FOOT BALL

Lately my son is so much addicted to football. He plays football e.v.e.r.y.d.a.y with his school mates at the school yard. This news is good news to me. But then there is always the bad news that goes along with the good news.

Lately he has problem with keeping himself awake when it's time for him to study. In the beginning I thought it was more driven by his laziness. In the second place, I thought he was too tired because he has to spend so many hours for his extra lessons after school. But then if I traced the past, he had never had this problem before. So what is it then???

As a short cut solution, I let him sleep till ten o clock, woke him up and studied until 12 midnight before he went back to sleep. There were times I had been too tired to stay awake, so I let him sleep till 4 am before he had to sit with me and study. However, this doesnt seem to last for my body began to ache.

As I was striving to find a way out, I then realized that I was trying to give respond to an unknown question. Was it really the hectic schedule or was it because he's lazy? Suddenly I remember all those stories about playing football after school hours. The story of desperate drivers and nannies who have to strive very hard to drag the children home. The stories of the change in his eating habit, the story of extra shirt to school and so many other stories that goes around foot ball.

Aha.. this is the bottom line of the story. Now I know that football is the main cause why he could hardly stay awake to study. Knowing the problem doesnt mean it's easier to find the way out. I dont know how to find a solution for this situation. My son loves football and period. Btw, my husband is a football player and that explains.

THE GOOD NEWS AND THE BAD NEWS

It was Saturday. It was time to see the doctor for the latest result of the medication. I left my house with a pessimistic view. My son is not doing any progress. In fact it's getting a bit worse. I didn't do any efforts to check my cellphones for this is week end.

I arrived at the doctor just in time. We dont have to wait long before the doctor invited us to get in. I knew the typical questions that he was going to ask, but I was in such a doubt to tell the truth, affraid of him prescribing a higher dossage for my son. So when he bombarded me with questions, I responded with lots of uncertainty. He asked me if the teacher is seeing any progress in my son. I said I dont know for I had not been communicating with the teacher. He asked me how my son was with his sisters. I said he still is the same, teasing his sister around. He didn't seem satisfy with my responses, so he asked me to go out of the room for he wanted to check the progress himself.

While sitting outside, I tried to contact my son's teacher. As expected, she complained a lot. I told her how sorry I am and make promises that I'm not sure I can keep. As the doctor asked me to come into his room, he showed me the result of his observation. My son is making progress. I then told him my conversation with the teacher. He retorted sharply, I didnt promise to make your child a genius, but I can help to  him focus. As with his lessons, you have to deal with it yourself. The medication that I prescribed is not meant to make them make the quizzes correctly.  Let's give him another two weeks to go before we decide what to do with the medication!

We went out of town on the same day. I took all his books, over reaction things as always. At night, we sat together on the dining table as the cool temperature rushed in through the windows. My son would have a quiz on phonics and he had to study more than 50 pages. I was surprised, for he could manage to do it quickly and happily. He focused and burried his face deeply into his books. Before dinner, he managed to finish almost half. My enthousiasm is augmenting. Thanks God for helping me out!

As I sat in front of the television I took my cell phone and saw a message from my son's teacher. She wanted me to come over to school on Monday. I know what it means and my heart sank deep into the ocean of uncertainty. As with my son, merrier and he's happy and handles his lessons better.

 

THE REALITY

It's been a week since the doctor increase the dossage for my son. I dont see any progress. The literature said that it takes at least 6 months to see the effectivity. The doctor told me that it took only two weeks to see the medication work.

I know if I tell the doctor that the medication doesnt show any impact, he will increase the dossage again. This is what im scared of, for the medication will have a hallucinative impact on my son. I watch my son on a day to day basis: he still tries to be in the opposite direction to my words. He would do it my way but then he had to rebel against me. He still played trick on his sister and that made them fight. He still have difficulties to focus and need to be assisted all the time, or else he wouldnt be able to finish his school work.

I dont know whether I should tell the doctor the truth or take my own decision and lie so that the medication will show its effectivity after six month? Lots of questions with no definite answer.

IT FAILED TO WORK

Yesterday was Saturday. It's been two weeks since I last took my son to the doctor. So, I took my son again to the doctor yesterday. The main target of the visit was to find out if the given medication had worked.

