The following request for information came in from Southwestern PA. Please respond if you have any recommendations.
We live in a house that my husband and father-in-law built on a corner of his family's farm. My seven-year old son loves it here, as do we. The problem is that my in-laws have 6 horses in various pastures who roam a large portion of the land freely and they are not about to get rid of them or keep them in a smaller confined area.
Several years ago one of the horses kicked my son when he walked up behind it and he was thrown several feet. Luckily he didn't have any internal injuries, but he was thrown several feet into some fencing and ended up having to have a number of stitches on his forehead and around his left eye. His vision was fine, but the plastic surgeon wanted him awake while he was stitching the eye. The scars are very minor, but because he was awake he was very frightened. He knows that the horse didn't mean to hurt him and that the kick was the result of its instinct. Now he respects the horses more and keeps a distance from them. Nonetheless, whenever he hears one whinny or sees one nearby, he seems to lose his ability to focus his attention and becomes really hyper. He is also a huge risk-taker in other ways.
His first grade teacher suggested that he might have ADHD, but when he wants to focus his attention, he can, as long as there are no horses around or anything that reminds him of horses. He also gets hyper and distracted when he hears any kind of siren or when there is any talk about hospitals or injuries. Could his on-and-off problems focusing attention in school and at home simply be due to the trauma he went through from being kicked by the horse and getting stitches, or does ADHD come and go the way his distractability and hyperactivity do? What kind of expertise do we need here? His teacher is recommending a local family practitioner who has provided ADHD medication for other children in her class, but I'm not comfortable with this. The chiropractic we use said that he is developing normally for a child his age and that most seven-year old boys aren't really ready to sit still and focus their attention all day in school. I trust him, but worry that a "wait-and-see" approach might cause us to lose valuable time in treating his problem--if it really needs any kind of treatment.
Dear Mom With Questions ,
ReplyDeleteI’m so sorry to hear about this experience your son had with the family horses, and I can certainly understand your thought process. Trauma and ADHD can present similarly in some cases and it’s commendable that you would want to dig deeper to find out the cause of his distractions. I have a few thoughts I would like to share with you in response to your question.
First, when it comes to raising your child, you are his biggest advocate. From what you’ve said, it sounds like you have already been advocating for him in your quest to find the answers. Great job! Next, I did some research and I found that you can likely get a referral from your pediatrician for a mental health professional who has experience working with children. According to the National Institute of Health, this person will rule out other reasons for this behavior, which would include a trauma assessment due to this accident.
If your pediatrician does not have someone to refer you to, then I would recommend calling your health care provider and asking them for a referral. This is a nice alternative for families who worry about their insurance coverage with specialists.
The last thing I want to share with you is that having a diagnosis does not mean your child has to be medicated. Each family must choose whether medication is appropriate for their child and it is a personal decision. People may try to pressure you in both directions, but ultimately this is your choice with your husband. Remember, you’re the advocate!
I hope that you are able to find the answers you are looking for. I found that the National Institute of Health website was very informative about the process of getting a diagnosis. I have included the link for their website at the bottom of the page. I wish you luck moving forward!
Username: AlwaysPeopleFirst
Hello,
ReplyDeleteI am sorry you are having some personal problems right now. I understand that you are seeking some assistance with whether or not your son should seek some help regarding some of the behavioral issues he is having. I understand that your in-laws have several horses that move about the property. I completely understand how hard it must have been for your son to go through such a traumatic situation. First, he is kicked by a horse into a fence, and then he has to sit through the experience of being awake when receiving stitches. I understand that your son’s first grade teacher feels that he has ADHD and has suggested medication for your son. I think you should consider consulting your pediatrician regarding some resources that could provide some assistance. For example, I’m getting that you are fearful of medication, so perhaps seeing a child psychologist would be helpful. The child and family counseling center (CFCC) provides behavioral health therapies to children/adolescents and their families (www.chp.edu, 2015). The therapies provide family focused therapies for anxiety, fears, and worries, which might be the area in which your son could benefit. The pediatrician could perhaps suggest a clinical psychologist that would be appropriate for you and your family. This could be beneficial as they could provide you with some remedies to assist you with some of his behaviors. I would also suggest looking into support groups for you and your family so everyone involved can be educated. The National Alliance on Mental Illness (NAMI) of Southwestern Pennsylvania provides an array of supports that you may be interested in. I hope this will benefit yourself and your son’s needs. Please take care and I hope everything works out for you and your family.
Care78
Dear SW PA Mom,
ReplyDeleteThank you for your post voicing your concerns about your son. While it is ethical for your son’s teacher to inform you of the behaviors your son displays in her classroom, it is unethical for her to suggest a possible diagnosis of ADHD. The symptoms of ADHD must be persistent for at least 6 months to a degree that is inconsistent with your son’s developmental level (American Psychiatric Association, 2013). Her statement that he can focus his attention when he wants to as long as none of his triggers are present suggests that his symptoms are not persistent. You are the expert on your son. You have been observing his behavior for several years since the accident happened. It is helpful that you have taken notice of what triggers your son’s distracted behavior and hyperactivity: horses nearby, whinnying, sirens, and talk of hospitals or injuries. Perhaps you could make a detailed list of what triggers this behavior in your son, how often, and where it happens. This would benefit him if you were to have him examined by a child psychiatrist, who would screen for PTSD (post-traumatic stress disorder) to see if the behavior is related to being traumatized by his accident and the experience of being awake while the plastic surgeon sutured his face. The behaviors that you have described are not uncommon in children with PTSD. The high risk play, attention deficit, and becoming hyper and avoiding going near the horses can all be his way of coping with what happened to him.
