ADHD and School Refusal

[mama2alex]

A good friend has recently brought to my attention that our ds presents with ADHD. She's researching it because her son has been diagnosed and they are trying to go the medication route. We are planning to have ds evaluated specifically for ADHD because I've begun to wonder if a) this issue and all its consequences are contributing to his school refusal and it is just becoming more obvious now because his workload and other responsibilities are increasing significantly now that he's nearing the end of 6th grade.

 

I've always been more focused on the underlying cause than symptoms, and we are continuing to work with a LLMD/DAN doc, but the school refusal has us on the brink of pulling him out of regular school, something neither he nor we want.

 

I'm just wondering if others who've dealt with school refusal ever felt there was an ADHD connection - as in they are anxious about being at school because they have trouble doing their work while other kids seem to have no problem and get in trouble for talking, getting up during class, impulsive behavior, etc. I've heard most people talk about OCD as the primary problem that prevented kids from getting to school, but now that we're looking at this closely, I (as well as my friend and two of our teachers) feel that the ADHD issues could be causing some (possibly most?) of the anxiety around going to/being at school.

 

Other things that make me wonder if ADHD is the primary problem contributing to school refusal are 1) his separation anxiety, which was severe at the beginning of PANS isn't much of an issue any more. He stays home alone, goes on overnights, and has no problem saying goodbye to me in most situations. 2) We tried Zoloft last Fall for the anxiety and it had no effect, except to cause intrusive thoughts once we upped it past 6mg.

 

Thoughts/experiences would be much appreciated!

Edited May 8, 2013 by mama2alex

[filinha1]

I'm trying to figure out the ADHD component for my 11 yr old dd, as well. Teasing out diagnoses can be very difficult, especially with PANS in the background, as a potential reason for the symptoms in the first place. Deciding at what point during treatment for PANS to look at other diagnoses as separate entities to treat is also a tough call.

Looking back, dd has always had characteristics of an ADHD kid. She makes friends easily but doesn't keep them - she's bossy and domineering and I think can come across as mean. She's impulsive. A chatterbox in class who managed to get good grades, although grades may have dropped off heading into middle school. (I homeschool her now.) Very touchy and easily frustrated.

I think in the long run, many things can cause school refusal and ADHD is just one of them. So, using school refusal as a possible diagnostic criteria for ADHD just isn't enough. Maybe getting a neuropsych eval might be a way to go, so many different components are looked at - learning disabilities, executive functioning etc., in order to get a clear picture of what your son is dealing with. I think we're going to pursue this route.

Good luck!

Heather

[mar]

My intake on school refusal and ADHD. I beleive ds has add or ADHD. He always had separation axiety and now older axiety in genera at times. He makes friends but they come and go and he is bossy but not impulsive. Gets easily frustrated and always got straight A's until fifth grade . Anyway he never complains about going to school. Now dd who is and always was impulsive. Who probably has ADHD who is completely open and not afraid of anything was the one who had school refusal in kindergarten and 1 st grade. She was having seperation axiety that she never showed when younger. She makes friends very easily. So much more social then ds and she is very bossy and domineering with them from what I see at times. I wonder if there is a connection. She went through her month of fear but I keep chugging along and would not let her stay home . I'm talking screaming crying in kindergarten and then some in first grade bc she got in trouble for talking. But then this year in second grade she is doing well. I might get the occasional my belly hurts or I have loose stools and I am sick and I tell her no its bc you are worrying and you are fine bc it happens to many people and we have been good this year!! She would get loose stools every morning when younger so I know in her cad it was stress. Why who knows. But she has been taking bus back and forth this year which she did not do in the last two years. I have not and do not want to put her on meds. But she defiantly has some type of add or ADHD. I don't how bad your children are with school refusal so in can't compare but I know it would be my belly hurts and then in washroom and then I would tell her she is okay and we would ride bikes in morning for 5 to 10 minutes and have silly races before I took her into car and drove the 5 min with at times tears in her eyes but told her to be strong! That was hard bc she would say I miss you!!! I never new how tough love is so important!! It would hurt me but I had to act tough and acg like those years didn't move me at all. She has had an awesome 2nd grade year with taking bus both ways and there even have been times that she came home early and I was not out there with garage door open and rings doorbell and i say sorry and she just smiles!! I think wow!!!! I say your so big and brave and she smiles!

