When the Back-to-School Honeymoon Ends and ADHD Reality Kicks In

It’s early October and Natalie’s fourth grade honeymoon is officially over. Up until now, she has had just a couple of behavioral blips at school. She stole an eraser from another student and, when caught, had to return it, miss a recess, and pay the child one dollar in restitution. Minor stealing incidents have long surfaced when Natalie’s anxiety is sky high, and this instance was easily explained -- her classroom teacher, special education teacher, and aide were all unexpectedly gone on the same day -- everything was chaotic. She also played sick in order to come home from school one day -- a ploy that often means she’s had her feelings hurt in a social situation. After taking her home, she eventually confessed that she was upset because a boy belittled her kickball abilities in front of her classmates in P.E. (after learning that, I had her back at school by 1:30 p.m.!) Other than those small glitches, most of her days have been great. Despite her attention deficit hyperactivity disorder (ADD/ADHD), anxiety, and sensory processing problems, Natalie has been able to focus on her work most of the time. Day after day, her special ed teacher handed her off to me after school saying she'd had a fantastic day.

Yesterday, I got the phone call I was dreading. “Hi, Mom, it’s me, Nat. My teacher wants to talk to you.”

Starting around noon she had been completely unable to focus -- to do any work at all. During reading time, the first post-lunch subject, she rolled around on the floor chewing on her glasses. It turns out that a pattern is emerging. Mornings are good. Around noon, things fall apart. Twenty or so minutes after she takes her 1:00 p.m. dose of Ritalin LA, things get a little better, but they never return to the preferred morning levels.

I’m convinced that this has less to do with medication than it might appear. Natalie went through all of last year following this same pattern. I’ve come to accept that this may just be as good as it gets. Since we long ago surpassed the maximum dose of stimulant that is recommended for a child her size, increasing doses is simply not an option. While she may be able to take her 1:00 p.m. dose earlier in the day, she’s already taking two doses of a drug intended to be taken once a day. On top of that, she needs a booster of short-acting Ritalin at 5:00 p.m. Would it really be a good idea to move the doses even closer together?

I’ll discuss these options with Nat’s psychiatrist at our next appointment, but I’m hoping to avoid having to tweak her medications. We’re going to start with some non-drug treatments -- exercise breaks and deep-breathing exercises. Maybe we'll add some incentives for staying on task.

The honeymoon was great, but it’s over. Back to real life with my ADD/ADHD daughter.