As the doctor invited us to get inside his room, he asked me about my son's progress. I had asked my helper at home how my son behaved during the two week in which he was under the medication. She told me that he was doing better. As with me, I had not seen any significant progress. The progress that he gained so far was basically based on my program and had been on even before the medication was prescribed.

The doctor assumed that the medication had no impact to my son. So he was trying to find the reason. He asked me if I had continuously given the medication. I told him that last Saturday was the only day that he missed the medication. He arrived to the conclusion that the dosage needed to be increased. I began to ask him questions about the impact of the medication for I understand that it will create hallucinations and increase the suicidal tendency. He told me that it is still safe for he would increase the dosage from 10 to 15. 20 is the most that my son could bear.

The medication doesn't work be it for the dosage or any other reasons. The answer has to wait for another two week time. Hopefully this time it works. But then there is another question that need to be answered. If it works, will my son be dependent on the medication for his entire life?

ANGELS ARE EVERYWHERE

My son tends to be disorganized. Today they lost their books, tomorow they lost their pencils and so on and on. My son is not an exception. He looses his school diary and makes us busy with making phone calls to know the agenda for tomorow, or he looses his coloring pencils, or books etc.

Last week he went straight from school to his chinese class nearby my mom's house. So I told him to take a nap at my mom's place. He was wearing his PE uniform when he went to school and by the time he got home he has changed into another shirt and pants. I didn't pay too much attention to all those nitty grity.

Yesterday he had to go on a field trip to the museum. He was supposed to wear his PE uniform but I couldn't find it no where. I forgot the fact that he wore it last week to my mom's place. We were all busy searching for his uniform when a text entered my cellphone:

"Good morning! My daughter told me that your son had lost his PE uniform. I happened to buy two pairs of them last year and still had one that I can spare. If you dont mind, I'd like to give it to your son."

I almost felt into tears when I read the text. Thank you Lord for sending me your angel. They are everywhere.

THE FIRST TERM

One term is over and that lasted for three months, commencing as of July to October. It's time for his report card. My daughter went to school to pick up my son's report card. I knew that things were not as good as we expected them to be for my daughter did not call me right away. I couldn't control my curiosity and called home."Things are not that good compared to the previous term! He got F for Chinese, he got A+ for music, with three Bs, 4Cs, and 7Ds."

As soon as I got home I traced his report card. He got 60 for Chinese which is F and Ds range from 65 to 74, Cs range from 75 t0 84, Bs from 85 to 93 and As from 94 to 100. My son is one level better than the lowest student in his class.

I do not pay that much attention to his grades but then the teacher does. For me his focus is the key to his success. Grade is just an indicator and it is important though not the most important part. He is below average with his grades, but he's progressing with the most important thing, his focus. Let's work it out together son.

TO WIN AND TO LOVE

Help my son. Ease his pain. Tell him that You love him God. He needs so much love that words can not explain. Why do people vote for those who need to win in a competition and why dont people vote forpeople who are in need of love ? Is winning more important than love?

...

Life has not been good within these last two days. Yesterday my son was supposed to take his first medication. It was not easy to find the medication prescribed by the new neurologist, but I managed to get it at Rumah Sakit Pondok Indah. The tablets has just been pusblished on the 2nd of October.

My son didn't want to swallow the medication no matter how hard you try to push him and no matter how persuasive you try to talk to him. The medication has to be taken in the morning. I did my best to persuade him and fail. My daughter helped me and we both failed. Finally my husband came and pushed him to swallow it. I almost fainted when I saw how he did it. Dear God, can't you help me with a better way of doing it?

My son got scars and bruises on his right chick. He has swollen fingers. and most of all he's so much hurt. The pain is nothing but the fact that his parents hurt him is more than the bruises. I went off the car and took my son. We both walked. I took him home and cuddled him. He told me that he didnt want to miss PE class. So I decided to take him back to school. I was late myself for work.

Lord, hurt me as much as you want to but dont hurt him. Put the cross on my shoulders and I won't complain but dont let my son carry the cross. He's only seven!

When I got home at 6.30, my son and I went into my bedroom and we studied arithmetic. He managed to finish one out of the two assignments within the time limit. I gave him a star. So far he's got almost 25 stars. Keep it up son, you need another 25 to get a bike.