Mar

[MomWithOCDSon]

Our DS had some school refusal several years ago, and he, too, presented with ADHD-like symptoms along with OCD. However, the ADHD stuff always was secondary to the primary presentation - OCD. So, when his OCD was backed down, the ADD/ADHD stuff evaporated, too. I think a lot of kids with significant OCD behaviors frequently look as though they are ADD/ADHD because their OCD thoughts distract them, and while they're trying to keep those thoughts, compulsions and rituals "under wraps," they can appear distractable, inattentive, even hyper because of what they're contending with internally.

 

His old psych tried treating the ADHD for a period with Intuniv; initially, we thought there was some improvement, but the benefits seemed to wane over time and when we ceased the Intuniv, we didn't see any increase in his behaviors.

 

In the end, his ADHD-type symptoms have all but disappeared over time (knock on wood), along with most of his other behaviors, with successful PANDAs treatment and our Best Friend, Time.

 

We also continue to supplement with zinc, which we came across incidentally and discovered that it seemed to help DS's focus overall.

[smartyjones]

Mama – in our experience, I say absolutely! And i do beleive middle school is a very common time for issues to surface that haven't previosuly -- both anxiety and learning issues b/c of the increased work and often with ADHD b/c of the increased independent responsibility to do work rather than in elementary where it is quite regulated.

 

I’ll try to be brief, but I say to anyone considering ADHD with a kid with pandas, it may also be good to check into 2E, depending on your child’s issues. A number of years ago, right here on this forum and forever grateful to EAmom, I was stating something about my ds’s apparent high ‘puzzle mind’ with also inattentiveness (or something), EAmom threw out he could be 2E. Years later and through testing, he is a classic 2E situation. In our disastrous year last year, school officials sneered and shook this head at his ‘manipulative’ style. This year, I can hand them one paper and anyone with basic education experience, has their jaw drop and their eyes bug out as they sadly say, ‘no wonder school is a challenge for this kid’. He has wide discrepancies in 2 areas of cognitive testing – and those ‘low’ areas are actually in the average range.

 

He had sudden onset at age 4.5 and fall of 2^nd year in preschool. Of course, we didn’t know what was happening and one day, I said I couldn’t allow him to go to school with such bad manners of fighting the teachers to get there (physically). As we were driving home, this sweet introspective voice from the back of the car said, “Mama, I don’t remember why I don’t like school.” I believe his initial school refusal and phobia was brain-PANDAS related with anxiety issues.

As things went on, he had handwriting issues, but he was so young, we didn’t see clear patterns or realize it. His teacher had marveled at his good handwriting previously and saw his refusal as obstinacy. This became a big point of contention the rest of the year and the next. This helped to solidify his dislike and refusal of writing and continued to feed a vortex for a few years that he is just now breaking out of as we are trying to unravel his written expression issues. He did just mention to me last night that he doesn’t like writing because it makes his hand hurt and it gets so tired.

 

We’ll never really know if he would have had these discrepancies anyway or if they have been brought about from PANDAS. This year, he is in a very good charter school with a great staff that suits him wonderfully. Last year, when the class was expected to get out their writing journals and write on a specific topic and he would just run his pencil over the binding repeatedly and it was seen as obnoxious, we were in a bad spot.

 

And that’s only the writing that I am mentioning – which is pretty much the biggest issue, but there are others. And likely ones I’m not even aware of and perhaps he’s not even aware of.

 

Now, I pretty much see it that he’s had 2 big strikes against him – pandas and learning/attention issues. I think the biggest way to help is with understanding where he is coming from. And that understanding must also include the realization that the world isn’t going to be so understanding, so my job is to best help him figure out ways to adjust and adapt to the world, rather than trying to get the world to adapt to him. So, I see we need to make accommodations for him now to help him learn to adjust himself so that he can make the accommodations he needs for himself rather than wanting or needing them made for him. That’s what I like to think my philosophy is anyway – tougher to live. But, it all starts with knowing what you’re up against.

 

It’s so easy to think something is one way and it may not be that way at all. So, I wasn’t so brief, but yes, I think if you are thinking this could be something, it’s something to investigate!

[smartyjones]

so i read what MOMwithOCD wrote -- perhaps she has a good clue in there -- how does the child present when at a good level of health -- if you have seen such a thing.

 

my ds has many inattentive, fidgity, swinging, etc behaviors that are ADHD when in exacerbation or even lesser sense of health, that i do not think of part of his normal make-up. these go away with better health.

 

the writing issues are always present. and it is enough, in a not proper environment, to fuel school refusal.