Week Seven

Kendall really enjoyed her freshman year of classes. Taking classes part-time was a great option for her because she was able to just get a feel of the time commitment for each class and how college classes are run. Kendall, Susan and Leroy sat down at the end of her freshman year and planned out Kendall’s future. One thing that is really beneficial for Kendall is that if she has short-term and long-term goals she is able to maintain her focus better. They came up with a list and decided that Kendall would register as a full-time student in the fall of her sophomore year. Susan and Leroy were very excited about it and they were excited that she wanted to stay at home to live. They realize how much Kendall has grown. She went from being a child with severe attachment issues with her parents to an adult who thoroughly enjoyed her parents company. This really made Leroy and Susan proud of their parenting. In addition, they have noticed how her behavior has been better than it ever has. They believe it has to do with maturity, really enjoying what she is doing, and new friends she has made in college.

Kendall takes the advisor’s advice and decides to get her personal training certificate. She does this in the summer before her sophomore year. She attends the classes and loves it. A lot of it is hands on learning and that is how Kendall seems to learn best. She exceeds all expectations in the class. In addition, she realizes how much she loves fitness and nutrition and she finally feels like she has found her niche.  The personal trainer who runs the course notices how energetic Kendall is and how well she does with other individuals and he offers to let her work part-time as a trainer in her newly opened gym. Kendall is ecstatic about this opportunity and takes him up on his offer. This is a great way for her to earn and save money for after college. When Kendall gets home and tells her parents the good news they decide to take her to her favorite restaurant and celebrate all of the success and achievements she has made within the past couple of years. The people working at the gym and the individuals who are members of the gym just love Kendall. She gives great advice, tries to find ways to achieve their goals, and is very encouraging. Kendall continues to work their throughout college and she actually becomes one of the most popular personal trainers at the gym. The constant exercise and productive work has really helped Kendall release some of the extra energy she gets due to her diagnosis of ADHD.

The last few semesters of college became very difficult for Kendall. She was stressed with work and she also noticed how her classes became longer and more difficult. This meant that in order for Kendall to do well in her classes things needed to change. She talked to the special services coordinator, Mrs. Evans, and she allowed Kendall to make some adjustments to her class time and test time in order for her to succeed. Mrs. Evans notified Kendall professors that Kendall would need breaks every 40 minutes to go walk around so she did not become so antsy that she would act out or she would not pay attention. In addition, Kendall was able to get increased test time. A lot of the time, the amount of questions and the time restraint stressed Kendall out and she would become very agitated. This increased allowance of time would allow Kendall to relax and read thoroughly through the test and answer the questions adequately. These minor changes ended up being very beneficial to Kendall. She graduated in the top 5 of her class and seemed to be doing extremely well.

Now Kendall was done with classes and she is now a certified nutritionist. Kendall applied for jobs all throughout the area. She increased her hours at the gym until she found something she enjoyed more. Kendall was working out much more and seemed to be doing great. Therefore, Kendall thought it would be okay to stop taking her ADHD medication without telling anyone in her family, her doctor, or her friends. This seemed to negatively affect Kendall in many ways and she experienced many side effects. Luckily, Kendall’s mom noticed after about two weeks the increased symptoms and she questioned Kendall about whether or not she had taken her meds. Kendall was honest with her and told her no. Susan was extremely worried and took Kendall to the doctor right away. Kendall admitted to her parents and the doctor that is was a rushed decision that she did not take the time to think about and she apologized for not talking to her parents about it before. Luckily, Kendall was not permanently affected in anyway.

Kendall continued to work at the gym full-time until she was 25. By the time she was 26 she had finally found a job full-time at a local hospital. She was offered great pay and good benefits. From all of the money she had been saving from working at the gym, she was able to move out of her parents’ house and into a studio apartment. Kendall was really excited about finding a job and becoming much more independent. In addition, she was able to fit a few hours in a week working at the gym. She finally had felt like her life was coming together. Kendall enjoyed seeing clients and adjusting food intake and working with patients with dietary restrictions. However, Kendall seemed to be suffering more with the symptoms of her ADHD. Because she felt like she didn’t need to medication as much, her doctor had lowered her dosage. But, with her new job, she was not getting that constant exercise she was able to do with her job at the gym. Sitting in her office with clients was very difficult and filling out paperwork seemed to become more and more of a struggle. However, she really loved her job. So, she needed to find a way to control her ADHD while in the work setting. By 27 years old, her dose of her ADHD medication was increased and it turned out to be very successful. She also would take a laps around the hospital in between clients so release some energy. By doing this, Kendall was able to get to know a lot of the employees at the hospital. She was talk with some as she was walking by and this really made her love where she worked.