DOUBT

I took my son to another doctor. This is the one that I got from Tempo. I went straight from the airport to the hospital which is located in the western part of Jakarta. I had waited for almost 30 minutes before my turn arrived. I went inside with my son and was quite amazed to find a gentleman in his forties, quite young, greeted me warmly. I told my son to go out of the room and poured out my problems. He seems to know all the doctors that I had been to. He then invited my son to come in and asked me to wait outside. This is where the problems begin. My son refused to be left alone inside the room. He insisted that I had to stay with him. The doctor began to judge me. He said:"Your parenting style is probably the reason." He's already seven and he's supposed to be independent. Does he always behave like this at school."

I responded and said:"I visited his school once in a month and most of those times he wouldnt let me go." Deep down in my heart I knew that my leaving him for a couple of days was the main reason why he didn't want to let me go. I tried to explain but the doctor did not take my excuses. He retorted rapidly, explaining the child development process: "A child has to be independent when he reached the age of 4. At this age, he's not supposed to have this kind attachment anymore. "

I am not in a good mood to explain so I let him rattle. I will prove that next time he will be independent. My child is in the process of stabilizing. I am not a doctor but I'm equipped with one thing which the doctor did not, a motherly instinct. There are times that he's independent but there are also times when he's insecure and stay attach to me. We all do!

The doctor gave him a series of toys and asked him ro arrange shapes by colors. In the meantime he videotaped my son. My son was focusing on the task but once in a while he turned his head around to see if I was still there. After he's done with the task, the doctor invited me to sit by his desk and asked my son to play in the corner of the room. He said bluntly:" Your son suffers from attention deficit disorder. And I need to prescribe some medication for him. There are two types of medication: the first one will impact his appetite and the second is a new medication and it is said that it doesn't have any impact. Basically it is dopamin. I leave it to you to decide."

I responded straight away:" Give me the prescription."

He wrote down the prescription and explained that I had to get the medication in another hospital located in the northern part of the city. That's the only hospital that sells the medication. I am still in a doubt. I didn't know if I wanted to give my son the medication.

THANK YOU SON

Today my son had his mid semester quiz on Bijbel and Bahasa Indonesia. He had been studying the afternoon and at nite he spent another 4 hours. It pays for today he gets 85 for Bijbel and the result for Bahasa Indonesia is still not announced. However, I am quite convinced that things would not be much different with Bahasa Indonesia than the Bijbel.

I did not know what to say when he broke the news. But one thing for sure I'm very happy. All the efforts pay and most of all he's doing progress. He feels more confident and I can feel it. It accelerates his motivation.

My son, I don't expect you to be a genius or what. I am just hoping that you could be independent in any ways that you choose to live. One thing that you can be sure of, I love you and I will do anything within my reach to make you happy and independent.

LEARNING WITH FUN

My son will have the mid semester quiz for an entire whole week, starting as of tomorrow. I decided to try a new method, combining learning with exercise, which is an afternoon walk. I know it's quite risky knowing that my son has inattentive problem. He has to study among the hustle bustle of the afternoon traffic. However, I decided to give a try for if he's able to focus in the heat and traffic then he will not have any problems with focusing in the class room like any other kids. It's a kind of exercise for his inattentive problems.

So, we went for our afternoon walk. It was so hot that no longer had we walked then we had to stop for a while in Mc Donald. The heat was unbearable. Despite all the sweat and heat, my son managed to finish one chapter out of 4 that had been targeted for tomorrow. He was grumbling all the way, but I knew that he was trying to adjust. As to motivate him I promised him that if we could reach Pondok Indah Mall, I would buy him a toy. The reward is indeed powerful. As I offer him to go by busway to another direction, he asked me to focus on PIM for he was aiming for the toy.

After Mc Donald, I added another topic, Bible. He had to finish 4 chapters and managed to finish 2. This time, he wasn't grumbling anymore, on the contrary he was very happy and learned quickly. As we arrived in PIM I told him how proud I am of him and how good he had been along the afternoon walk. We went straight to the store and he bought, again, a car. He was lucky though for the shop was offering a special deal. For any purchase of two cars, one gets another car for free. So my son brought with him 3 cars. And...believe it or not, I added arithmetic and he didn't show any serious reluctance to it. Instead he memorize them well! We agreed on going to do the afternoon walk again next week. Sport and toys are his strength!

