Tuesday, January 24, 2012

ADHD or Hypervigilance?

If you’ve read my blog for some time, you know The Princess is going through, and dealing with, a LOT of trauma stuff these days.  She is diagnosed with PTSD (post-traumatic stress disorder), anxiety, attachment issues, and ADHD (Attention Deficit/Hyperactivity Disorder) – emphasis on the H!  It’s never dull around here, and I am quite literally EXHAUSTED from it all.  Lately, my patience is so thin, and my therapeutic parenting tool box is so scattered about my brain, that when I need one of those therapeutic tools, I really have to root around my head to find it.  This is especially true when we’re out in public.

Last night at Applebees, The Princess was as animated as a 3-year-old on steroids that were washed down with a 2-liter bottle of Mountain Dew.  She was like that going into the restaurant.  She was like that all through the meal.  She was like that when we left, as she bounced backwards into two people coming into the restaurant while we were going out.  She was like that when she ran out into the parking lot, in the dark, in front of a car driving way too fast for a restaurant parking lot.  (Thankfully, Hubby grabbed her.)  She was also like that as we were getting into the car -- until I yelled at her, “I.  have.  had.  E-NOUGH!”  (No, this is not a therapeutic parenting technique.)  Strangely, I think it shocked her because she stopped, doe-eyed in her tracks.  Still, the shock broke the craziness and she was (mostly) quiet on the ride home.

I’m sure most people who witnessed The Princess’ behavior last night would have either agreed with her ADHD diagnosis or thought we were “those kind” of parents  -- the ones who allow their children to behave poorly.  (For the record, I am not one of “those” parents.  I am a “mean mommy,” and I am proud of it.)  The thing is, when it comes to that ADHD diagnosis, I’m not so sure all the craziness The Princess displays in public is due to hyperactivity as much as it’s due to hypervigilance.

The next time we go out (and it won’t be any time soon), I will spend some time preparing The Princess for our family time.  She needs to be reminded she’s safe.  She needs to be reminded she’s a big girl.  She even needs to be reminded that she will be protected and not abandoned.  We will take care of her.

ADHD is the most commonly diagnosed disorder in adopted children.  Articles I’ve read suggest children diagnosed with ADHD often have a biological parent (usually the father) with ADHD.  Research suggests  environmental factors also play a significant part, including prenatal exposure to alcohol and drugs, a mother’s smoking while pregnant, and low birth weight.  Lead poisoning also seems to play a role in a great number of children diagnosed with ADHD.  Kids coming from orphanage backgrounds, like my kids, are even more likely to be diagnosed with ADHD. 

However, I’ve also read some adopted, hurt kids diagnosed with ADHD may actually be hypervigilant due to past trauma.  There’s an article on Boris Gindis’ website here that explains this observation.  The more I watch my daughter and get to know her, the more I believe she is hypervigilant more than ADHD.  She is able to focus and settle down when she is motivated to do so.  She loves to read books for long periods of time.  She can sit still when she feels safe.

The things that make her seem hyperactive include the behaviors she displayed last night at dinner.  When I yelled, she snapped out of it.  I believe she was still hypervigilant after I yelled; her behavior just changed because she was afraid of my reaction.  As my kids have gotten older and have begun to try to reason (even if they’re often not all that successful at it), I can see how “snapping them out of it” works sometimes. 

Now, I’m NOT saying the WAY to do that is to yell.  However, I am saying a little bit of understanding of how others perceive your behavior isn’t such a bad thing.  Some may call it “shaming.”  I call it “awareness.”  If my child is stuck in asinine, annoying, anti-social behaviors, she needs to be made aware those behaviors are unacceptable.  Sometimes, that awareness needs to happen sharply and quickly.  Otherwise, you’re paying for an ER visit for some poor guy who just wanted to have a nice dinner with his wife, or you’re scraping your kid off the macadam. 

Still sometimes, I think it’s all just a crap shoot.  What works one time doesn't work the next and I'm always trying to figure something else out to do.

Sudden “awareness” can sometimes trigger hurt kids into full out rages.  This happened with The Princess at the zoo back in December.  Thankfully, this is very rare for her.  (A public, full-on rage has never yet happened with Youngest Son.)  Usually, “awareness” works to stop extreme animation in The Princess.  Some may say, “Yeah, but you pay for it later.”  I’m not so sure I wouldn’t be dealing with something later anyhow.  If it gives me a relatively quiet ride home after a dinner that four out of the five of us did not enjoy because The Princess was the star attraction of the Applebees’ Review that night, then I’ll take it.

1 comment:

Diana said...

I've had many of the same thoughts lately. Then I took my kid in to the psych yesterday. I asked lots of questions, she made lots of observations. We talked about what is going on and the behavior manifestations we're seeing (would never want to make a Dx or concrete assumptions over the internet, but what you're saying here sounds a lot like the convo I had with the psych yesterday...just sayin') Hypervigilance is a given, we all know that, but what she said kind of surprised me. She said it sounded like the biggest problem we're dealing with is most likely ADHD that isn't being completely or appropriately addressed (wrong med, wrong dose, or a big part might be jolts with the meds going in or out of the system) And so a med dose and timing change was made. Her thought is that if we can get a handle on the ADHD, we'll have a better idea where to go with the anxiety and other issues which she thinks will settle some as we find a more appropriate treatment for the ADHD.

One of the big things we talked about is how it feels when these meds rise and fall in the system (even some of the long acting/slow release ones can cause jolts to the system) and how it can make them feel really jumpy and edgy and then the hypervigilance takes over. The hypervigilance is there. We all know that. But, I was quite surprised to hear her thought on this...that it's the ADHD feeding the hypervigilance rather than the other way around, which is what I've always thought it was. She feels if we can get the ADHD better controlled and managed that the anxiety and other issues will lessen as well and we'll utimately be more successful in being able to treat the whole package.

After my chat with our psych yesterday, I'd definitely recommend having a similar chat with your doc about her meds and see if a timing, dose, or formula change might be in order. There's also a new one out that I've never heard of...very likely we'll try it with my older son and possibly both kids, esepcially since even at regular price, it's quite a bit cheaper than concerta!