You say the accident was several years ago, but that your son is only 7 now. This says to me that he was likely young enough to not have established strong language skills at the time the horse kicked him. If indeed your son’s symptoms are PTSD related, a pediatric crisis intervention specialist can assist a child in clarifying the details and being able to establish a coherent narrative about the incident that has traumatized him, whether it was the kick itself, or being awake while his wound was tended. A specialist should be the one to diagnose your son. The good news is, there are many approaches to helping your son recover from the trauma effects, and it is entirely possible that he can make a complete recovery at some point and no longer have these behaviors inhibiting his school career or development process. While the teacher and the chiropractor are well meaning, a pediatric specialist holds the expertise you are searching for. The pediatric psychiatrist or psychologist would want to be sure of your child’s diagnosis before determining what treatment approach is recommended. Medication is not the first choice for children diagnosed with PTSD, so there is no need to “wait and see.” Recovery from PTSD is a slow process, but there is no need to wait for fear having him put on medication, because ultimately, it is your right to be involved in deciding which type of treatment he receives. Getting him screened by a specialist right away would allow the healing process to begin and prevent the effects of the trauma from becoming layered over time (Christopher, 2015).
It is clear from your post that you are concerned parent who wants to do what is best to help your son. I appreciate that you have reached out to ask for insight on who is best qualified to help him. I hope that my response is helpful to you in your decision. I wish you and your family the best.
Hi there! It sounds as though you are feeling a bit conflicted between the different sources of advice. You are well attuned to your son’s emotions and have paid a great deal of attention to when these symptoms appear. You are correct in thinking that the characteristics of PTSD and ADHD can be similar. It does seem that he has very specific triggers related to the source of his trauma. Without spending time with your son and obtaining more information, it is impossible to fully assess the situation.
ReplyDeleteYou may want to consider a psychiatric evaluation. In this region, it can take weeks, sometimes months, to get an appointment with a psychiatrist. I understand that you do not want to delay intervention that could help your son manage these feelings and behaviors. Most psychiatric offices also have therapeutic intervention as part of their services. I would suggest scheduling an intake appointment with a therapist to expedite services for your son. The therapist will then have time to fully assess your son and relay this information to the psychiatrist prior to the evaluation. Be sure to fully explain the incident with the horses and the hospital. Continue to keep track of when your son experiences these challenges. The office may want to talk with your son’s teachers to get a better picture of how he functions in school. This will assist in making an accurate assessment.
A physical with his pediatrician is a necessity as well. This will rule out any medical condition that may be impacting his well-being. As with the therapist, you will need to make sure that the doctor is fully aware of the trauma he experienced as well as your reservations regarding pharmacological interventions at this time. As a mom, you know your child better than anyone else. Do not allow anyone to coerce or guilt you into doing anything in regards to his care that makes you feel uncomfortable. It is okay to disagree with a recommendation and seek other opinions. You are taking steps to help your son. Regardless of the cause, the fact that you are attentive and willing to seek assistance will allow your son to get the help he needs. Best wishes to you both.
-A social work friend
Hi there,
ReplyDeleteWelcome to the board. It appears as though you are looking for answers regarding your son’s current behaviors. These behaviors include lack of attention in school, distractibility, and hyperactivity. Behaviors are usually indicative of an underlying issue. In your son’s case, you appear to be leaning toward trauma exposure, ADHD, or a developmental phase. Though I cannot provide a diagnosis for you, I can help you choose the best path to take.
Several types of medical professionals can diagnose ADHD; however, child psychologists and psychiatrists are most appropriate to obtain accurate diagnoses and care. This is also true for trauma exposure. Regarding ADHD, children must exhibit a specific amount of specified symptoms (APA, 2013). According to your description, your son has not met the requirements. Though, when seen by a professional, you may realize there are more or less symptoms exhibited. Behaviors that occur after traumatic experiences and/or exposure can, often times, be confused with ADHD symptoms. Some of your son’s risk-taking behavior and distractibility when re-exposed to traumatic stimulus followed by hyperactivity may be indicative of a trauma-related diagnosis (Scheeringa, Zeanah, & Cohen, 2010). The siren or whinny could be observed as a trigger (stimulus) to the behavior followed by the behavior (coping mechanism). In agreement with your chiropractor, some of your son’s behavior is appropriate for his age and activity level (Hutchinson, 2013). Your son was exposed to several traumas, from being kicked to getting stitches; therefore, there may be more to his behavior than his developmental phase.
The “wait-and-see” approach may be appropriate if you have no other options. If you have medical coverage, a visit to a specialist may be the best option. Even if you do not have coverage for a specialist, you may have access to subsidized or free evaluations for your son, especially if you are willing to take him to a university center. In the time being, you may want to track his behavior through an A-B-C form and/or record the time, place, and activity when troublesome behaviors occur.
Due to the trauma experienced and your pressing concern, recommendations are to seek an assessment and/or treatment for the behaviors being exhibited at your earliest convenience. I hope this helps.
Sincerely,
Whatischange