ADHD and high school

[olivehater]

Just spoke to my recently ADHD diagnosed Y6 child’s teacher and she was more negative than expected. Said he’s wild at times and really struggling in class and she felt sorry for him. I asked if they have been implementing some of the recommendations from the dr that diagnosed him and she said they had. He is not on any medication and as we had him diagnosed privately it would probably be difficult to go down that route quickly.
Thing is they have been doing sats exams and he is getting greater depth in everything and she says she full expects him to get 100% in his maths. So so far it doesn’t seem to affect him on an academic level. He is also very popular with lots of friends so socially it isn’t a big issue either.
DH not keen on medication if we can get away without it and also not keen on him being diagnosed under the NHS for fear of it affecting his future.
I guess I just worry about the future and how he will cope with high school and whether he will be able to keep the academic side up. He’s is naturally very bright and doesn’t have to work at the moment but I guess that can only get you so far.
His adhd is more related to the impulsive hyperactive side. He does have some aspects of inattention but didn’t meet the threshold so I realise he is mild in comparison to others.
Will things get better or worse at high school? What are others experiences?

In our experience, secondary was when it really started to have an impact. Especially as academic work gets harder and they are expected to be more mature and to start focusing more and having better executive function.

Why would you feel an NHS diagnosis would have an affect on his future?

For us medication has been a huge benefit. I knew DD was ADHD, but she was coping fine... until suddenly she wasn't. We then had to pursue medication and diagnosis in a rush. I wish I'd done it in Y5/Y6 now.

The chances of schools implementing any techniques at secondary are very slim. He'll have different teachers for every class and they'll change every year. If he's clever and doing okay (not necessarily near potential) then there won't be much help, but they crack down hard on poor behaviour and disruption.

My DD is not disruptive at all, so we don't have to deal with that side of things, but I hear so much from parents with boys who are endlessly in trouble who are ADHD.

I would think very carefully about whether you really want to avoid medication.

My son was diagnosed and medicated in Y9, he never had an issue in primary. He is inattentive but not hyperactive and they just used to roll their eyes at the forgetting/late/disorganised. He was in constant low level trouble in secondary for the same sort of thing - lots of negative behaviour marks. It’s difficult to say what has made the most difference - the diagnosis and an IEP means the teachers cut him a bit more slack, the medication has improved his grades significantly. In my experience secondary is when things fall apart for SEN children unless they are robustly supported. I’d go back to private provider and discuss medication - will NHS accept shared care? If not then get into right to choose waiting list for an NHS diagnosis.

My son has inattentive and hyperactive aspects of ADHD and now yr8 of secondary. Luckily his secondary is less strict than many, so he's not getting too much flack over his behaviour. He has been medicated on and off, but he is quite resistent to the medication so it is a struggle. What has really helped is e-mailing each of his subject teachers individually with his one-page profile and talking about what works for him and the difficulties he has. I've explained the need for clear, written instructions and needing to use a laptop/tablet for longer writing tasks. I was told by some experienced in this sort of thing that I needed to step back and leave it to school to deal with, but they are stretched and if I had waited for them to share his info with teachers he'd likely have been in trouble before they knew and I didn't want him wrtten off as 'naughty' before they'd been told.

As an example, he swore at a boy who had been winding him up in class, the teacher called for someone from the inclusion centre to come and support him, but they were busy and forwarded the issue onto 'general callout'. The deputy Head of Year who hadn't had any previous dealings with him came and took him into isolation and told him to copy text out of a textbook. A completely inappropriate response to the indicent (maybe okay for a NT child, but not an AuDHD one) so I wrote a strong letter to school asking why this had happened and that it assure that it wouldn't happen again. That deputy Head of Year is now one of his subject teachers and has a great relationship with him and constantly encouraging him and praising him, and put him as "exceeding" in the subject. All because she now knows about his needs and struggles. That is the difference between teachers knowing the child's needs and not knowing, so I have made it a priority to ensure all teachers know about him, and have said I'm happy to discuss any issues to prevent them escalating.

Good luck with your son.

Based on your last paragraph, I’d be concerned that he will be in trouble/detention a lot because the rules are usually much stricter at secondary and year 7 is a common age for boys to be act silly because of hormones and trying to act older than they are.

How is his organization skills ? Not having the right equipment or bringing the right books/homework is often cause for a behaviour mark.

Why would a diagnosis affect his future? It's the ADHD that could affect his future

Get him diagnosed if you do care about him.

There will be tradeoffs when it comes to being labelled, in his own mind and by others. However, he surely is aware he's different from his peers and also the struggles he has to handle some basic tasks when others don't have any problems. It would really affect his confidence and self-esteem.