INDEX FINGER

In my previous post I wrote down how I had realized that my son's inattentiveness had contributed to his reading ability. It's not that he's not able to read, but he could not focus. He sees the first or the last syllable and guess the rest of the word. I asked him to point the lines with his index finger to help him focus. It helps, he can read faster now and most of all he understands what he reads.

I discussed this issue with a lecturer I happened to meet on my trip to Yogyakarta. He looked deeply into my face and said:"You know what? That's what Japanese organization requires the employees to do. For every object that has been the focus of the attention they have to point it with their index finger. I didn't realize why they have to do it, not until I heard you talk about your son. Maybe that was the reason, to keep people focus."

INFORMATION...INFORMATION...INFORMATION

Tempo magazine 26 September - 2 Oktober 2011 edition, covers a two page story on ADHD, under the title The Bouncing Ball in the Class Room. The feature covers inattention as the main symptoms that need to be intervened. The people who were interviewed were basically psychiatrists who major in ADHD. They provide their professional knowledge and opinion on ADHD.

The article expressed the concerned about the number of ADHD patients that has been stated to cover only 3-5% out of the children population. A recent survey (held on December 2010 to Juni 2011) reveals more than 26,2% of children in Jakarta suffers from ADHD. The high populated children with ADHD have not received proper care. It is either parents do not understand ADHD and blamed the child of being ill mannered, or parents are ashamed to accept the fact that their children suffer from ADHD or there aren't too many professionals who can diagnose the symptoms of ADHD. In my case it was the latter.

I have been taking my son to the pediatric and to a neurologist as well as to a number of psychologists, they all said that my son seems to be "normal" ( I hate this categorization). It was later on when he's alredy 7 years the same neurologist told me that something is wrong with my son and the same pediatrician wanted to give my son medication. As the development of a child brain is slowing down at the age of 7, I realized that I had to spend more effort on his intervention. This shouldn't have happened if only the media or the department of health would have paid a little bit attention on such issues. It is the public right to get proper information on growing issues. Don't they believe that children are the future generation? During the earthquake in Japan, all efforts were primarily aimed at supporting children since they realized that children are their future.

I'm not a beginner with the internet, yet, I could hardly find any informative stuff on ADHD from Indonesia in the internet. I do to some extent but most of them break my hope for they told you that ADHD children tend to be drug addicts, deal with crimes and all the negative stuff. I prefer to read information from other advanced countries for they give me information and a bit of solution, since the real solution is unreachable due to the distance.

I have to thank Tempo for providing quite an informative feature on ADHD. They even broadcasted the fact of the surveys and give information on the very few school that will accept ADHD student. So far, I only know one that specializes in learning difficulties in Sekolah Pantara and Sekolah Dasar Pela Mampang.

As for me, it was really reliefing to know that we do have some good professionals who specialize in ADHD. Some of the names are mentioned in Tempo. I searched for the name on the internet and registered my son for consultation next Saturday for this Saturday I have to be out of town.

Finally, I still keep the hope that my eldest daughter who majors in graphic design would work on information on ADHD for her final project paper. She could contribute a lot to so many parents.

STUMBLING BLOCKS

I have never believed that life proceed without upheavel. All that is smooth is nothing but a fatamorgana. It appears as if it is smooth for many reasons. Either we don't know much about it, or we imagine things the way we expect them to be, ignoring the facts. The program that I designed for my son has to face stumbling blocks. The fact that I work and has to be out of town at least once a month or twice a month have disturbed the progress of my program.

Last week, I had to go to Bandung for my work. I had to be there for 3 nights but I made sure that I stayed only two nights. But those two nights had altered some of the programs. This week end I have to be in Yogya, again for two nights. This means I have to arrange a new time slot for his program. Next week I will be away for another 3 nights. Hopefully I can rearrange everything so that he won't be behind in his school work.

CONSISTENCY

Behavior formation has the urgency to include consistency! No matter how excellent the programs are, or no matter how good you are in guiding the programs, it will fall into pieces unless you add consistency into it.

