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ADHD and the Wrong Crowd
Q: My son was diagnosed with ADHD in first grade. He is now in eighth grade. He has been treated with medication since first grade with varying degrees of Ritalin®. Last year my son started seeing another doctor who didn't like Ritalin® and put him on Dexedrine®, which didn't work for my son. He became more hyper and very obnoxious, disrespectful, etc. Then the doctor changed his medication to Adderol® and it seems to be keeping my son pretty focused. He is also taking Imipremine® before bed. But, my son is a very unhappy boy. He has been in special education classes since he was diagnosed and he has done pretty well until middle school. The kids have been quite mean -- calling him stupid, etc. Last year my son was in a lot of trouble at school. Because he felt lonely and friendless, he connected with a couple of boys who were always in trouble -- we had several bad disagreements over the boy. Fortunately, summer vacation came before more trouble. We have since moved to another state and another school for my son, but he is again falling in with kids who are a bad influence. My big question is how do I keep him away from them without the disputes I had with him last year? He thinks I am being judgmental and unfair. I want to nip this in the bud before detentions and suspensions start again, let alone other problems. My son is a big kid for his age and I have always had discipline problems. I would appreciate your input.
P.S. I have brought my son to several child psychologists and I have been to many different ADHD classes, seminars, etc. -- to no avail, it seems.
A: Sounds like you have your hands full! You've got a son who has had difficulties in school that have resulted in him being a bit of an outcast. Without the chance to experience academic or social success, he has been drawn to kids who promise to give him some status and some excitement -- what a difference from the way school feels! He needs to keep working on improving his academic skills, but this has to be done in a place that will help him understand his own learning style and needs, so that he can be more involved in his own learning. Sometimes a specialized program for students with learning or attentional difficulties is the only way to break into a cycle of defeatism and failure. Your school system may have an alternative program within the school which might be appropriate. Be careful not to enroll your son in a special program that is designed for students with significant behavioral problems. I worry that he would sink right to the bottom. If the program focuses on learning difficulties -- that's another thing. If finances permit, you might consider having your son attend a special private school that can help him understand himself as a learner and feel more successful. You may only need to do this for a year or two in order to get him back on track. This would also put him in contact with a larger number of "nice" kids who are just having trouble learning.
In order for your son to pull out of this, he's got to have something outside of school that is more attractive than school or those tough kids, or other bad influences. Some students find it easier to resist the temptation to do the wrong thing when they get involved in scouts or a church or temple related youth group. It would be very good to find someone who can serve as a mentor or guide for your son. The right teacher may just be able to play this role. Finding your son a Big Brother, a service which may be available in your area may also be a good way to connect your son to better influences. It sounds as if he is too young for a "real" job, but having a chance to work in a family business or in the school (perhaps as part of a work-study program) would add meaning and purpose to his life and help keep him on the right track. Programs such as Outward Bound, that engage teenagers in safe but challenging encounters in the out-of-doors, might help your son get in touch with his inner strengths and develop a better self-image.
A consultation with a psychopharmacologist who specializes in the treatment of adolescents can help you determine if your son is on the right doses of the right medication. You can ask your pediatrician for a referral or call a children's hospital in your area. Since you and your son have gotten into some struggles about his choice of friends and activities, you might think about seeking the services of a family therapist to help you communicate better and work out some mutually agreeable guidelines. Contact the school guidance counselor for a referral, or call the state affiliate of the American Psychological Association (www.apa.org) in your state capital. A group at school run by the guidance counselor or school psychologist may also be a way for your son to form more wholesome relationships with other children.
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Jerome (Jerry) Schultz is the founding clinical director of the Learning Lab @ Lesley University, a program that provides assessment, tutoring, and case management services for children with learning challenges. Schultz holds a Ph.D. from Boston College, and has completed postdoctoral fellowships in both clinical psychology and pediatric neuropsychology.