Plus, the life in secondary requires so much more independence - he needs to rely on himself way much more than up to now. Putting academic demand on the side, he would need to be able to cope the much stricter standard in terms of behaviour at secondary and the autonomy extended to them to be able to organise their daily schedules/equipments.

All these outweighs your husband's worry. As parents, we can't control the far future. What we can do is to provide support for them to grow and adapt to what life is asking from them. Medication or not, two worlds differences.

We diagnosed privately and titrated medication privately too (cost a fortune). Once the dosage is settled, our psychiatrist reached out to GP and set up the Share Care Agreement to allow GP for regular prescription. It's a standard procedure in NHS.

This is mostly my husband speaking. He is very wary of labels and has always dragged his feet over getting a diagnosis. He also shows traits of adhd ( and would admit as such) but has managed to be successful in his career so thinks it is uneccesary .

My DH is the same. He thinks labels will have a negative effect and prefers to have him struggle and figure things out for himself which will be beneficial for him on the long run. It's one of those things where do you let the child suffer and be misunderstood but ultimately the child knows that there is something wrong with them or do you allow the child to muddle through with difficulties but let them figure out later in life on what works and what doesn't. My DH also has adhd and very hardworking and very financial successful but also struggled academically despite finishing uni and a masters degree but he did have a hard time in the school environment. We are currently discussing an assessment for our boy and my main worry is secondary school years although we are a few years behind but arguing the benefits of an assessment. My argument is for him to reach his full potential, my dh's is that he will if we allow him to without interfering with assessments and adjustments as life doesn't make you any adjustments.

Thing is that if a child is ADHD and it's noticeable to the point where you are going to the effort (and expense) of getting a diagnosis then you can forget about the label worry. It will be blindingly obvious to anyone who knows anything about ND kids.

The chances are that it will be massively less obvious if he's treated for it.

DD's ADHD symptoms are very recognisable when she's not medicated. Medicated she copes with everything so much better and most people probably wouldn't know if she didn't tell them.

I know many, MANY people with successful careers despite their ADHD - but they would all have had a happier and easier life if they had been diagnosed and treated as children. There are no medals handed out for suffering your way through.

Nowadays life makes you lots of adjustments if you have a disability.

The difference the medication makes can almost rewire their brains - even if it's just being more confident in their own abilities. The relationships with other people when your executive function isn't useless (especially teachers and authority figures).

Extra time, prompts and rest breaks in exams. All helpful adjustments.

as an adult, your dc can decide what he does with the information - it's not compulsory to tell his employers for example. A child won't have exactly the same experience of adhd as his parent had, so there's no guarantee he will cope with school in the same way.

Do you think you might be minimising the symptoms a bit due to his academic achievements? This bit from the teacher jumped out at me ‘Said he’s wild at times and really struggling in class and she felt sorry for him.’

Thats quite a big red flag to think about medication before secondary as I imagine they’d come down much harder on him in that setting.

Your son already has an ADHD diagnosis. An "NHS diagnosis" isn't a separate thing. You can ask your private provider to agree a shared care agreement with your GP. Being diagnosed with ADHD has no effect on his future beyond meaning he has access to support he needs.

There are options which aren't medication, but doing nothing and just leaving him with a diagnosis but no therapy or treatment isn't going to be helpful.

For many people, meds are the best choice and change lives.

ADHD kids often really struggle at high schools as so different from primary. Totally different and could have up to 20 teachers in a week.
As the parent of a child with adhd I don't get why you'd not try help them and try medication etc. Shared care is private diagnosis and nhs prescriptions. If a child has poor eye sight or deafness they don't get left to struggle

In my view, and I know views are mixed and I respect that....a diagnosis is empowering. My son (ADHD and Autism diagnosis a few years apart), started struggling a lot more in year 7 onwards and that's what led to us seeking a formal diagnosis. He owns his neurodiversity beautifully and is open and very articulate about who he is and what he finds harder than his peers. He wouldn't be able to do this without a diagnosis. He's a great advocate for other people at his school also.

He takes medication, only on school days which is OK with certain types of meds. I was hesitant for a long time but it's helping him stay "OK" at school. He's in Year 11 now and sitting GCSEs in a few months.

As others have said, a diagnosis done privately, if done by the recognised professional, will be passed to his NHS record already I suspect. Getting medication via CAHMS is very hard in my experience. We'd still be waiting if we'd not gone private. Which is a bit eye wateringly expensive (£75 a month), but worth it as it helps him get through school.

Your son may be managing now but at some point he might need support and meditation. My very bright son managed all through school, but would have failed his degree without the ADHD medication which he started in his 2nd year. He said the difference was amazing and for the first time in his life he could concentrate on what he was doing. Why would you leave your child to suffer without offering him the option.

There's another factor steered me towards medication after a very long period of hesitation.