Reward system for my son has been developed together with him. Lately he's been asking me for a new bike. I promise him that I will buy him a new bike if he manages to collect 50 stars. Each star represents his achievement in one subject area. Everyday if he manages to finish one or two subject areas he will get the stars. I have been implementing this reward system and it works quite well. I need to manage the consistency so that it will impact his behavior. If he manages to get 50 stars within a month I will consider it as excellent. For 50 stars in a month indicates that he review 2 subjects in a day. That will be enough to catch up for his lessons.

My son seems to enjoy the program. He begins to see the stars as his aim in studying. I have the intention to include sport to be part of the program. It will serve as an indicator to his strength. As for me, I begin to see the other side of my son. Instead of his inattention and hyperactivity, he can be managed if we show our patience for he now has a motivation, a reason to do his best, though it is still a very short term reason and a material based reason. I am hoping I could accelerate his motivation further as it touches his existence, a reason for living, a reason to become a better person as to be able to contribute to life. Consistency will lead him to reach for his real stars.

NEUROTRANSMITTERS

Neurotransmitters are chemicals that transmit messages from one neuron to another. Human brain comprises 50 neurotransmitters that connect separated billions of nerve cells in the brain. Neurotransmitters can directly or indirectly affect neurons of the brain, affecting behavior. Norepinephrine and dopamine are neurotransmitters responsible for ADHD. While norepinephrine is exicitatory neurotransmiters, dopamine is inhibitor. ADHD are caused by imbalances between the two and play a large role in attention and focus.

The picture and the following process depict the mechnism of impulse transmission taken from mental disorder encyclopedia:

Neurotransmitters are chemical that transmit messages from one nerve cell (neuron) to another. The never impulse travels fro the first nerve cell through the axon-a single smooth body arising from the nerve cell-to the axon terminal and the synaptic knobs. Each synaptic know bommunicates with a dendrite or cell body of another neuron, and the synaptic knobs contain neurovesicles that store and release neurotransmitters. The synapse lies between the the synaptic knob and the next cell. For the impulse to continue traveling across the synapse to reach the next cell, the synaptic knobs release the neurotransmitter into that space, and the next nerve cell is stimulated to pick up the impulse and continue it.

Understanding of the mechanism can help prescription of medication for ADHD. Based on Wikipedia an ADHD patient requires psychostimulant medications such as asmethylphenidae (Ritalin/Concerta), dextroamphetamine (Dexedrine), and Adderall (a mixture of dextroaphetaine and racemic amphetamine salts) to help increase levels of norepinephrine and dopamine.

Not much do I know about ADHD and the medication used to treat the patient. I hold strongly to the view that I wont use any medication for my son.

TIME MANAGEMENT

Today my son had to do his arithmetic homework. My son had been joining the KUMON class ever since he was 5 years. He has gone through number recognition, addition, subtraction and currently he's doing multiplication. He has been quite good in all those separate levels. But problems appear when he has to apply them in real life which in this case mix all the levels in one case.

Being an ADHD patient, my son has problem with his short term memory. Every time he moves to the next level and is busy with that level, he forgets the previous level. As with Arithmetic, he remember the subtraction and multiplication but he forgets everything about addition. As soon as he sees cases with addition he claims right away that he doesn't understand it. I'm still trying to find out how to deal with it.

Aside from the above problem, I manage to find a way out for his time management in doing his work. I read somewhere in the internet that you have to control an ADHD patient focus with a time limit. I try it with my son today. He loves competition, so I challenge him to finish his homework within a time frame and if he wins, we will be doing a game this afternoon. To my amazement he could finish his homework 15 minutes beyond the set time. I am very happy for normally he does it longer.

Time limit is a good tool to make him focus on his homework. Time management is a good tool to help him focus. Since he wins, we both agree on reward scheme. I understand that a long term reward scheme doesn't have any impact on ADHD children, therefore I develop a small rewards that will lead to a big reward. We both agree on the stars that he could gain every time he finishes his work within the time limit.

We both sat in front of the computer and developed the forms. He needs to collect 50 stars to get a new bike to replace the old one. Today he collected 2 stars because he can finish his arithmetic and language lessons on time. We both had a chance to read a story about the invisible alligators that I found on the net. I know that I have to find a story related to the program of improving his inattentiveness. For the time being I took that story simply because he likes it.

