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?