The Magic Pill (part 4)

[This is the fourth part of a series of posts telling a single story.  You can read the first part HERE.]

“You have a number of options,” the doctor said. “As far as your school system goes, they’re not going to do anything for you, at least in terms of putting him in an Individual Education Program or classifying him somehow, because he does not meet their definition of learning-disabled.” She weighed two sets of papers, one in either hand. ”The way it works is, they look at the intelligence test scoring and the academic test scoring. The intelligence test scoring shows them how smart he is, and as a derivation of those numbers, how well he should be performing academically. The academic test scoring shows how he is actually performing, in reality. If there’s too big a discrepancy between how he is performing and how he should be performing, that represents a learning disability. Which brings us back to the WISC-4.” She dropped the papers. “Unfortunately, because his new WISC-4 score is now lower than his original WISC-3 score, his academic performance lands squarely in the target range of where the WISC-4 predicts it should be. Indicating no necessity to take action. Even though he’s sliding, and you know he can do better, and his teacher knows he can do better, and I’m positive he can do better just from having spent this short time with him.”

Great, I thought, scowling. He’s getting boned by a more accurate test. Will wonders never cease?

“However,” she continued, “what you can get put in place is something called a 504 plan. The 504 plan– it takes its name from the paragraph number of whatever bill it was that made it a law– allows you to approach the school system, and work with them to get modifications made to the classroom environment and teaching structure, because your child has a medical condition which necessitates it. And ADHD is a medical condition.” She shrugged slightly. “Takes a note from his pediatrician or a pediatric neurologist or whatever authority they recognize. Lots of parents do that, and generally, in my experience, school systems like that option, because it takes a lot of stress off them, and doesn’t cost them any money like an IEP or a specialist teacher does. They have a book of stuff they can do for 504. This thick.” She held up her fingers, a few inches apart. “They’ll ask you what you think should be done to structure his program in the classroom, ask his teacher. And it’s not set in stone, they’ll review it every year, see if it needs to be changed, or if it can be done away with altogether.”

“There are also plenty of things you can do at home, in a similar fashion,” she continued. “Environment modifications and work strategies. You can change the way you and he do things, to help him learn coping strategies and work-arounds. Like the math problems, for instance. If he’s got a mixed page of multiplication and division, it can be a simple as you highlighting the divisor signs with a highlighter, or teaching him to do that first, so it draws his attention to it, and he doesn’t mix up one for the other if he gets distracted. Things like that.”

Weaver looked dubious. “It took the two of us working together with him four hours to get his book report done, and it was like pulling teeth all the way. If you put him at a table with stuff on it to do his work, he’ll play with all the stuff. If you take that away, he’ll play with his pencil. If you take everything away, and leave him sitting there with nothing, he’ll play with the crumbs and the dust bunnies, and be perfectly happy, just as happy as he was before. And still not do the work.”

The doctor smiled. “I can see that. Just based on what I saw here alone, I can imagine his teacher is pulling her hair out.” She glanced at me, saw my slight scowl and the puzzled look I was giving Weaver, quickly assumed a more neutral expression. “I’m not advocating one course of action over another here, I’m just making sure you guys know what all your options are, that it’s all on the table. Another option is medication.”

“What does that involve?” asked Weaver.

“Stimulants, essentially,” she responded. “There are a number of brand names– Ritalin is the one everyone seems to know– but pharmacologically, they all use the same two or three drugs, and they’re all stimulants. You wouldn’t think you’d want to give stimulants to someone who’s hyperactive or can’t concentrate, but in people with ADHD, they actually have almost a reverse effect, dramatically improving their ability to focus. We’re still not 100% sure why. There’s a lot of variables, including in the delivery. You can give two subjects of identical weight, age and sex the same dose, and one will show no effect at all, while the other will show dramatic improvement, because of their relative metabolism speed– or because one is no good at swallowing pills and cheeks them.” She allowed herself another smile. “Each person is different. We have a very large, very concrete, very long-term body of evidence showing that the medicine does work, for a lot of people, and decades of experience working with people to get them on the right dose of the right drug with the right delivery. But it doesn’t work for everyone. And you may or may not be comfortable with the whole idea. I’ve had parents who have had their kids on it for a few years, and it hasn’t worked out for them, because the child doesn’t seem to be getting any more benefit out of it than he can with the coping strategies. I’ve had other parents who have resisted doing it for years, used the coping strategies instead, and then when they’ve finally tried it, have said, ‘Oh my God, why didn’t we do this years ago?’, the change is that dramatic.” She leaned back in her chair. “There are definitely lots of people with ADHD who go undiagnosed, who never have the option to take medication. We tend to find them in high-energy careers as adults, where they can turn it to their advantage.” She grinned, suddenly. “We also find, interestingly enough, that a high percentage of those people– the ones who start out undiagnosed and then get accurately diagnosed later– turn out to have been self-medicating the whole time, via intensive use of non-pharmaceutical stimulants. They drink a lot of coffee and Red Bull. Smoke a lot of cigarettes, to get the nicotine.”

Gah! All I could picture was the “Ironman” movie, with my grown-up son replacing Robert Downey Jr. He’s doomed. He’s already Tony Stark as it is, standing in that CAD hologram, building weapons. It was a neat finding, though; I smiled, too, and nodded appreciatively.

“You can also do all of the above,” she stated. “The approaches are not mutually exclusive; they complement each other, and often give better results in tandem than they do separately. We call that approach ‘multimodal’.” She looked at us both. “We’re here for you as a resource, to give you information and help you help decide what’s best for you and your child. Deciding what that is, that’s up to you.”

I glanced at Weaver, but she didn’t glance back.

“We’ll have to discuss it,” I told the doctor.

[continue to the next part]