Thank you son for making my day!

EXTRA... EXTRA...EXTRA

My son's therapist dropped by today. She wanted to see my son's behavior at home. We then got involved in a discussion about my son. It seems that we both agree that my son suffers from Attention Deficit Disorder with mild hyperactivity. She added some of her assumptions. She believes that going to an international school has added my child confusion and my son doesn't suffer from dyslexia.

The next step she proposed a home schooling program for my son. With her background in education for children with special needs, she is willing to help my son. In her opinion, my son will have more problems when he sits in the fourth grade later. I agree with her though not entirely.

I decided to discuss it with my husband prior to my approval to her proposal.

My husband suggested me to take the two times a week program instead of three times for one main reason: my son's education requires extra money, extra effort and extra time. He has taken extra classes for arithmatic, swimming lesson, extra chinese lessons and now we have the inattention intervention program twice a week. His days are full with extra this, extra that and extra who knows what.

SWIMMING

This morning we went swimming. Our target for swimming is preparing my son for the next level. We are motivating him to join a swimming club with the understanding that swimming is his passion. We are hoping that he could gain his self confidence through it.
The teacher began to push him to do the breaststroke. In the beginning he refuse to do so, for he is comfortable with the freestroke. The teacher persuade by encouraging him to compete with most people who can swim freestroke. The teacher seemed to press the right button, for my son right away swam in breaststroke.

My son loves to compete and win. It's both positive and negative. In sport he'll manage this enthousiasms well, but at school, it might turn to be a factor that will pull him down. Learning difficulties that accompany his ADHD made him learn differently than other children. He requires more time than any other children, so is also with the method of learning. I have to make sure that his schoolwork is chopped into small pieces and made him work on it. I also have to make sure that learning is fun. Therefore I have included games as part of the process of learning.

Today the therapist will come to our house to see how my son behaves at school. She promised to be at our place at 10. My son will have his chinese class at 2 o'clock. It's gonna be a hectic day for him, but hectic is the exact word for his remedy.

PREDOMINANTLY INATTENTIVE

All the professionals that get involved in my son's difficulties have given me contradictories assessments. While waiting for their formal reports I'm doing anyways I can to find it out. I found diagnostic criteria issued by the American Psychologist Association, and compare my son's symptoms against the criteria. Each criteria is graded H for High; M for Medium and L for Low. A couple of criteria are not graded for my son doesn't show such symptoms.

1) Six (or more) of the following symptoms of inattention have persisted for at least 6 months to a degree that is maladaptive and inconsistent with developmental level:

Inattention

a) Often fails to give close attention to details or makes careless mistakes in schoolwork, work, or other activities (H)

b) Often has difficulty sustaining attention in tasks or play activities (H)

c) Often does not seem to listen when spoken to directly (H)

d) Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (not due to oppositional behavior or failure to understand instructions) (H)

e) Often has difficulty organizing tasks and activities (H)

f) Often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (such as schoolwork or homework) (H)

g) Often loses things necessary for tasks or activities (eg, toys, school assignments, pencils, books, or tools) (H) h)Is often easily distracted by extraneous stimuli (H)

i) Is often forgetful in daily activities (H)

2) Six (or more) of the following symptoms of hyperactivity-impulsivity have persisted for at least 6 months to a degree that is maladaptive and inconsistent with developmental level:

Hyperactivity

a) Often fidgets with hands or feet or squirms in seat (M)

b) Often leaves seat in classroom or in other situations in which remaining seated is expected

c) Often runs about or climbs excessively in situations in which it is inappropriate (in adolescents or adults, may be limited to subjective feelings of restlessness) (L)

d) Often has difficulty playing or engaging in leisure activities quietly (M)

e) Is often "on the go" or often acts as if "driven by a motor" (M)

f) Often talks excessively (H)

Impulsivity

g) Often blurts out answers before questions have been completed (L)

h) Often has difficulty awaiting turn

i) Often interrupts or intrudes on others (eg, butts into conversations or games)

My son appears to suffer from Attention-Deficit/Hyperactivity Disorder, Predominantly Inattentive Type. We'll see what the experts have to say!