Check this page for a research article. There are some others across many years to suggest the same. Medication might help normalise the ADHD brain structure. Obviously, you can debate you never know if any research papers are backed by big pharmaceutical companies. But there's always a judgement call to be made by us in this information saturated world.

https://pubmed.ncbi.nlm.nih.gov/38409281/

It’s isn’t about leaving him to suffer. Even the psychologist that diagnosed him was hesitant to use medication at the moment. She suggested we read up, educate ourselves a bit more, and try different strategies first which is why I am interested in what others experience of high school are.
But I will go to his GP and ask what next steps would be through them. Even if I just got him on some sort of wait list. So that we could speed things up if we did need him to have medication.
One thing I do recall her saying is the medication helps more with the inattention side of things. If he needs to focus he can. He struggles with is impulsiveness and his pent up energy.

Medication needs to be supervised by a psychiatrist and can't be by a GP (they can prescribe under shared care, but all follow ups will be with the consultant). In our area it was a minimum 3 year wait for NHS.

To be honest, the strategies that work are basically you, the parent, taking over as much of the life admin as possible - so ensuring they have everything packed for school the night before, being on all emails and apps and sitting over homework etc. Also assuming that they're probably about 3 years delayed in terms of frontal lobe development - so not letting them have the same kind of freedom as their friends as you might if they were NT. Lots of physical exercise can also help a bit.

But none of them really work without medication as a back up.

DD is primarily inattentive but has ADHD rather than ADD. The biggest visible effect is on things like fidgeting and impulse control, she's always had extreme hyper-focus, it helps a bit with focus on things she's not actually interested in but I wouldn't say it's the primary effect.

With Y6 at the moment, you might be okay with NHS waiting times. It did take around a year to get meds to the right level for us, so bear that in mind. We ended up going private in Y9 as needed everything sorted fast because of GCSEs.

ADHDer generally manage to focus/hyper-focus on things of interest and can't get interested/focused/started on things that do not interest them. the name ADHD itself is a misnomer sadly and only confuse everyone. I don't any ADHDer is not able to focus at all :(

ADHD is primarily an regulation issue (lack of ability of regulating the attention) and a performance issue (they know what needs to be done, they know how to do it, but can't perform it).
Medication quieten the mind so instead of having 1000 thoughts running at the same time, you have less noise.
To quite Dr Russell Barkley "medication makes your child less disabled". please listen to his podcasts or find him youtube. or look on the very informative and balanced website ADDtitude

Well, you came here for advice but don't seem to be ready to take advice. Why post this?

Return to the basic I don’t know know part of my post suggests I am not ready to take advice.
I am just a mum trying to work out what my next steps should be, stating what I have been told so far, and what I do/dont understand about him.
I have already said I will go to my GP to get the ball rolling on the nhs which I initially talked about not doing, and to see what my next steps should be. I can’t really afford to keep going down the private route unless it becomes the only option and I won’t rule that out either . I have had quite a difficult weekend with him this weekend. So am feeling quite emotional about it all.

I am taking all of the advice written on board and will read all the articles linked.

I would start the ball rolling with the NHS wait list...in 3 years you might be desperate to try meds.

bunny cat I do think his academic achievements have delayed his diagnosis. Whenever I asked teachers in the past if they thought he had adhd they just said “no. He is able to focus. He is bright.” I had a long phone call with the sen person at school when he was in year 2 or 3 and she was adamant he would not be diagnosed. Then he had a couple of very laid back male teachers who didn’t seem bothered. It was only when we have got to his year 6 six teacher ( newish to the school ) that is started to come up again and she seemed concerned about his behaviours that it prompted us to get a private assessment. The sen teacher remains the same. I don’t at this point have much faith in her. If she had helped me with a referral to cams or whatever it is we wouldn’t be in this situation now.

He scored on the 99th centile on the qbe test so there really is no doubt in his diagnosis but the fact it isn’t Combined ( he did not meet the threshold for inattention ) is confusing things for me. It is also, I have been told, the rarest from of adhd making it difficult.

Sorry OP, my comment wasn't nice. But I did feel a sense of frustration that your husband tried to downplay the suffering of growing up with ADHD. And I felt angry for the logic of leaving him to deal with the world alone and "suffer" when we all know he can't function like others. The damage on self-esteem is non reversible sometimes, particularly at teen years when social life is a very big part of self identity .

Do some more research online about the pros and cons of medication yourself. A lot of research across decades. Advices from us only apply to our situation. Medication do have drawbacks and risks. Collect as much information as you can and then make informed decision.

CBT is a proven way to help him learn to be self aware and regulate emotions without medication. Some people believe in dietary adjustments to help too. But nothing can compare with medication if it works for any individual.

As a mum with ADHD to an ADHD child, I do hope your DC finds his path either way. Good luck.