Week Two

Both Leroy and Susan continued to notice more signs of ADHD as Kendall began to develop. At 3.5 years of age, the couple decided to take her to a pediatrician to get some more information and help Kendall reach her full potential. The pediatrician listened to what Susan and Leroy had noticed about her behavior and he agreed that a lot of Kendall’s behaviors were very similar to ADHD. However, he was very hesitant to prescribe any time of medication with her being so young and he also wanted to see how she would interact when she started pre-school in the fall at 4 years of age. Children this age are very active and display signs of difficulty in paying attention and difficulty listening to directions, therefore he felt that if she has ADHD then her symptoms will stand out more when compared to the typical developing child her age. If in fact she continues to show signs of ADHD, he wants to start parent- therapy to help with the development of the child, play-therapy to help with inattention, hyperactivity, and impulsivity and when she is older he will combine the continued therapy with medication. The doctor has executed this plan with other children Kendall’s age and said he was very successful. Leroy and Susan both agreed that this was their best option and they set up a follow-up appointment 2 months after Kendall’s first day of pre-school.

In addition to talking to the pediatrician about Kendall’s ADHD, they also mentioned to the doctor the attachment difficulties that Kendall has displayed since the adoption. Susan indicated that things have improved since the adoption a year and a half ago but she was still concerned and noticed herself becoming more anxious and depressed because of this situation. He referred Susan to a therapist who specializes in adoption and has worked with attachment issues. Susan learned from the therapist that attachment difficulties is very common with adoption. The therapist assured her that it was not her parenting that was leading Kendall to have a difficult time bonding but it is the lack of nurture Kendall received as an infant. The therapist gave Susan different tools and exercises on attachment parenting that will help establish a strong bond fairly easily.

In the fall, Kendall was enrolled in a local pre-school in San Diego. Leroy and Susan both had a meeting with Kendall’s teacher, Ms. Adams, and made her aware that she may have ADHD and to let them know of her behavior with the other kids and how she is developing. Ms. Adams talked to Susan and Leroy after a week of pre-school and talked about some of the things she noticed with Kendall. She indicated that Kendall was a very active 4 year old which was typical of most of the 4 year old in her class. Kendall did a great job with playing catch with another girl in the class, she did well with bouncing the basketball out on the playground, and also was very good at skipping, and running. Physically, Kendall seemed to be on track and have typical development. However, Ms. Adams noticed that after play time, Kendall still had an immense amount of energy and did not want to settle down for story time. She has a very difficult time sitting there and listening to the story, she kept fidgeting and bothering the other kids around her. Ms. Adams did say that a lot of children in pre-school has difficulty paying attention but Kendall seemed to have more trouble than the other kids and was very forgetful. After story time, Ms. Adams asks them questions about what they read and the kids answer. She said a lot of kids were blurting out answers and not raising their hands but Kendall seemed to have more trouble and had a hard time waiting her turn and this would result in Kendall experiencing a lot of frustration and would throw a tantrum and would end up disrupting the class.  

Ms. Adams also talked about Kendall’s language ability. She indicated Kendall talked more than the average 4 year old and seemed to be in need of constant attention and reassurance. Ms. Adams was impressed that Kendall did not have difficulty using past tense, could speak in sentences of 5-6 words, could tell short stories, and her speech was very intelligible. However, Kendall did have trouble following instructions. She indicated that she feels that Kendall is very bright but her inattention and hyperactivity may lead her to have difficulty in the future in the classroom.

Kendall seemed to really be enjoying being around other kids her age in the classroom, it also seemed to help with creating a bond with Susan. Kendall loved to come home and tell her everything she did that day. Her favorite time was play-time and she loved playing catch with the other kids and asked her parents if she could play t-ball. Susan and Leroy were very happy that this was opening Kendall up and she seemed to be very happy but they were still concerned about if she would face learning difficulties in the future when she started Kindergarten and 1^st grade. In addition, Susan still felt attachment difficulties in specific situations. Kendall was being more open and talking to them more but she still felt a lack of a mother-child bond. From Susan’s therapy, she learned that Kendall could have a mild form of Reactive Attachment Disorder due to the conditions of the adoption facility and the lack of caregiver attention she received as an infant. Some definite signs of this disorder Kendall displayed is her extreme affection with strangers, lack of eye contact, and persistent nonsense questions and chatter. However, Susan was just happy that she was seeing some type of progress.

