ADHD – Impulsivity

ADHD Impulsivity

Week 1

It was time. She was having rough days 9 out of every 10 school days.  Her impulsivity was significant — she was lying, stealing, and sneaking food each weekend. Every once in a while, we had that uneventful day. The last one still fresh in my memory.

“Isn’t it great I had a good day?” she asked me, her wide toothy grin in the rearview mirror. She has the look of wanting validation.  “Yes, it is. It’s a day you can have every day.”

ADHD impulsivity

Her special needs are not immediately visible.

Again, she revisited the topic. “Isn’t it so special! I had a great day! Are you happy, Momma?”  I answered, “Yes, I am. I know you can have lots of good days.”

The self-praises continued that afternoon. By dinner time she had revised once more, “I love having good days! I was so special today, right Momma?”  I made the silent coyote signal with my hand, gesturing for her to be quiet. Then I corrected, “It’s not special and you are not behaving special. Your teacher said it wasn’t a bad day. That’s what she said!”

And there it was, my words cutting through the glee. Yes, it is time. Our former therapist emailed me back with instructions to fill out the intake paperwork so that we can schedule a consultation with her. Within 18 hours, I had completed the hefty packet and hand delivered it to her office. I wrote her: when are you free?

I asked Beth how has she been?! She and I both chuckled. I started explaining the continuation of problematic behaviors, the parenting techniques we have tried, the beginning of the school year. Hurray for kindergarten! I was somewhat optimistic that with the structure of the classroom, the experienced teacher, and a group of 20 same age peers that my child would shape up. Her teacher, Mrs. M, had said in the Fall that my child would soon figure out the expectations and would learn from social situations. It’s now February and she has many difficult days. Beth asked for descriptions of her behaviors and typical scenarios. I gave many. Then she explained my child to me. Beth reported on two areas: delayed processing and significant impulsivity, as in ADHD impulsivity.

My child cannot filter out the stimulation around her, she absorbs a little information at a time. She stores the knowledge randomly. Those pockets of knowledge would explain why at times she is reasonable and cooperative, other times seemingly clueless and defiant about following social cues and safety rules. She is highly reactive as she attempts to manage all this information. In effect, when a kid asks her to move her chair or for a turn with the scissors, my daughter lashes out. Between the screams is her message: I am busy working through this information, don’t bother me! I am overwhelmed! I cannot calm down. AAAAaaarrrrrrrgggghhh!

The other area is a tricky one. My daughter is highly impulsive — non stop chattering, singing, making noise, putting items in her mouth, speaking for others, blurting out, interrupting, running ahead of us, grabbing things, provoking the dog. There are graphic messages all over her kindergarten classroom. One has a few words with drawings to match: stop, think, pick a tool. She is nowhere near following this sequence. Her method is to react with emotional distress in seconds, like a sports car accelerating along the highway on-ramp. Her response time is so quick, there is no hesitation, no moment of reflection, just zoom zoom zoom!

Beth suggested medication. I agreed to a medication evaluation with a child psychiatrist. First, I took home a behavior checklist — a list of about 100 behaviors that I rated in frequency. Some seemed irrelevant: runs away, sets fire, intentionally damages property. Others were a given in our home: steals items, lies, does not wait for turn, blurts out answers. I gave the same one to my daughter’s teacher. I compared the teacher’s and my questionnaires. Yup, looks like we are rating the same child. The psychiatrist also asked me for typical scenarios to support the presenting problems. The psychiatrist briefly interviewed my child and took her vitals. Then the doctor discussed ADHD medications to address her issues of impulsivity, distractibility, and reactivity. Wow, sounds like a Schoolhouse Rock song — so catchy. The doctor asked me if I am agreeable to a trial of medication.

Last year I said, “No thanks Beth. Let’s try another reward system. Let’s be more consistent with time outs.” In this meeting, I said, “Let’s! hand over the script so I can drive over to Rite Aid. I am ready.”

Actually we are all ready:  the family members, the dog, the cats, the neighbors, her classmates, her teacher, the children in her tumbling class, the swim instructor, we are all ready.


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