Yesterday we had the appointment with the Pediatric Nurse Practitioner who specializes in pediatric mental health. She was wonderful. She took the time to really hear our concerns and asked very relevant questions. I felt like she was present with us in the room and not just trying to get to her next appointment. She spent a whole hour with us.
She agreed with the diagnosis of ADHD (obviously). She also talked about RAD. As completely weird as that sounds it made me hurt to hear her verbalize that. But she also talked about another diagnosis that, as odd that this sounds, gave me relief.
She believed us. As scary as this diagnosis could be, it was huge validation that we are not just raising a difficult kid, it is not our fault that she is acting this way, and we are not making a big deal out of nothing. It is something. It is a big something.
In the mental health field there is a book that has been revised many times called the Diagnostic and Statistical Manual (DSM). It is what we use to diagnose mental health conditions. It is controversial and many many mental health professionals all want their research to be used or to prove that their viewpoint is better than someone elses. The current revision is the DSM-5. A lot of people are unhappy with this revision, but one good change (in my opinion) was the expansion of the Bipolar Disorder category. It used to be that "everyone" was diagnosed ADHD. Then "everyone" was diagnosed with Bipolar Disorder. A lot of people felt they were "garbage can" diagnoses for what didn't fit elsewhere. The DSM-5 revision expanded created a new category that I am much more comfortable with for those kids who don't meet full criteria for bipolar disorder, but also have behavior that is "more" than "just" ADHD.
Behavior that is exactly what we deal with in this house.
Tucked away in some research that I read about it, it says that:
"The SMD group had very high rates (≥85%) of attention-deficit hyperactivity disorder (ADHD) and oppositional-defiant disorder (ODD) over the lifetime"
SMD (Severe Mood Dysregulation) is just the name the research group put on it, it isn't the name of the actual diagnosis as it is currently listed in the DSM-5. But it clearly captures that kids in this category also have a very high likelihood of having the symptoms of ADHD and ODD too, like Grace does. Some researchers argue that it isn't actually any different than "just ADHD and ODD" and therefore there should not actually a new category. But obviously enough argued that it is enough different that it was included in the revision.
Unfortunately, because DMDD is such a new category (only several years old), there isn't a ton of research about it. Especially research on successful treatments. But she was started on a new med and that med has been around for a long time with good clinical trials and results. It remains to be seen if it helps this disorder well or not.
But at the end of the day, I am thankful for a clinician who took the time to hear us. I am thankful that the clinician is hopeful that the medication can mediate the extreme mood swings and constant irritability that she has. I am thankful that there is a medication at all that can be an option other than "just live with it." I am thankful that yesterday, this morning, and tonight's bedtime Grace did well, even with a lot of situations that were outside of her control and routine. She starts therapy on Thursday. We shall see how that goes. It will be very, very weird for me to be on the "other" side of the counseling table lol!
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Yesterday we had a pretty good day together, just the 4 of us. Since we had to drive a couple of hours to the appointment we stopped at the Cabela's there and my husband got to pick up some items he had ordered. I played the shooting game with the kids;) Then after the appointment we went to Red Lobster as JJ wanted "big shrimp." He has been asking for "big shrimp" for a few weeks. I cannot believe how much he likes shrimp lol! Grace tried a bite...then spit it out lol!
We rushed home to get to Grace's Christmas concert for school. We had some items we had to get at Walmart. JJ had a tantrum leaving the store (due to the rushing) and we didn't have time to deal with it due to the rush so it got hairy (I am more than a little scared that many of JJ's behaviors are just like Grace's - except he clearly does not have ADHD. I really hope he doesn't have DMDD too...). I got Grace there 45 minutes before the concert like I was supposed to, and waited in the car until closer to the concert to go inside. She came out crying and said that since she missed school they would not let her participate in the concert. She was hysterical. Hysterical. I was livid. How in the world can taking a child to a psychiatrist office mean they can't participate in a school concert? This appointment was a big factor in whether or not the child even remain in our home and still attend the school. How was it that when we told the school she would be gone, that when the teachers all handed her the slip with her homework on it since she would be missing a day, that NOT A SINGLE PERSON told us that she couldn't attend the concert? We had the option of this appointment or one in February, so obviously we were going to take the first appointment available (who looks at a calendar to see if their kid has a school concert when making psychiatric appointments?!?!). It was a total reminder of why we started homeschooling in the first place (opposed to a school board decision when Beautiful was to start kindergarten...) But, if we would have known ahead of time we wouldn't have rushed home (and would have avoided JJ's meltdown. I was shocked I didn't have to carry him out of the store - only my fear that security would have thought I was stealing him kept me from doing it - at least as he was chasing me and hitting me they knew he was coming willingly...) and would have avoided Grace's meltdown. Ha. Meltdown. Their tantrums are soooo much bigger than a "meltdown." Anyway. It is over now. Done venting. We will be better prepared next time.
Deep Breath...
However, amazingly, I got her calmed down within 30 minutes and held her while we drank hot chocolate and watched a movie together. Half way through the movie she said "this is better than the concert" lol! She went to bed (with her new meds) later than usual but didn't have any problems. This morning she actually said, "I am in a good mood." She was surprised that she felt good - and I was elated at a drama free morning!!! She also had a good bedtime tonight. 2 consecutive mornings and bedtimes is as rare as a unicorn. The meds should take full effect within 2 weeks - just in time for Christmas break. Praise God!!!!!
Thanks again for the support and prayers. They are tangibly felt and MUCH appreciated!!
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