It has been a long time coming.
First, there was the conference with Nemo's teacher in November that confirmed that she was seeing the same types of issues that I had been seeing, and that he'd benefit from being evaluated for services to treat those issues.
We saw our pediatrician in November, who asked "Is he always like this?" as Nemo basically climbed the walls and didn't stop moving. Yes, yes he is. We got a referral to Children's Hospital specialists. We called for an appointment and were given one. In May.
We talked to a private OT about his fine motor issues. That was cost prohibitive for us at that time.
We went to the county Child Find. They screened him. They referred him for further evaluation, in the form of more specific fine motor evaluation and observation of his classroom by a psychologist. And my worst fear? That he'd be having a good day? Came true.
He had a phenomenal day. He buttoned buttons. He'd never done that before or since. He was fast putting tic tacs in a small pill bottle. He held a pencil almost properly, and he scootched it back and forth in his hand, though she had to hold his left hand down to keep him from assisting that way. He'd never done that either. My husband and I were both shocked. He cut, he drew, he wrote, he built things with blocks. He was fantastic.
Still, he scored 8 months behind in his grasping, and was missing some skills that he should have mastered at 48 months. Despite that, his overall score put him in the 47th percentile, in the average range, and does not qualify him for services. He needed to have a greater than 25% deficit to qualify and they did not feel he fell into that range.
The next day his teacher told me it was like he spent all he had at the evaluation, because the next day his writing skills were worse than usual. Both she and I were intensely frustrated.
The psychologist came and observed the classroom but signals were crossed and neither Nemo's teacher nor I knew she was coming. His teacher was able to talk with the psychologist later, though, and tell her some of the things she had been seeing in the classroom. The psychologist basically recommended a "wait and see" approach, but told us at the "IEP" meeting (I put that in quotes because they were simply telling us that he didn't qualify for an IEP) that she was glad we were going to see a developmental pediatrician, because she was going to recommend that if we hadn't seen vast improvement in certain issues to see one in six months anyway. We were ahead of the game.
Both the occupational therapist and the psychologist stressed that they were only looking at educational disabilities. All they cared about was whether or not he was available for learning, so they wouldn't look much at his social skills or behavioral issues, except as how they may or may not impact his capacity for academic learning. But the developmental pediatrician would look at the whole child. Social issues, academic issues, developmental and conceptual issues. Everything.
And so we come to May, and saw the developmental pediatrician last week.
The room was just like a regular exam room, with an examination table on one wall, three guest chairs perpendicular to that on another wall, the doctor's computer workstation on the next wall perpendicular to the chairs, and a sink next to that. While the doctor asked a ton of questions and I answered them, Nemo tried his very best to be patient, but it was a long time for him. He started climbing down off the table, onto and over the chairs, around me, back along the chairs again, back up on the table, and back again. He responded to the doctor when she addressed him directly, interrupted liberally with whatever his concerns were (which were totally unrelated to what the doctor and I were discussing), and was his general charming, cute, and exhausting self.
After she had examined him, made copies of other reports I had brought with me, and had me fill out a questionnaire, she said "I feel secure giving him an ADHD diagnosis right now." She wrote out a bunch of instructions, referred us to the psychiatry department to have him further evaluated and have behavioral therapies prescribed, and referred us to OT to work on his fine motor deficits to hopefully get that improved before kindergarten starts next year. She gave me information on 504 plans and we talked a bit about what they are, what they mean, and what types of accommodations we will be asking of his teacher next year.
As she filled out some paperwork she had to do, she turned her said to the side and said "Oh, by the way, nobody has a history of heart problems in the family, do they?" Uh, yup. We do. So she told me she wanted him seen by a cardiologist before she would prescribe any medications for him, even though we agreed to start with behavioral therapies before thinking about medication.
I stopped by the registration desk to schedule the cardiology appointment, and serendipitously they were able to see us right away -- it turns out the cardiologist who was there that day happened to be our regular pediatrician's neighbor and had done her residency with him and his wife. One 12-line EKG later and Nemo had a green light for medications, if he needs them.
There's still a lot of work to be done, a long road ahead of us, to help Nemo be the best Nemo. But for the first time in a couple of years, I'm hopeful that we can get the help we need. Friday night I noticed that my neck and shoulders were sore and wondered why, then realized: I'd relaxed. For the first time in months.
Anybody with experience with young kids with ADHD who might have any tips or want to share your experience, please do. I have a steep learning curve ahead of me.