I have an almost 4 year old dcg who has recently been diagnosed with ADHD. I was actually happy to hear that as it gave some reason to her extremely unruly behavior. I was happy until I found out that her mom is refusing the medication rec from the doc. Mom says that as a child she always had to take medication and hated it so she doesn't want to do that to her own daughter.... So can I terminate her for behavior since this is technically a disability? Even though she is refusing to treat it? Really not sure where to go with this one....

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Mom isn't refusing to treat it she is choosing NOT to medicate; which isn't same. Doctor's can and some will suggest medication but it isn't a cure all ADD/ADHD requires behavior modification with or without the use of medications. How mom chooses to treat is up to her. It isn't like her kid has diabetes and mom is refusing to give her insulin.

Bottom line though is it is your business and you can basically term for any reason you wish to. I would just say that your agreement isn't working out. No need to give any long drawn out explanations. It just isn't working.

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There are all sorts of reasons you could term.

Going to part-time

Only taking full-timers

Changing your hours

Child not a good fit

Etc. Pick one, and if you need to, just be as vague as possible. Direct and to the point. If they question it, don't give details. Just say "Can I help you with resources to find a replacement?" Have your Resource & Referral's number handy, as well as names or websites of newspapers in the area.

Bottom line is that it's YOUR choice. As long as you give them sufficient notice, you're fine.

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I agree that it's your business and you can terminate for whatever reason you choose and you don't have to go into lengthy discussions/debates with the parents. Simply write a letter stating you are terminating daycare effective <insert date>.

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I agree, especially with the Mom not willing to even try out the medication. I think she should definately give the medicine a try, meds are not for every child that has ADHD, but the majority of them, do very well on meds.

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If you do not have the staff to meet her supervision needs then YES you can terminate her even though she qualifies under the disability act.

It is your obligation to make accomodations that are NOT substantially impacting your business. If the ONLY accomodation you know will work for the child is having her own adult then you have every right to terminate. You should NEVER keep a kid in your care who you can't properly care for and/or who is a harm to the other children.

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This was really helpful, thanks everyone! I was hoping this is what everyone would say so wow I swear a 50 lb weight just got lifted off my shoulders!

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That's great to hear! This can be a stressful job, can't it?

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I think that you can terminate the child without addressing the ADHD status if you don't want to open that can of worms. You could make the termination about your schedule and the needs of the family not matching up or if the child is PT, then you can tell the parent that you are only taking FT kids. If you're nervous about breaking laws regarding the Americans with Disabilities act, then the reasons above can help you to avoid any problems down the road.

If you choose to terminate the child because of her behavior issues and you want to be completely honest with the parent, you are completely within your rights to do so. The child and her mom are not the only people who are using your services and you have to do what you think is right for everyone. As far as having kids in care that have ADHD, I'm the first to admit that it can really be a struggle even when the parents and you are on the same page. I have a daughter with ADHD and I understand the challenges that children with ADHD can present for their teachers and daycare providers and I know how hard it is to be faced with the decision, as a parent, to medicate your child or to try different approaches. My husband and I did opt to medicate our daughter but not before we tried all kinds of plans that didn't involves medication. I have daycare kids that have ADHD and they are both on concerta and it works beautifully for them. I have also had a kid in my care that I would bet a year's salary had ADHD but his dad was not willing to have him evaluated and said that the kid was just making sure that nobody pushed him around. I booted that kid, along with the kids of the woman that he was living with (3 kids in total) and the little boy's behavior was the biggest factor in my decision. With this little girl's mom, I would ask her what her plans for treatment for her daughter are. I think that if you are going to be keeping her in your care, the mom owes it to you to keep you in the loop with what her treatment plan for the girl is.

Have you read the book "Driven to Distraction"? I read it after my daughter was diagnosed with ADHD and I got a lot of really useful information from it. It is a book that is pretty much "agenda free" which is nice. I think that if the mom is open to the suggestion of reading the book, then it might be nice to suggest it to her to read.

Good luck!

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yes I had a child with issues who came part time and I would lose sleep the nite before he was due to come. I had to let him go and my reason was I was not taking on part-timers anymore and filled his spot

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I understand that caring for children with disabilities can be a difficult challenge. However, under the ADA law you cannot discriminate against children with disabilities (ADHD for example) unless doing so would create a "significant" difficulty or expense. In your case, failure of a parent to follow the recommendation of a doctor to give the child medication is not grounds enough to terminate this child who has a disability. You have to focus on what the child needs in your program and how you can provide this appropriate care.

If you can adequately care for this child (and all the other children in your program) even if the child isn't taking the medication, then you have to do it. If you believe that you cannot provide appropriate care you should consult with the child's doctor or parent or some other health care official to get advice about what you can do to provide appropriate care. If the parent refuses to cooperate in your effort to do so, and you believe that this child is not getting the care the child deserves then you can terminate.

I'm happy to discuss this further if you wish - call me at 651-280-5991.

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Have you SEEN the diagnosis of ADHD? Do you have the paperwork from the Doctor including treatment plans. Is the Dr she visited a Child Psychiatrist or did she go to a regular family practice? Was she going specifically FOR a diagnosis or was the child ill at the time?

First you need to make sure that the child actually HAS a diagnosis. Sometimes parents pick out parts of the conversation with the Doctor and decides that THAT is what the kid has. The Doctor could have suggested that at some point medication may be needed and the Mom refuse on that level.

I've seen a number of cases where parents TALKED to their Doctor during an acute illness office visit and came back to tell the provider that the Doc said the child had ADD or ADHD. When asked for the documentation for this the parent then changed the story and said the Doc THOUGHT she had it but suggested the child be seen by a Doc who could evaluate it. Normally that would take a few visits and some testing on the child. It's not something that can readily be diagnosed in one visit.