One of the people who Kendall met through her laps throughout the hospital was a male nurse practitioner named Cody. Cody was 29 years old, the same age as Kendall. They had started out as good friends and both seemed to develop feelings for one another as they got to know each other and spend more time together. Cody also suffered from ADHD growing up and is still struggling with the symptoms to this day. This was something they ended up bonding over and Kendall had finally felt understood with the frustrations she had always felt growing up. Kendall and Cody ended up dating for the next two years. At 31 years of age, Kendall found out that she was pregnant. She was completely shocked and scared but very happy because she had known from the time she had met Cody that he was the one. However, Kendall and Cody were not married and had not even talked about marriage. Susan and Leroy were ecstatic when they had found out that Kendall was pregnant and they were going to be grandparents.

This new milestone in Kendall’s life left her feeling like she had no idea what she was going to do with her life. Does she take a maternity leave or quit her job? Should her and Cody get married before they have the baby? Is it a boy or a girl? Questions circulated throughout her mind all day and finally her mom made her realize that life doesn’t always need to be planned out and it’s okay to have questions unanswered. The most important thing Kendall needed to do was relax and not stress because it could negatively affect the baby. Now, Kendall was finally very excited and ready to have a baby.

Decision point: Does Kendall work until she has the baby and then take a maternity leave for a couple weeks or does she decide to quit her job to stay at home to raise the baby?

Questions:

1.       What are the negative effects of stopping a medication completely instead of gradually weaning off of it?

2.       How could this have affected Kendall socially and emotionally with her family and friends?

3.       What is the average pay of a full-time personal trainer? What is the average pay of a full-time nutritionist?

4.       What type of settings can a nutritionist work? What is the post popular setting? What is the job outlook?

Week Six

            During the summer leading up to Kendall’s first year in middle school, her parents and doctors decided it would be the best time to switch Kendall to a new medication since she had seemingly built up a tolerance to her ADHD medication, Concerta. They switched her to Intuniv, which is a non-simulant medication. The new medicine appeared to have a dramatic improvement on Kendall’s behavior. She became more in control again and she was not experiencing the negative physical side effects such as headaches and shakiness that had begun to plague her while on Concerta.

            Middle school can be a challenging transition for typical children, so Kendall’s parents worried about how the transition would affect Kendall. In elementary school Kendall only had to deal with one classroom environment and a few faculty members such as her teacher and her aid. In middle school she needs to switch to several different classes during the day requiring much more self-organization and management. These executive functions are difficult for a child with ADHD.

            Her parents got together with her education team to plan an effective approach for Kendall’s transition into middle school.  They decided that Kendall would have an aid in her Math, Language Arts, Science and Social Studies classrooms everyday while she adjusted to her new schedule. For physical education, art, music and the other electives Kendall would try a more independent approach.

            Taking the suggestions of the education team, Kendall’s parents enrolled her in a study skills and organizational skills class. The class spends time teaching Kendall ways of organizing her time and space in order to make things easier to remember and focus on. One of Kendall’s aids also helped her organize her locker in order to help her remember things and stay focused. They color coded her binders and hung a matching color-coded class schedule and checklist on the inside of her locker.

            These strategies helped Kendall keep track of where she was going and what she needed to bring to each class or home. Although it was an adjustment, by seventh grade Kendall had a good grasp on changing classes and managing her time by using her organizational strategies.  She could keep track of making her own reminders with sticky notes and was able to create lists for herself. Academically, Kendall kept her grades up and stayed on par with her peers.

            At home Kendall’s parents made sure to check Kendall’s assignment lists and make sure she was keeping up with her schoolwork. They still utilized the white noise strategy when Kendall was studying.  The education team also lightened the amount of days Kendall was aided to two days a week.

            Kendall still played and exceeded in soccer. Her parents also involved her in karate which greatly helped learn more discipline and concentration.

            In eighth grade Kendall seemed to mature greatly compared to her past history. The education team decided that it would be good for Kendall to try having all classes without an aid before she entered high school. Kendall’s parents were not keen on this idea as they feared it would greatly affect Kendall’s academic performance. They came to the conclusion that Kendall would independently attend all of her classes but her study hall period would be spent in the library with an aid going over any lessons she was having trouble with, maintaining her organizational strategies and practicing new study skills. As eighth grade was ending Kendall’s performance was satisfactory but there were marked changes in her attitude towards her aids and counselors. She would try to avoid going to her study hall sessions by claiming she felt ill or when she was there she would act out. Finally Kendall told her parents that she was very embarrassed to be seen with an aid and that other kids teased her about it. Kendall wanted to get rid of having an aid completely so that she would look “normal.”

