Here is the really long post in SN http://www.mothering.com/community/forum/thread/1303888/talk-to-me-about-neuropsych-evals-and-the-almost-4yo-long#post_16331924
ETA; Just realized that I didn't specifically mention that this is with Isaac (DS3). Oops--very tired!
The short version is that our ped has referred us to neuropsych for an eval of sleep and behavior issues (suspected ADHD). We have pretty much ruled out medical causes. I pretty much ruled out adoption trauma related causes. When he first came home, he grieved really, really hard, so for the first year really, I attributed his sleep and behavior to that. And honestly, this is better than it was, as impossible as that sounds. Then after he got through a lot of his grieving, we really still had to focus on his attachment and trust issues, and so I attributed his sleep/behavior to that for these next 2 years. But his attachment is really good, and I am pretty convinced that for the most part it is not an issue in his behavior/sleep (he still cries at daycare drop off for a few seconds, but is easily distracted and prolonging goodbyes make it worse, and it is more that it is "ritualized" and just part of the routine than actual distress if that makes sense). He sleeps in a toddler bed at the foot of my bed, and moved out of our bed on his own completely about 6-8 months ago. Keeping him close in my room at this point is as much for my sanity to not go as far at night as to reduce interruptions to my other kids' sleep (he would be moving in with them). He frequently wakes them with the crying anyway.
So, with that background, I am mulling over how much of his adoption story I need to share. We have a reasonable medical and social history about his birthfamily, nothing that would directly relate IMO, but may be significant to the psych in ways that I am not aware of. We have suppositions about foster care based on direct observation, conversations, and photos. We also have complete medical records from about 5m, and limited ones prior to that.
Can anyone share about neuropsych evals, especially with preschoolers, adoption info, whatever you can. I need reassurance that it is the right thing (even though I, and our ped, feel we have exhausted any other options), and just an idea of what to expect.
Ok, I just posted on your other thread but wanted to put my adoption-related thoughts here. DS had a full private psych evaluation as well as a private OT evaluation. He also had evaluations through his school. I shared as much information about DS's early life and birth parents as I have. In your situation, it's is visually apparent that your DS is adopted and I suspect that if you don't bring it up, it will be asked.
I replied on the other thread, but wanted to pop in a minute here, too. I figured the adoption stuff would be addressed, and I am comfortable giving pregnancy/birth info as that is basic medical, birth family medical, too. Where I am unsure is on the social history of the birthparents. Some of it may be important to clarify, but I'm not really sure. I also have some impressions and deductions about his 2 foster homes that are probably relevent, but as they are not absolutes but opinions supported with some documentation (photos, medical reports), I'm not sure if that would be helpful or hurtful, either. I'm sure I am overthinking this, too. I have a tendency to do that when I am tired and fixated in an attempt to focus :)
FWIW, I do have a full hearing eval scheduled, too, just to rule that out. I think the loudness is just who he is, but at least it is something we can check on and work on if needed.
Anyway, thanks again. Hallelujah, it is almost naptime and Isaac and Connor are playing pretty well together overall for a change. Or not, just heard the fussing...
I'm not here as much anymore (the new format moves really slowly on my computer), but I wanted to send some hugs and ask how the meeting went?? Did the dr. give you some ideas for sleep medicines? J. was on one for a while when he was 5 and it helped...let me know if you need the name of it.
ROM, I thought the slowness was just my little netbook being overwhelmed LOL I am still waiting on a call from them to set up the app, which is annoying. Actually, it is on my to do list for Monday, now that externship is over, to call them back. Its been a crazy 2 week push to finish up and I just had to put if off a few days. I would be interested in the name of the med if you don't mind, as we I have got to get some sleep. At least the middle of night tantrums and all night crying has stopped again. Wonder if it was triggered byRrick and Jimmy being gone a few days camping. He hasn't reacted like that to other camping trips, but who knows? There is no real rhyme or reason that I can discover to a bad night vs. a "good" (relative term--he's still up 4-6 times) night.
Not sure I'm really functioning LOL More like surviving...it does feel much like that newborn fog but much, much longer, with no end in sight...I kept thinking "after he grieves" then "after her attaches better" then "after he weans" (he's never going to wean, I'm convinced of it! None of my bag of tricks works, which means he's not ready to wean, right? But he's almost 4, and should be nightweaned, but he acts like it is a need still and I then go in circles) then...I'm out of afters. When he goes to college?!? He has got to sleep someday, or at least wake but not need me or dh, right?? Tell me yes, even if you are lying LOL
It will get better, because you are doing what you need to do to make sure it gets better. I think your step by step approach is just right: deal with the sleep, then see how it affects the ADHD-like daytime behavior.