Also, you have the right to ask specifically WHAT is the treatment. You don't need to know what they AREN'T doing but rather what they ARE doing. If the Mom says no meds then what is she actually doing to deal with the child's mental illness. Do they have a behavioral therapist on board, how often do the parents take the child to treatment, and does that therapist have specific reccomendations for the child in child care.

Don't assume a child qualifies under the disability act until you SEE in writing a diagnosis that may be covered under it.

As Tom said: " under the ADA law you cannot discriminate against children with disabilities (ADHD for example) unless doing so would create a "significant" difficulty or expense." With home cihld care it is usually quite easy to show "significant" difficulty because you only have one staff with multi level aged group kids. The main area to address IS supervision. You are required to properly suprvise ALL of the children so if one child's needs require that your supervision be primarily on them then you can easily show that you do not have the staff to care for the other children while you are providing her needs.

I suggest you keep a time log book. It's kind of a pain to do it but it's VERY affective in showing the hard cost of caring for a child who has mental illness. Keep a little spiral notebook in your pocket on on your counter and document your actions and the TIME from start to stop where you are providing one to one care to the child. Even if it is in three minute increments. Have a check box alongside of each entry that designates whether or not you were able to interact with a provide direct care to the other children and/or their other care during the times you are documenting. Keep this for a couple of weeks so that you yourself can see the enormity of it (that you already know) and the documentation you should need should the parents challenge your decision.

Most parents will be okay when you tell them that you can't care for the child properly and care for the other kids. They are going to be unhappy at first but they do eventually understand it is a lot. They can't imagine having four other little ones with their child with no help or back up.

I haven't ever read a case where a Home Child Care provider was sued over the disability act. I've heard of providers being required to put in structural things like ramps and stuff for access but I haven't heard of a provider being forced to keep such an ill child without any staff in place to serve the child. We do have to follow the disability act but we are also SO limited in our supervision abilities because we only have one person with the children.

http://www.daksol.net/~huck/wp-conte...ers%202004.pdf

Example. A child may need one-to-one care, but your
program is designed for group care. If you do not have the
resources to hire an assistant, this may qualify as a
fundamental alteration. However, you must first explore
other alternatives before denying admission. For example,
are there alternative funding sources to pay for an aide? If so,
this is a reasonable alternative and you cannot deny the child.

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Totally 100% agree with this. No medication does NOT equal no treatment. There are LOTS of natural ways to treat ADD/ADHD. It is up to the parent how they want to handle this. I have had a parent whose son had ADD and ODD and she DID choose to do nothing. She is a single mom and said she had NO time to do the things that needed to be done to change things. AND she wasn't going to do meds. That poor child. Change the diet (cutting out carbs which break down into sugar would help I am sure, as well as cutting out sugars). I have been reading lately that many ADD/ADHD diagnosis may really be mercury/heavy metal toxicity. A friend of mine had a doaughter that was diagnosed with ADD and when she didn't want to medicate her child, she took her to a naturopath and they diagnosed her with mercury toxicity and treated it and she is completely fine, no signs of ADD or anything like it! Talk to the mom, maybe she IS doing something. 1 2 3 Magic talks a lot about ADD/ADHD and positive discipline methods. Good luck!

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Being 4 with this type of diagnosis qualifies the child for services through the public school system that serves her home address. If an actual diagnosis has been made, the parent should contact the Special Ed dept in their public school system and start the process to get the services the child needs. Which in this case would mean a behavior and social skills program. This also could mean is that the child qualifies for free preschool and transportation to and from a location in her home town in order to attend. Depending on the state they could also qualify for assistance with health insurance and in home services. All of these things benefit the child, the parent and you as her dcp. They can help you do the things you need to do in order to manage her behaviors.

The key here is it is all based on where the child resides. When my DD turned 3 we either had to find a new daycare or someone to transport her to and from so that she could attend the program. Our dcp lived 1 mile from our town's boarder and they could not go get her. We loved our dcp so we paid a sahm to drive her everyday, but had we not found her we would have had to find another dcp.

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Most parents will be okay when you tell them that you can't care for the child properly and care for the other kids. They are going to be unhappy at first but they do eventually understand it is a lot. They can't imagine having four other little ones with their child with no help or back up.

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You don't need to make this about ADHD, you simply need to make it about behavior. If the child's behavior is disruptive, put the child on probation, document all behaviors and then terminate.

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I agree with Jen - let the extremely unruly behavior be the reason to dismiss, not the fact that the Mom refuses to medicate her daughter.

I personally would not medicate a child unless they were violent or suicidal. ADHD children need to learn to cope in society, not be drug addicts. Everything you put into your body affects your liver including tylenol.

Parents of ADHD children need to pay attention to what they are feeding their children and document the food and unruly behavior. There may be a connection and while it won't remove all symptoms, the proper diet can help them cope with today's demands.

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Completely, totally agree.

I have adult ADD (I really, really don't have the Hyperactive part of the description) and I was having a harder and harder time coping with it as it got worse and worse in college...then I went off gluten and most of the time I feel like a completely different person! I still need caffeine in my system every 2-3 days to keep my brain functioning usefully, but it's NOTHING like it used to be.

Other people I know with ADD/ADHD find themselves helped immensely by eliminating food dyes, dairy, casein, and/or gluten. Soy can be another hidden culprit, too.

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As I've posted elsewhere, my oldest was diagnosed ADHD (although I truly feel he's an Aspie) and Peanut products increase his symptoms.

He can eat them but tries not to unless he has nothing really stressful the next day.

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