Questions:

1.     What are some other strategies for helping kids with ADHD keep them selves organized?

2.     Do kids with ADHD learn better visually or through spoken instruction?

3.     What are some affects of having low self esteem?


            In high school Kendall’s parents and teachers decided to lessen her study hall days with an aid.  At the same time they did speak with the school guidance counselors about the isolation and bullying Kendall had been experiencing in middle school. The school, having realized that there was an issue with many kids not just Kendall, sent out for an organization called Rachel’s Challenge to come talk to the school about compassion. The program has a few parts to it. The school assembly really brings kids together and points out the struggles that everyone is going through while teaching about having compassion for one another. The next step is that within the school a club called Friends of Rachel is formed. This club’s goal is to get to know and help their school community peers, whether it be including people who are usually isolated or raising money for a good cause. The program seemed to have a great impact on the students and teachers as the amount of bullying complaints and incidents has dramatically decreased.
            Kendall has also started playing soccer on the high school team. This has helped build a strong group of friends and support within the school. Kendall loves exercising
            Academically, Kendall is at the appropriate level through freshman and sophomore year. She even does well enough to earn her parents approval for dropping the study hall aid all together. Junior year, however, her classes begin to get much more difficult for Kendall. The math is much more involved and time consuming causing Kendall difficulty when trying to focus on it. She often skips steps in long math problems or does things out of order. Kendall’s parents get her an after school math tutor who specializes in helping kids with ADHD.  She also begins doing study hall with an aid again, once a week or three times a week if it is an exam week. Kendall’s grades do improve back up to satisfactory.
            Another issue that becomes clear during junior year of high school is what Kendall is going to do after high school. Kendall is just making satisfactory grades in high school and college is going to be even harder. If she goes away to a four-year school, she will be put in the position of being in a completely new environment with little or no help with regulating her activities. That’s assuming Kendall even wants to continue her academic career. Kendall’s parents begin taking her to different career fairs to get an idea about what she might want to focus on as a career path.
            Senior year Kendall decides she does not want to go away to school but she does want to give college a try. Kendall also realizes that she wants to work in a field that deals with exercise and fitness. Kendall and her parents decide to sit down with her guidance counselor to discuss possible options. They decide that Kendall will attend the local community college on a pat time basis first to get her feet wet. She will begin taking her regular gen ed courses and does not have to declare a major right off the bat.
            Her first semester in college she takes a nutrition and health course. Kendall loves learning about healthy eating .  The other part of the class is an exercise class, which Kendall excels in. After enjoying her class so much she goes to talk to her college advisor about possible career choices in that area. Kendall’s advisor says there is a kinesiology major but Kendall does not want to do it because it requires an extremely heavy load of math and science courses. Kendall’s advisor then suggests the culinary arts program which she can do a specialty focus on healthy living and nutrition. Kendall and her parents agree that this is a great idea. She will continue taking part time classes for the rest of the year and they will reevaluate whether to go to full time her sophomore year or not. When Kendall completes the coursework she will have her Associates of Applied Science in culinary arts. Kendall’s advisor also brings up another idea since Kendall will only be going part time. Since Kendall is so into exercise, she thinks Kendall would enjoy the personal training certification program.  It is a nine-week program that meets twice a week. Kendall will learn all different kinds of exercise and how to help other people with fitness. It would also be a great certification on top of her major. Kendall seems very excited about this idea and decides to go for it.

Decision Point: Does Kendall move up to a full-time school schedule after freshman year or does she stick with part-time?

Questions:

1.     What kind of careers can Kendall get with an associates degree in culinary arts and healthy eating?
2.     What is the average income of a personal trainer?
3.     How can nutrition impact the effects of ADHD?

Week Five

 Kendall is growing very quickly since being on her ADHD medication. In third grade they originally dropped her time with an aid in the classroom to two days a week. When first marking period grades came in she had a marked drop in her grades. She was still passing and still cognitively up to speed with her peers but her parents met with her teachers and IEP team plan to talk about the next steps anyway. Together they decided that Kendall would have a total of three days with the aid and her parents decided to hire an outside tutor who specializes in children with ADHD to come in occasionally after school.