Kendall attended kindergarten at the same place school where she attended pre-school and she was fortunate enough to have the same teacher who was very aware of Kendall’s unique situation. Kendall seemed to continue to excel in her speech and language development. She was able to carry conversations with others, and define specific words. Kendall also still was really enjoying her play-time. She loved going out on the playground and playing hop-scotch with the other girls and also enjoyed doing a daily stretching and exercise with the class. Her favorite exercise was jumping jacks! When Kendall was able to sit still, she was able to write out the alphabet and was using correct grammar. However, there were times that she was unable to complete these tasks because she needed to be in constant motion.

Two months after pre-school started, Leroy, Susan, and Kendall started therapy for Kendall’s ADHD. They were seeing some progress and teaching Kendall how to play nice with other kids, how to take turns, and raise your hand when a question was asked. They noticed significant progress in Kendall’s behavior from pre-school to Kindergarten but Kendall was still having difficulties when they had to sit and learn a lesson or sit and listen to story time.

Luckily, since San Diego is a pretty big city, there are many options Susan and Leroy had for sending Kendall to therapists and doctors to help her adequately learn and be the best she could be. The doctors and therapists felt that it was best to not medicate Kendall. As she entered 1^st grade they decided to increase the therapy and focus on teaching adults to target upsetting behaviors, pay attention to positive acts, and consistently use time out and offer rewards. In addition they decided to think about their possible options to make sure Kendall did not fall behind. They also decided to incorporate therapy of “white” background noise to help with Kendall’s ability to focus on her homework.

As Kendall continues her education in first grade, there goal is to keep working on these different therapy approaches to see if they see success in school compared to the typical developing child her age. There seems to be continued success with her speech, although she talks a lot faster and more frequently than other kids her age. She also seems to have typical physical development as well. She has grown around 2 inches since kindergarten.

Susan and Leroy want to continue to monitor Kendall’s behavior and take whatever action they need to in order for Kendall to be successful in a regular classroom and for her to keep continuing having fun being around kids her age. In addition, Susan and Leroy want to continue working on Kendall’s attachment difficulties and see if any progress will be made with the tools Susan’s therapist has given her.

Decision point: Do Leroy and Susan decide to have Kendall evaluated to receive services for an Individualized Education Plan (IEP) or do they just continue with the intensive therapy?

Questions:

1.     What is an Individualized Education Plan?

2.     Is it common for the parent to feel depressed and stressed when having a child who has a difficult time with attachment?

3.      What age range are children typically identified as having ADHD?

4.     How is “white” noise beneficial for cognitive performance in a child with ADHD?

Week One

Kendall Eckenrod was born in the Philippines on July 2, 2009 as a result of an unplanned pregnancy.  Her birth parents were both 18 years old, uneducated and unemployed.  They have one son at home who is 13 months of age.   Kendall weighed 4 pounds and 2 ounces at birth; however, she was born prematurely at 35 weeks gestation.  The birth mother acknowledged having poor nutrition during the pregnancy and was a smoker.   Shortly after delivery, Kendall was placed for adoption because her parents were both financially unstable and felt that they could not support another child. She was placed in a facility for two years before a final adoptive family was found.  Identifying concerns noted are her premature birth, poor gestational nutrition, mother smoking during pregnancy and mother’s two pregnancies in short period.

