Period of Adjustment

When a child's behavior suddenly strays off course, look for the real reasons.

Period of Adjustment ADDitude Magazine

If your child's behavior goes suddenly sour, it may not be him — but his meds.

Larry Silver, M.D.

In early April I saw a 15-year-old boy for a follow-up visit. I first evaluated him in fifth grade and diagnosed him with ADHD Combined Type. He was started on medication. At the time of his visit, he continued to be on medication.

Bob was in ninth grade. He was a good student and had never gotten into trouble in middle school. Teachers liked him. He was polite and had a good group of friends. He loved music and played several instruments in the school band and in his own band.

However, Bob had some difficulty getting used to the rules of his new high school. Teachers sometimes needed to remind him not to talk in class or not to be late. He was in all honors classes and his grades for the first part of the year were good. Then came winter break. (I can only surmise that school policy was to go easy on new freshman initially; however, after winter break, all rules were expected to be followed.)

Innocent but guilty

In mid-January he was taking a test. At one point he whispered something to a friend. (“Meet you after school.”) He was sent to the principal’s office. This school had a strict rule: no talking during tests. If you talked, it was assumed that you were cheating. He was suspended from school for three days and given an F on the test. No one listened to him explain what he had said. He spoke; therefore, he cheated.

Two weeks later Bob walked into school. He realized that he had not turned off his cell phone. (Cell phones were allowed; however, they had to be turned off during the school day and students were not allowed to use them.) It did not occur to him to go to the office and explain what he had to do or go into the bathroom. He took his phone out to turn it off. A teacher saw him. Five days of suspension. Three days after returning to school, Bob was sent to his math class to make up an exam. He finished about five minutes before the end of the period and decided to return to the class he was missing. He forgot to pick up a pass from the math teacher’s desk, was caught in the hall without one, and was suspended for another five days. (By now, the Assistant Principal saw him as a troublemaker and took severe action.)

Bob had gotten As and Bs for the marking period that ended before winter break. However, for this marking period, he got Cs and two Ds. The grades reflected the price of being suspended. He made up all of the homework. However, he missed what was taught in class and had a lack of information to study for tests. He was devastated. His parents were angry. They asked to see me to see what I could do with his “adolescent rebellion.” They had taken away his big interest, guitar, but his behavior had not improved.

Bob was a nice kid. He was upset about what happened, and tried to explain each event. There was a common theme. Each infraction was done quickly and without thinking — speaking to a friend in class, turning off his phone, and returning to class. None of them were done with malice or with any concern about possible consequences.

I learned that Bob had had a growth spurt over the summer and fall. He’d grown about four inches and two shoe sizes. He spoke of being more fidgety and having difficulty staying on task. He had not thought of his behaviors as impulsive, but they were. I suspected that the amount of medication he was on was not adequate any more. The dose was adjusted upward, and the “bad” behaviors stopped.

But the damage was done. He had a reputation in his new high school. His grades had dropped. There was a question about his remaining in honors classes for the next semester.

Bob had a 504 Plan, a program of instructional services put in place to assist a student with special needs. His ADHD was known to the school. What happened? When he had problems, why did no one at the school remember his diagnosis and wonder? His parents knew he had ADHD. Why did they not wonder why this nice kid was getting into trouble? It is easy for teachers, administrators, and parents to blame the victim. No one looked at his 504 Plan and speculated about this change in behavior.

Maybe the problem is that, if a child with an IEP (Individualized Education Program) is suspended, a special IEP meeting must be called to review whether the behaviors reflected his disability. However, there is no such plan for that course of action in most school systems for students with a 504 Plan.

Look at the whole picture

Parents! Teachers! School Administrators! Please listen up. ADHD is a neurologically based disorder. Medication can minimize or stop the behaviors caused by ADHD by correcting the neurochemical deficiency. If the behaviors return, it is necessary to find out why. Are there stresses? Is the dose or type of medication adequate? If a diabetic who was on medication suddenly began to pass out in class, wouldn’t there be questions as to the effectiveness of the medication? Why is ADHD different?

If a child with ADHD who has been under good control with medication begins to have less control, should not teachers and parents ask similar questions? Is the medication working? What’s wrong with this picture? A nice kid suffered emotional and educational setbacks because no one stopped to ask whether his behaviors might reflect his disorder, and whether his medication might need an adjustment.

The lesson here: Be your son or daughter’s advocate. Don’t take the easy route and blame the victim. Stop to think about what might lie at the root of the behavior. In Bob’s case, a slight adjustment of medication stopped his “rebellious behavior.” But the damage to his self-esteem and to his reputation at a new school still had to be repaired.

 

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