Last week we took Noah to see a new doctor.
The developmental pediatrician wanted him to see a pediatric psychiatrist to help manage his medications.
The problem with seeing a psychiatrist, at least in our area, is that the good ones rarely take insurance. We've found the same thing to be true with psychologists and therapists.We've had Noah evaluated by a psychologist twice, when he was 2 1/2 and when he was 4. Each time was $1000. We've seen therapists at $120 an hour (which is really 50 minutes), where we sit there and tell them the same things we tell all the doctors and Noah refuses to interact or cooperate, and I literally sit there counting down the minutes in dollars. Our first developmental pediatrician wanted us to see a colleague of hers that had recently gone in to private practice. Her initial assessment? $2,500. Yeah, I know. We never did make that appointment.
When we looked in to finding a psychiatrist this time though I knew it was time. Noah's medications have become increasingly complex over the last year and a half and I'd been having doubts for a while that the doses weren't quite right. I hate that he has to take medication. Hate, hate, hate it. But, if he's going to take medication I want to make sure he is getting the right medication at the right dose, and that it is actually helping him!
We knew one of Noah's classmates saw a psychiatrist and that his parents were very pleased with him, so I asked for the information. I was lucky and there had been a recent cancellation and we were able to get in for a new patient appointment with just a few weeks wait.
Our first appointment lasted about 2 1/2 hours. The first 30 minutes the doctor spent reviewing copies of Noah's records that I provided. He spent the next hour talking with Rich and me, and then a half hour talking with Noah by himself. After that he sat with us and we came up with a plan.
This is the first doctor we have seen that I felt was looking at everything that is going on with Noah, including his early history of deprivation in the orphanage.
We talked a lot about how the brain works in kids like Noah and how too much or too little of the neurochemical's serotonin, dopamine and norepinephrine effect behavior. I'm somewhat familiar with all of this but he had a great way of simplifying it and applying it to Noah.
We talked about the difficulty in diagnosing kids this young. He asked what we thought was going on and where we thought we were headed with a diagnosis.
We discussed the different medication options. We discussed how difficult it is for doctors that don't specialize in treating kids like Noah and don't use these medications every day to properly dose the medications.
I asked about brain scans and we discussed the work that Dr. Daniel Amen is doing. He showed us pictures of brain scans of normal brains and brains of adults with ADHD, both without treatment and after taking medication. We discussed that if children like Noah don't get treatment to hep normalize their brain chemistry, their brain suffers permanent damage by the time they are adults.
He told us that treating a child like Noah now and through his adolescence often resulted in the child not needing medication, or needing less medication, as an adult.
We are adjusting Noah's medication. Two of the three prescription medications he takes are not at therapeutic doses, as I had suspected. We started increasing one of the medications and will see how he does. Depending on his response we will talk about increasing the other one.
Noah did great during the majority of the appointment. He started to act up a bit and get silly at the end. I told the doctor at the end of the appointment as we were getting ready to leave that the most frustrating thing for me is not having a good understanding if Noah's behavior is under his control. He said that it is really 50/50 and that until we get handle on what is going on with his brain chemically it is going to be very difficult to work on the behavior.* He also said that we are going to need to continue to make changes in how we parent, but as we get a better handle on the medication these parenting changes will be more effective!
FINALLY! Finally I feel like we are working with someone who gets it! Finally someone who isn't only focusing on parenting, or only focusing on medication.
Now for the best part! We saw the doctor just over a week ago and increased his stimulant dose the next day. And we saw an improvement! Noah had a great week at school last week, not perfect, but overall he showed improvement. He exhibited more self-control according to his teacher. Monday she told me they had a fire drill and instead of kicking mulch all over he stood and waited quietly and patiently.
Today in karate class he was amazing. Usually in his Wednesday afternoon class he is all over the place. He listens well, but he does everything twice as fast as everyone else. I can't tell you how many parents have commented on his energy level. Today? Today he was just right. It.was.awesome!
It's not perfect by any means. I think he's more irritable in the late afternoon/evening. Yesterday wasn't as good of a day at school, but he was also up very early in the morning and we already know that lack of sleep makes it more difficult for him to control himself.
I'm seeing more "flash" tantrums. Very quick, very unpredictable. He can go from being quite pleasant and seemingly happy with what is going on to angry and nasty in just a few seconds. With seemingly no antecedent. I don't really think they are happening more often though, I just think that he's better able to control some of his other behaviors so these incidents are more obvious.
I feel good about things right now. I feel like we are on the right track and there is hope. I also feel somewhat vindicated. And yes, I know this isn't about me, but it does feel good that my mommy instincts haven't been that far off.
* I owe all of you an update on the behavior program we started with Noah in late August. I am working on it and hope to have it up in the next week. It hasn't been an easy post to write because of the personal feelings I have towards the woman we were working with, so I want to make sure that what I say is fair and truly represents the program and our experience. I do have a separate blog ready to go, but she didn't follow through with her part of our agreement so I never went live with it.