            The rest of the year Kendall passed with flying colors. Socially Kendall is at the top of her game. She has all different friends from school and sports. She is very outgoing and does not hesitate to try new things. Kendall’s parents were once concerned with distracting her from her studies by signing her up for soccer, now they couldn’t imagine not having her involved in competitive extra-curricular activities. Kendall is fantastic at sports. All of the extra energy that seems to be built up in her seems to get put to very good use when she is out on the soccer field. Sports have also helped Kendall learn discipline and focus that has carried over to her academics. At the end of fourth grade, Kendall is invited to join a more competitive traveling soccer team. Kendall and her parents make a deal that as long as her grades stay consistent she can join.

            During fifth grade Kendall’s parents and teachers notice that Kendall’s behavior is taking a turn for the worst. She is having difficulty concentrating and her grades started to drop. In addition to that she is experiencing headaches and jitteriness which are affecting her soccer playing. Susan and Leroy take their daughter to her physician and psychiatrist. It is decided that Kendall has built up a tolerance to the Concerta she has been on but due to the fact that she is experiencing the headaches and shakes they are concerned about increasing her dosage.

            The doctor’s lay out several options for Kendall’s family to choose from. They can completely remove Kendall from medication and focus on behavioral techniques, they can try a new method in which they use a lower dosage of the drug she is currently on (the simulant Concerta) in combination with the non-stimulant Intuniv, or they can try completely switching to Intuniv. Due to the fact that Kendall does have very severe ADHD they do not believe completely removing Kendall from medication is in her best interest at this point. They want to make sure they have Kendall back on the right track before entering middle school in the fall.

Decision Point: Do Kendall’s parents decide to switch her completely to a non-stimulant medication or do try the new combination of drugs?

Questions:

1.     What is the difference between stimulant medication and non-stimulant medication?

2.     What are the benefits of non-stimulant medication?

3.     What are some alternatives to ADHD medication?

Week Four

Leroy and Susan decide to set up a doctor's appointment with Kendall's pediatrician to learn more about ADHD medication and how it can help Kendall. At the appointment, the doctor explains that medication can be extremely helpful to Kendall. Putting her on ADHD medicine will help her focus more during her lessons and take less time with her work. The medicine should also help Kendall sit quietly during reading times and pay attention during appropriate quiet times. This should make it much easier for Kendall to participate in a general education classroom. The doctor does recommend that Leroy and Susan instill very strong eating habits and sleep schedule before she is prescribed ADHD medicine. ADHD medicine can cause decreased appetite and insomnia in some individuals so it is very important that Kendall continues eating a recommended healthy diet and has a very routine sleep schedule. If Leroy and Susan do notice any change in her diet or sleep schedule, they must tell the doctor immediately to ensure that Kendall is receiving all the nutrition she needs to keep growing strong. Another side effect that Kendall's parents must be aware of is the "rebound" effect. The "rebound" effect occurs sometimes when young individuals take ADHD medicine and it begins to wear off. This usually happens around dinnertime and children might become extremely irritable and aggressive. The doctor recommends that if Kendall shows any signs of this, they should remove her off the medication.

            At the end of second grade, Kendall has reached grade level for her reading and writing levels! To reward Kendall for all her hard work, Leroy and Susan throw her a pizza party with all her classmates. Kendall really enjoys herself at the pizza party because she has become very good friends with her classmates and feels socially accepted. She also really enjoys all the attention she receives at the party. Kendall's second grade teacher believes that Kendall really shines in a social setting and has been rewarded multiple times over the school year for her tendency to share and include everyone when playing at recess. She even receives an award in front of the entire school for her outstanding friendship behaviors. Leroy and Susan are so proud of her!

            After taking 20 mg of Concerta for six months (January to July), Kendall has made significant strides cognitively. Kendall can read at a second grade level and enjoys reading books about animals. Kendall's IEP team believe that she is ready to tackle third grade and focus more on "reading to learn" instead of "learning to read." Kendall will still be put with an aid to help her focus, but the aid will be less present during the school days. Kendall will only work with an aid twice a week during the school week while in third grade. Another IEP team meeting will occur after her first semester in third grade. After second grade, Kendall is cognitively up to speed with her peers and is ready for third grade.

            Physically, Kendall is a healthy eight-year-old girl. She can run and play just like every other girl her age and she has even set a school record for the fastest mile time for second grade girls. Kendall has also shown a great interest in joining her neighborhood soccer team. Leroy and Susan believe that playing soccer will be a great outlet for Kendall to get all of her built up energy out. They are worried though, that Kendall might not be able to keep up with her academics if soccer takes up too much of her time.

Decision Point: Do Leroy and Susan sign Kendall up for fall soccer or do they keep their focus on her academic progress?