As a newborn, Kendall appeared to be a very healthy baby. She reached her milestones relatively on time. She was rooting, sucking and grasping at age appropriate expectations. However, Kendall had episodes where she was a very agitated baby. She would cry and fuss a lot and was difficult to comfort.   This resulted in an obvious need for immediate attention. She was often placed in a swing to sooth her agitation because the placement facility was understaffed and crowded.     A problem Kendall faced was that she was unable to develop a caregiver bond, which is crucial to development. The way we are treated determines our life long mental health. In addition, our early experiences with caregivers shape our adult love. Because of Kendall’s unique situation, she was unable to experience that bond which has resulted in her constant need and want for some type of attention, which sometimes results in Kendall acting out. In addition, because the adoption agency is short staffed, her bonding time with the individuals working there is limited and sometimes inconsistent. This may result in some future problems, behaviorally or psychologically. 

Developmentally, Kendall’s language seemed to be on point. At 3 months, Kendall was reacting to loud sounds, recognizes specific voices, cooing, cries depending on specific needs, and is smiling. The only issue Kendall seemed to be facing was a lack of attention and more frequent crying. At 6 months, Kendall was able to follow specific sounds with her eyes and respond to changes in tones of a voice. She also frequently noticed toys that made sounds and often would get very distracted from these toys. Kendall was babbling with bilabials (/p/, /b/, and /m/) and often babbled more than the typical child.  Often she would babble louder than another child who was also babbling. Again, this seemed to demonstrate her persistent need and reassurance of attention.

At 1 year old, Kendall began to take her first steps. However, it is important as a caregiver to the child that the caregiver is close when they begin walking. This was a difficult task in an adoption facility. She however developed all her gross motor skills on time. At this time, Kendall however showed signs of difficulty following simple commands and would become distracted with outside stimuli resulting in Kendall no longer paying attention. She would also move very quickly from one activity to another. This posed a serious concern for some signs of ADHD. Her constant need for attention, consistently distractibility, difficulty paying attention, and some behavioral issues seemed to indicate that she was showing signs of Attention- Deficit Hyperactivity Disorder. The adoption agency noted this in their files however, they were tentative and thought she was too young to make an official diagnosis.

Kendall’s speech developed normally, she was pointing to pictures when named in books, was acquiring new words on a regular basis and was using some two- word combinations when speaking. Kendall’s undiagnosed ADHD signs continued up to her official adoption when she was 2 years old.

Kendall was officially adopted at 2 years of age from a couple from San Diego, California in the United States. Leroy and Susan Eckenrod were respectably 39 and 37 years of age. They tried to have children for years however were unable to so they began the adoption process. Susan is a science teacher at Mt. Caramel High School in San Diego and Leroy in a police officer. The couple was very excited to finally become proud parents. The adoption process went through Bay Area Adoption Services in California. Kendall arrived in the United States and met her new caregivers in August of 2011.

Leroy and Susan reported that Kendall seemed to be a relatively happy baby; however seemed to have some emotional and behavioral problems that occurred. Still, they assumed that this was to the sudden change in atmosphere and the overwhelming attention of new faces. They also noticed Kendall having a difficult time attaching to them but they also felt that is could be a possible result of the adoption process. Nevertheless, at 3 years of age, Kendall was talking much more and becoming more comfortable but they started to notice more signs of ADHD. Kendall was having a difficult time paying attention, she wasn’t listening, was very distracted, would fidget a great deal, talk a lot, would not take turns when playing with other kids, would blurt out answers, interrupt other kids, and couldn’t stay in one place which also resulted in her moving from one activity to another very quickly. These signs and symptoms had both Leroy and Susan concerned however, they love Kendall very much and want to provide her with the support and proper care she may need.

Decision Point

Do Leroy and Susan take Kendall to the physician to get a confirmed an official diagnosis of ADHD to potentially start behavioral therapy or do they wait until Kendall starts school to see if it is going to actually affect her or impact her in any way?

Questions:

1.     What are common signs of attachment difficulties at birth?

2.     What role does the adoption play on Kendall’s attachment and behavioral problems?

3.     What is the average cost of an adoption?

4.     Because Kendall was born premature, does that have an impact on her potential official diagnosis of ADHD?