some sort of action from the school. They then agreed that this new teacher does require some extra training on how to handle children with ADHD. We worked through a plan of action for the classroom and for James to cope at school – After a few hours, I felt satisfied that they now understood my view on the type of education they should have been offering my son.
The unfortunate issue here being is that the department of education does not identify ADHD as an Autism spectrum diagnosis for which the school can obtain the learning and teaching resources they would need to assist James. So I do have an ulterior motive to all this reading and research. James needs help and the only way he will get the kind of help he needs is if we can somehow fit him into a category that the DOE will recognise as needing assistance.
 
I’ve been doing a lot of reading, in the hopes of finding alternate ways to assist him with the issues that he is experiencing and a lot of what I’m reading about SPD and Aspergers is hitting home on several points.
 
In relation to the SPD and Aspergers, some of the traits that stood out for me include:
·       Extra sensitive to touch – I’ve explained briefly below
·       Sensitivity to sounds – Covers his eats very regularly when he feels overwhelmed – there may not even be excessive noise, but the sound contribution to the sensory overload seems to be the final straw
·       Picky eaters –I’ve explained in detail below – not something he can really help though.
·       Hyperactivity – mostly when off the meds / late afternoon and evenings
·       Fear of crowds – our solution to this was to get him ‘wheelie’ shoes – he doesn’t seem to have this problem anymore, thankfully.
·       Excessive risk taking – for example: a million reminders to check before crossing the road and he still walks out in front of cars – it’s not intentional, but happens every time and we are extremely fearful for his safety
·       Avoidance of sensory stimulation – See above and below explanations
·       Easily distracted – particularly by noise, movement, and touch.
·       Struggles making and developing friendships – he finds it hard to talk to others and he has big issues with participating in large group activities
·       Selective mutism – This is happening a lot more recently – he is shutting down and refuses to speak to teachers of peers at school – this in turn is making it difficult for teachers and school to determine his needs and assist
·       Empathy – I think in James’s case its more about feeling remorseful than empathetic. He can put himself in others situations and understand how they are feeling, but he isn’t always remorseful if something has gone down that he feels wasn’t his fault or was the result of someone doing something to him first.  I think the overriding response is fear of getting in trouble
·       Eye contact – he will not do this unless prompted.  At home we obviously make a point of doing this every time we speak to him or he to us, but the teachers are saying he struggles to make eye contact with them in class – I wonder if this is more of a lack of trust with his teachers than it is an inability to make eye contact?!
·       Social awkwardness – he is now particularly struggling with friendships – if he makes a close friend he is struggling to understand that that friend may have other friends he wants to spend time with – James feels left out and angry in such situations despite us explaining it to him. Truthfully though he seems to ‘know’ a lot of peers but doesn’t really connect with them and form proper friendships. He often spends his time at school alone because as he sees it, he doesn’t have any friends to play with.
·       Narrowed interests – this is very much James – once he finds something that interests him, nothing else seems to factor in for him and he can even get quite annoyed/angry/distressed when we encourage him to leave what he is doing to experience something else. Despite knowing this is his reaction, we absolutely make a point of limiting his time on the things he is so focused on and almost force him to do things he wouldn’t choose to do.
·       Sticking to routine – if we don’t work on a routine, James will fall apart – he likes structure and order and absolutely needs to know where he stands with time – we have routine for almost everything at home and provide a running countdown on his activities so that he can mentally prepare himself for the next thing. He seems a lot more focused if he has a time limit on something that he can work towards achieving something.
·       Literal interpretations – oh boy – this is a tough one – we find it so difficult to joke with him sometimes as he takes everything at face value. The difficulty arises at school often as other kids will say things to James in the heat of the moment that he will then obsess over and have a meltdown over. (A child last week told him to stop acting stupid at school – he was so distraught because he knows he isn’t stupid and why would this other child think that he was stupid)
 
James’s eyes hurt because he has to try to focus on what he is doing so much more because his brain isn’t always processing as it should. I guess he feels that if he sees it, then hopefully some part of his brain will remember it. His sense of smell is greatly heightened, which as you can imagine causes issues with food and going new places. He is extremely sensitive to sound, his brain is already working overtime to accommodate for the lack of attention and focus, loud noises – definitely a no-go. As you can imagine his taste buds are off the charts – bland food with minimal flavour must surely be a boring way to sustain yourself. 
 
James doesn’t like anything runny/saucy; he refuses to touch red meat as he cannot digest it and being constipated is not pleasant, he doesn’t like certain textures or smells. We are super lucky that he doesn’t mind the colour of his food. He also doesn’t like pasta (slimy texture), potatoes (grainy texture), tomato (too wet/slimy), any dairy (too creamy and thick on his palate) and vegetables of any kind (each one has a texture he cannot handle).  And what he can and can’t eat this week, will change next week, so every meal is trial and error.
 
I often find myself sitting on the floor next to his chair, simply rubbing his hands because he cannot stop the nervous movement that is preventing him from doing anything with his hands. He crushes his knuckles against the desk or chair as hard as he can as the pressure/pain response triggers more quickly with the brain than he himself can instigate and process, which relieves the symptoms. To take his mind off it, at home - we put on a video or something he can simply sit still and focus on, thus allowing his brain time to catch up and calm down, at school – they have only as recently as last week allowed me to send in a therapy pack containing a squishy ball and some stretchy snakes/lizards that he can fiddle with to assist.
 
I think one of the worst of all is the sense of touch. He doesn’t like to be touched by strangers because It’s too much stimulation for his brain to process and people smell different.  I sit and rock him every night before bed while rubbing his back and arms and legs in the places and manner he can tolerate and finds acceptable. Over the years I’ve sung the same songs over and over again to build up his tolerance as I know how calming soft singing is to him.
 
I have to get down onto my knees to look him in the eyes to make sure that he hears me when I speak to him. I have to remind James several times every single day that he has his pants on backwards or his shirt on inside out. I have to make sure James wears underpants because society says it’s unacceptable for him not to wear underpants even though I know the constricted feeling of tight undies drives him insane. (I also do it because I know that other kids are cruel and will tease him for something so insignificant)
 
I have to brush his teeth for him because he gets distracted and forgets to do it properly. I still have to wash his hair every day in the shower because he hates water so much and even though the shower water is falling onto his body, it’s so much better than him submerging his little body into a bath of water.  I have to remind him to wipe and flush every time he goes to the toilet because it has to be done despite him hating the feeling of wiping his skin and the sound of the flush. I have to buy him velcro shoes because despite him learning to tie his shoelaces at least once a week, he forgets. He has to sleep with the light on because being in the dark is too much sensory deprivation for him to cope with.
 
This has turned into a really long one and again I apologise but sometimes the 30 minute meetings just aren’t enough to discuss these things and they are valid concerns.  I'm hoping we can perhaps set up a date to catch up and discuss the above email.
 
Again, I appreciate your time and assistance.
Chat soon
Colleen