My son has always been an active little boy. Ever since he started walking (pretty late, at 15 months) he would dash places. Not just run, actually dash. I have legs way longer than his (I like to think) but I have trouble keeping up with him. And recently, I have begun to suspect that it isn’t just him being an active boy. ADHD and autism share a genetic risk factor, and the conditions seem to coexist quite often. So it is likely that his impulsive and hyperactive behaviour is caused by ADHD.
There are three types of ADHD. There’s Predominantly Inattentive ADHD, the main signs of which are (you guessed it) lack of attention. A child with this kind of ADHD might find it hard to pay attention, be easily distracted, and have trouble completing tasks.
The second type is Predominantly Hyperactive-Impulsive ADHD. A child with this type might be very fidgety and have trouble staying seated for long. They might have trouble with ‘quiet play’ and be extremely over-active.
The third type is Combined, where you exhibit both of these types together (of course Michael being Michael, this is the type he has). And while we might all exhibit some of these characteristics, the key to ADHD is that you do a lot of them in your everyday life, in a way that is out of keeping with your developmental level. Michael being only just under three, we can cut him some slack. But his symptoms are pretty extreme. I have found a video of a child with ADHD and he does everything that this boy does – only more so!
You’d think I’d have figured this out earlier. There are so many signs. I can’t give him a massage – because he won’t stay still for it. I can’t play games with him unless they involve a lot of action. If I help him jump on a bed (which he loves) he will wriggle away within about two seconds because he can’t even stay still or concentrate on jumping (!!!!!!).
How ADHD has made Michael’s life challenging
Most things in life that he might enjoy, he cannot do because he can’t stay still long enough to do them. He has a scooter that he loves, but all he ever manages to do is climb on it. As soon as I run over to help him by pushing it, he runs off. Most of the time, even before that. Even when he sits on a see saw, he needs to get up every five seconds, dash to one end of the backyard, and dash back again. Sit down, ride for a little while, and repeat.
I used to joke that if you could bottle Michael’s energy, you’d make a fortune. And then in Gymbaroo when he was 15 months old and I saw him next to about ten peers, I stopped joking. How can he learn, if he can’t even walk in a circle? He dashed off from every activity. For heaven’s sake, children with autism are supposed to have obsessive interests. They’re supposed to concentrate really hard on things, and line up toys and stuff. It says so in every textbook!!!!
Until we started therapy, I had never seen Michael concentrate hard on anything for over two seconds, without running off and coming back again. Except cartoons, he’s ok with those. Or food, if he’s strapped into a high chair. He doesn’t seem to be able to control his behaviour. Even if I put on a toy that he likes, that I saw him watching, he still had this irresistible impulse to get up and run off.
How ADHD Has Made Our Lives Challenging
It has made many things very challenging for us. In some ways I’d argue more challenging than his autism.
It has made it hard for him to learn new things, as he can’t hang around long enough to watch them. It has meant he has very few ‘rewards’ that I can use for him and has nothing to do in his leisure time other than running around madly. The only way I can get him to sit still is to put a cartoon on, or to put him in motion (for example, in a pram). That whole ‘quiet play’ part of a bedtime routine, only happens with the help of some ‘quiet cartoons’. If I didn’t use those, he would spend the hour before bed running around the house.
Where’s that obsessive interest when you need it? It would be super handy in therapy sessions if I could have a reward that worked every time. Where is that neat lining up of toys? I was promised that my child would line up toys and stack things. Stupid experts.
Every time I see a child enjoying something with his parents, I think – Michael wouldn’t like that. He’d have to sit still for that. He wouldn’t even bounce on a trampoline, because that isn’t enough motion for him.
Channeling the Energy Into Productive Channels
Maybe one day he will become a champion sprinter or soccer player. Well not soccer player because you have to concentrate on a ball and follow it. Probably not a sprinter either because you have to wait at the starting line and listen out for the pistol. And of course stop at the end. Maybe a champion marathon runner? Except for his tendency to run deliberately onto busy roads into the pathway of cars with no regard for his personal safety…I’m working on ball skills with him all the time in the hope that he grows up to be a soccer star. No luck so far, but he does enjoy holding the ball and licking it so that’s a start. Right?
