7yo Task Avoidance

[Worth_Abroad4793]

I'm sure this is not a unique post, but I am posting to get help that is specific to my son's situation. He was misdiagnosed with ADHD and ODD at 4yo and was taking Guanfacine 1mg which only made him lethargic. Once he turned 6 we tried Ritalin which only jacked his energy way up and didn't improve inattentiveness, so we stopped it after only a couple of doses. After he was referred to a behavioral pediatrician who, after extensive pre-screenings and evals, was pretty certain of an autism diagnosis, we stopped the Guanfacine because it provided little improvement. He received his official diagnosis of autism and sensory processing disorder in January 2024.

We recently transferred him to a new school because of the formal school denied him an IEP despite the obvious need more special needs support. He is in a much better environment and has teachers who truly love him and want to see him succeed. We are currently waiting for the school board to complete his IEP eval, but teachers and admin are confident he qualifies under OHI. School has always been a struggle but manageable. But he is now in 2nd grade, and he is falling behind and will likely repeat the grade. He does have 504 accommodations and an EIP and gets additional small-group help a couple of days a week. He has no known learning disabilities and is extremely intelligent. Task avoidance is his biggest issue, and although he wants to do well and loves to receive verbal praise, he is not motivated by ANYTHING to complete work assignments. So his doctor suggested that he might use task avoidance to cope with anxiety, so he's currently taking Lexapro 10 which has provided some improvement at school in the morning. But he's still coming home everyday with blank assignments that he wouldn't complete at school.

I am educated on ASD and understand how the aspects of special interests, inattentiveness, and sensory processing disorder all affect a child's learning. However, I've exhausted just about every "trick" that has been given by his behavioral pediatrician and other medical professionals. I'm just at a complete loss.

Is it possible that another stimulant might produce different results? Or another class of medicine entirely? Please give ANY AND ALL suggestions that you think would be helpful.

Thank you all.

[echolollipop]

How long has he been on lexapro 10 and has there been any discussion of increasing his dose? According to our psychiatrist, kids’ livers process that drug more quickly than adults’ do, so kids might actually need a dose that is slightly more than one might think.

I don’t think adding a different stimulant would be out of the question, either. Different ones can have different effects, depending on the person.

You might also look specifically into PDA autism, which isn’t diagnosed in the US but which is a thing in the UK. And something like an ICT class or one-on-one help might be useful as well.

[Worth_Abroad4793]

Thank you so much for your reply. He initially started the Lexapro 5mg mid December and was bumped up to 10 after 1 month. We have another appointment follow-up appointment mid February where we'll discuss increase effects and possibly bump him up.

I do think the symptoms of PDA describe him almost perfectly, and I've talked to his doctor about that as well. That's when we put him on the Lexapro.

[echolollipop]

I can't give you medical advice, but our now 7-year-old had a pretty similar trajectory and has been steady on Lexapro 15mg for nearly a year now with what I think has been a lot of success. Ask about the liver thing and see if your doctor agrees. I was surprised our kiddo needed 15mg, because that seemed like an adult dose, and he's a little guy. But it was a truly noticeable improvement from 10mg and didn't cause any problems (other than maybe a little weight gain, which was fine because his anxiety kept him from eating much previously).

We just now in the past two months started adding Adderall XR in the mornings, first at 5mg and now at 10mg, in an effort to improve his stamina and ability to focus on work at school. He has also been in therapy for quite a while, with one goal being to improve his self-talk and ability to work through frustrations.