In your post on the SN forum, his need to control your behavior around his bottle being "perfect" did jump out at me, perhaps because I am on another adoption listserve where we have been talking about the intense need for control that many of our kids have. Once you feel like some of his neuro issues are better understood and any biological barriers to sleep are being addressed, it might be time to look a bit at that issue as well. I know that our daughter often tries to make us jump to her will and whim in order to try to have a sense of internal control that she struggles with. We have to be really firm, limit her choices, and even verbally remind her that "I'm sorry, but you aren't in charge of my behavior. I know that's frustrating, but I'm not going to get you a new banana because the one you have has a nick on the corner of it. You can eat that one or not." Just something to watch for down the road when you get out of emergency mode.
At any rate, I wish you well in these next steps. In the meantime, any chance you could leave the house for a couple of nights to get some sleep? As someone who has had chronic insomnia off and on, I know how it feels to consistently (like for years!) lack adequate sleep. It's a serious health issue; I hope you can find a way to take care of your need for sleep a bit at least, while you are trying to find a solution for him.
Have I mentioned lately how great you all are??? The support is really helpful right now. I have been feeling discouraged that this is where it is and that is where things will stay. So thanks!
As far as getting away, it is not really in the budget right now. And TBH, dh is just as exhausted. He is doing more night time right now than I am. I don't know that I can put it all on him, either.
Talked to the neurospych office yesterday, trying to find out why we don't have an appt yet. They are waiting on insurance auth. Except they think the ped's office should be doing it, and insurance says the neuropsych office has to. Think there is some confusion over the level of insurance we have--we have the PPO plan not the HMO type plan, and not many people seem to choose that option, and the "rules" are slightly different. So I guess I will have to stay on them. I even considered paying out of pocket, but I want to give them a chance to fix it first. Plus if we have to extensive follow up, then auth would be tricky since we started without it. So going to work with them a bit yet, then consider going back to ped and asking for something for sleep (ROM than ks for the name, I will be floating it to our ped!) in the meantime. Also, a Mom on the SN board gave me info on a time release melatonin capsule that can be used as sprinkles, so am checking that out, too.
Diane, I definitely want to come back to this control thing when I get this going and get past comps/graduation (1 month, 1 day!!!). I have noticed from early on a huge need for control, and have attributed it to needing to control something while feeling so much is out of his control, as have a few of our perceptive family friends. It makes me think of the theory behind what is happening with tpeople with eating disorders controlling what they can (need to look at his food issues now, come to think of it, since feeding was an issuewith swallowing disorder stuff and now we have behavior-related food issues) I have tried various ways of dealing with it, but have finally settled on a method that sounds similar to yours--X is what you have, you can have it like this or not at all. FWIW, the cold bottle is no longer an issue, it lasted about a week. But this child will say no to ice cream just to argue with you sometimes!
OK, off to work on my comps presentation. Despite not wanting to fly the puddle jumper plane that will be landing on icy runways, and terrified of my comps (all oral yikes!) I am looking forward to the 4 nights in the B&B where I will be staying LOL The same way dh looks forward to sleeping on the ground camping with Jimmy--he gets more sleep LOL LOL See we have gone off the deep end!
Just got off the phone with the office, and the insurance confusion is straightened out. No auth is needed ( I knew that LOL) and appt is set for Monday at 4. The secretary is trying to work it so we have a workable plan in place before PreK registration in May. Have to say, I like them so far! Once I called them, they had the insurance problem solved within 24 hrs, an appt in less than a week and taking school choices/timing to register for next Fall, etc into consideration. Feeling hopeful...
Course, he will probably be an angel and sit still and calm through the entire appt and I will look crazy LOL
So we had the appt today, and I really like her. Isaac did fantastic with her, boisterous but well behaved. But enough to see that he is hyper LOL Was complimented on how well we have done, and on some parentimg moments in the office. Took me seriously! and started problem solving. Feels like I'm on the right track with the sleep being the root of the behavior and where we need to start first. She needs to do some consults on her own (ped, attachment therapists, play therapists), but is thinking attachment/grieving issues were the root of the sleep problems initially, compounded by the physical issues (making up calories at night, breathing issues) and are now an ingrained pattern nutritionally (still used to eating a large portion of calories and liquids at night) and emotionally (reference his preference for routine and rigid schedule for security). Referenced different levels of development emotionally/attachment wise, feeding skills, and chronological age, and that while stubbornness and arbitrary-ness is developmentally appropriate, he is on the extreme end and we want to take away his comfort mechanism and sleep strategy and change his routine all in one. She wants me to order and start using the sustained released melatonin, and consider giving him extra daytime doses for extra naps on the weekend and see what it does to his behavior with having more rest. Whatever we do, she feels we need to go very slowly, and bump up security and attachment stuff when we do it, and that what we do "has to fit with out family". We will meet again after my comps (no time to implement changes that could backfire before then LOL) So a little slower than what I would like--I want magic pills and answers LOL--but at least we have direction and validation.
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