Questions:

1. What are other ways for Kendall to use up her built up energy due to her ADHD diagnosis?

2. How might Kendall's social life be different than typical third graders due to her ADHD diagnosis?

3. What is the average cost for neighborhood sports teams for children in elementary school? Would Kendall's experience with soccer be any different because she has ADHD?

4. Does insurance usually cover medication for children with ADHD?

Week Three

            Leroy and Susan decide to move forward with an evaluation to receive services for an Individualized Education Program. The evaluation occurs at the very beginning of the summer before Kendall enters second grade. After the evaluation, Leroy and Susan sit down with the principal, school psychologist, and Kendall's first and second grade teachers. The school staff explains how Kendall did on the evaluation and how they believe they can help her academically and during these critical middle childhood development phases. They tell Leroy and Susan that Kendall is eligible for services under IDEA's definition of a "child with a disability." Although ADHD is not an official disability category under the IDEA's definition, Kendall still will receive services under the official categories of "developmental delay" and "other health impairments."

            The next week, Leroy and Susan meet again with the school staff to come up with Kendall's Individualized Education Plan. Her IEP team consists of her second grade teacher, the school psychologist, Leroy and Susan, and the school principal. For the initial meeting, Kendall's first grade teacher attends to give feedback on how Kendall behaved in her classroom. The principal asks Leroy and Susan to list their main concerns academically for Kendall. They explain that Kendall is below grade level for reading, writing, and spelling. They also describe how long it takes for Kendall to complete her homework every night due to her inability to concentrate and constant walking around. They also get extremely frustrated with Kendall's forgetfulness to complete assignments on time or bring home appropriate materials or books.

            Next, Kendall's first grade teacher describes her concerns as well. Kendall's lack of organization skills is very disruptive for her schoolwork and causes more problems on top of her other attention and hyperactivity problems. Although Kendall did seem to get along fairly well with her classmates, she did have occasional outbursts and disruptive behavior during lesson times or story times. The main disruptive behavior that Kendall's teacher noticed was that Kendall often distracted other students by talking over the teacher during lessons or walked aimlessly around the classroom while students were supposed to be working on assignments. She also seemed to have frequent bathroom breaks where she would sometimes be found walking around the hallways. By the end of first grade, a teacher would have to walk Kendall to a restroom multiple times a day. The teacher also touched on the same concerns as Kendall's parents such as her poor writing skills and incomplete assignments.

            The next order of business was Kendall's social and physical development. Socially, Kendall gets along well with classmates but can be disruptive in the classroom at times. Her physical development was extremely typical for a child her age but she sometimes seemed more hyper and distracted than other students.

            At the end of the meeting, the IEP created three goals for Kendall to strive for during her second grade year. Her first goal was to keep organized with her binders and material during the school year. The procedure for evaluation would consist of daily binder and backpack checks done by her teacher at the beginning and end of each school day. If for any reason she becomes concerned with Kendall's organization habits, she would email Leroy and Susan to alert them. Leroy and Susan will then reinforce the importance of organizational habits with Kendall at home and hold her accountable. Her second goal was to finish homework and assignments at around the same pace of the rest of the class (an additional 15 minutes can be added). To accomplish this goal, Kendall will sit with a teacher's aid that specializes in ADHD while she does assignments to help her stay on task and focus on her assignment. At home, Kendall will sit at the kitchen table with Susan and work on her homework together. Kendall's last goal is to raise her reading scores to grade level by the end of the year. Once she enters third grade, the curriculum will transition from "learning to read" to "reading to learn" and her IEP team is very determined to keep her on track. Kendall will receive special services at her elementary school and work with her teacher's aid in another classroom to ensure that she stays focused and concentrated on her reading assignments and lessons.

            At the end of Kendall's first semester of second grade, she has still not made much progress on her reading scores. She is not at grade level for reading or writing but is making small strides on her organization skills. Her parents and teacher both agree that the main frustration is in her hyperactivity and inattentive behaviors. Her general education teacher sets up a meeting at the end of Kendall's first semester in second grade to discuss the option of medication. She recommends that Leroy and Susan set up an appointment with their pediatrician to discuss the possibility of prescribing ADHD medicine to help Kendall focus more in school.

Decision Point:

Do Leroy and Susan move forward on acquiring a prescription for ADHD medicine for Kendall?

Questions:

1.     What type of side effects might ADHD medicine cause in a child Kendall's age?

2.     What other special services are available to children with ADHD in elementary school?

3.     How might Kendall's IEP team ensure that Kendall is in the general education classroom as much as possible to ensure that her social development is not affected?

4.     How might Kendall's IEP goals change following second grade? How might her goals change?