I’ll think of something eventually. I will of course help him with the sensory challenges and the behavioural ones. My job is to channel that energy into a productive channel, no matter how hard it may be. After all, I do kind of like the kid. But for now, it is just driving me absolutely mental!
Treatments that help with hyperactivity and impulse control
Lately, I’ve been doing a lot of research about ADHD treatment. This can be both psychological and medication based, and obviously the first type is always to be preferred. Medical bodies tend to recommend that young children under school age should not be given access to medication, and should pursue behavioural strategies to help with symptoms.
Once Michael is older we can perhaps send him to Cognitive Behavioural Therapy, which apparently also helps with symptoms of ADHD. I know that this has been modified for individuals with autism and maybe one day it will be an option for us.
However at the moment all we can do is use ABA strategies to help him to control his impulses, pay attention, and complete tasks. And of course, try our best to make sure that he gets enough sleep, plenty of opportunities to run around, and has a good diet.
Our Behavioural Strategies To Help With ADHD
So far, the behavioural strategies we have used have definitely helped Michael calm down. We have worked on increasing the period of time he can play with toys or look at a book, up from two seconds to a minute. In a separate program we worked on how long Michael could stay seated in a chair. Miraculously he can now do this for five minutes, as long as we stay with him and keep him engaged with mildly interesting toys. To keep him safe, we have programs to teach him words like ‘STOP’ and ‘No’ but of course if he wants to run into traffic, there’s very little I can do to stop him other than grab his hand.
Many of these have been improving his ability to complete tasks and control his impulses. For example, he can now sit to complete puzzles or put shapes into a shape sorter. He still loses concentration often within the task, but he can bring himself back and keep going. And of course we work on his impulses to get up and dash off. We do this by making him give us a ‘GO’ visual every time he wants to leave. That way he can get up any time, but it is not so impulsive – and hopefully not as disruptive in a future classroom.
These behavioural strategies have helped Michael and we have been using them for about a year. However he is still extremely hyperactive and impulsive, with many dangerous tendencies to dash off into danger. I also worry that he is not getting as much out of his early intervention as he could. He has so much trouble completing even a simple task that it stretches out from ten seconds to a minute. He can probably only pay attention for about five seconds continuously without needing a pause.
Therefore I have also been researching medication options and have made an appointment with a specialist to help us decide if this is appropriate. Possibly, we won’t pursue this option until he is at least six years old. Maybe he will ‘calm down’ and learn to harness this energy in a more productive way by then. But I want to hear my options from a professional now and make an informed decision. Autism Speaks have a great decision sheet that allows you to consider the pros and cons of medication.
So far my research has brought up two main medication options. There are stimulants like Ritalin or Concerta. They target behaviours like hyperactivity and a short attention span. Their side effects include loss of appetite but Michael is on the 75th percentile for weight so I am not worried about that one. However, it also causes difficulty in falling asleep and that is already a problem for us.
There are also Alpha Agonist medicines like Tenex and Intuniv. These also target short attention spans, hyperactivity and impulsive behaviours. However they have an added ‘bonus’ for us that they also help with sleep problems. Their side effects include drowsiness (therefore taken at bedtime) and irritability. Often a combination of stimulants and alpha agonist medicines will be prescribed. A child might take Intuniv before bedtime and Concerta with breakfast. Mostly this will be children aged six and over, and of course they would need to be very closely monitored for unforeseen side effects.
I am not one to jump into medication. It took me a long time just to start melatonin, even though that has helped us tremendously and it is relatively harmless. So the idea of giving my little one this much stuff every day, although we would be replacing the melatonin with one of them, is pretty scary. Especially since their effect on his nervous system is unknown, with the autism a possible complicating factor. On the other hand as long as he is monitored and we find the right combination of medicines it is possible to find ones that will have maximum benefit for minimum side effect. I suppose it will be one of the many difficult decisions we have to make as special needs parents.
I suppose my main conclusion so far has been that the behavioural strategies will continue no matter what. The medication will be kept to the smallest doses, and any symptoms carefully monitored. If there is no ‘WOW look at that result!’ we won’t keep going. But from my reading it seems that if you get the combination of medications right, it can have less ‘bad’ side effects and can really help with school and home. Decrease stress levels. Help with sleep. So bring on that specialist appointment, I am ready to maybe possibly consider this.