When All The Typical Rules Don't Work...

I'm a fairly well read parent, who has always read up to date advice on parenting topics. I know that spanking and yelling isn't supposed to help anything, consequences are supposed to work better if they're directly related to the offense, that nothing will work if you don't follow through with consequences. I know that it's important to find a balance between being firm and being understanding, but I do not understand my six year old son. I follow all the rules, I've tried the supernanny style parenting, I've done everything I can, but he is beyond control and escalating.

He's been tentatively diagnosed with ADHD. He's on concerta(yes it works, but wears off by dinner and it doesn't work consistently and entirely) and melatonin at bed time (take about 4 hours or more worth of struggle without it, two hours with it just to get him to get into bed and stay there) I know there is more to it than that though. I think he may have some issues with anxiety. He has a hard time transitioning from one activity to the next. He has a really hard time going to bed, but once he falls asleep, he sleeps through the night. When I try to get him ready for bed, he immediately starts working himself up. I've seen him literally start bouncing off the walls at the slightest whiff of bedtime approaching. All the advice I've found has been to develop a routine that includes a bath, a story, some snuggles, and so on. Some predictable bedtime things. Unfortunately, this seems to make the problem worse. If he sees bedtime coming, he has more time to work  himself up and is harder to settle down. The best solution we have so far is to keep bedtime fairly brief and to the point. It still takes longer than it should and he still pushes every limit he can and draws things out. This brings me to the really puzzling behaviour-

He can't seem to predict the consequences of his actions. No matter how consistent I am. No matter how firm, but fair and relatable the consequences are, he waits until his chances have expired before he will cooperate. No matter how many times the exact same routine is repeated, he acts genuinely surprised when his chances have run out and a consequence is imposed. It happens at bedtime and it happens throughout the day during routines like getting ready for school and so on. Here's an example of bedtime tonight:

-I helped him find pyjamas and gave him some time to get them on. I told him bedtime was coming and he should finish up his games so he could get ready for bed.
-He got his pyjamas on (surprisingly without a struggle tonight) and I reminded him to brush his teeth and take his melatonin
-He wanted to watch some of his Transformers DVD, so I let him have 15 min to watch and let the melatonin kick in.
-I went to get him for bed and he asked me to pause transformers so he could watch it tomorrow. I paused it, turned off the TV and took him to his room.
-the rule in our house is that if he doesn't get into bed nicely, and I am standing there while he's not in bed (without a reasonable excuse), I give him one warning, count to three and if he's not in his place, he does not get a tuck in. He's recently stopped the "I need to get up and pee, can I get a drink, I forgot X animal in the other room, excuse, excuse, excuse..." and exchanged it for just standing there refusing to get into bed and offering no explanation. If I ask why he isn't getting into bed, he'll either say nothing or giggle.
-He decided to lay in bed upside down this time. I've had him do this before and my attempted solution was to give him a chance to right himself then go about tucking him in upside down, but it didn't work. So this time, I simply told him that if he didn't put his head on his pillow, he would not get tucked in.
-He ignored me, so I proceeded with the usual "On your mark..." (I found that he liked it when I challenged him to "On your mark, get set, GO TO SLEEP!" at one point and it worked for a few weeks so it became part of his routine)
-He still wasn't going to get "on his mark", so I started to count to three. He just looked at me smiling while I approached three. I said three. He knows the rules. I always follow through. So I said, cheerfully, "Ok, you don't want a tuck in, that's fine, goodnight." and went to leave the room. He jumped out of bed, latched on to me, refusing to let go. I pried him off, left the room, closed the door and of course he wouldn't stay there. The thing is, he seems genuinely surprised when saying "3" results in the forewarned consequence. This isn't new to him. I've been using the 1, 2, 3 for 3 years now with the exception of a period where I tried reducing things to one warning and no count to see if more immediate consequences would help him get it better. That trial was actually worse. It worked for a day then proceeded to make our lives miserable.

I'm tired of everything being a struggle with him. positive reinforcement for good behaviour seems to have no more effect on him than punishment does. I rarely have an opportunity to reward him for a good bedtime anyways, but I make a HUGE deal out of it when it does happen. I make sure he knows how proud of him I am when he does anything he's supposed to without a struggle. It seems like we are constantly at odds these days and it's only getting worse. My patience is wearing thin and I just don't know what to do.

Is it possible that he is not capable of relating his actions to consequences?

Some other info about him that might be helpful:
-He seemed perfectly normal aside from a speech delay up until age 3. Then like a switch, he began to have tough bedtimes, followed with a gradual progression of odd behaviour.
-His older brother is severely disabled (mitochondrial disease)
-There is a history of ADD in our family as well as an other cognitive issue that is yet undiagnosed (similar to chronic fatigue syndrome) in several family members.
-He doesn't look me in the eye when I'm talking to him
-He is sensitive to sound mostly, but also to touch and light a bit.
-When he asks a yes or no question, he doesn't understand any other forms of yes or no, such as "yep", "uh huh", "nah", "sure thing", or  head nods or shakes for example. He'll ask me "was that yes, or no?" then when I answer him with a clear "yes", he seems to not hear the answer and repeats his question several times.

We are going to be meeting a child psychologist next month. In the meantime, I am struggling and could use some tips on an approach that might work better for getting him through these standoffish moments without a big blowout. I'm tired of having to ground him, walk out on tuck in, confiscate things because he's playing with them when he should be doing something else. I don't want to be the evil grinch that is slave-driving and taking all the joy out of his life....but it seems like just to get him to function through normal, daily routines for a child his age, it takes all day, leaving little room for leisure just because he resists everything.

Do you have any insight into why he behaves this way? Is there anything specific I should ask his psychologist to look into when we meet her? This has to be something more than ADHD, doesn't it?

[Sandman2]

  Oh wow, from the length of your post and the effort that you put into it - I can tell how this is effecting you.  And this may take several posts to answer your questions.  Its getting kind of late here, gotta be a lot later there.
   First you asked, "This has to be something more than ADHD, doesn't it?"  
Not really, cruise over to the ADHD site where I post a lot and read some of the posts about kids.  He is not that unusual for a 6 year old with ADHD.  Doesn't make it any easier for you, but with the proper guidance - there is a lot that you can do to help him.
   To me, a key statement by you was when you said, "Is it possible that he is not capable of relating his actions to consequences?"  At 6 with ADHD.  Thats the name of the game.  No filters.  And the really sad thing is when the teacher or the parent punishes the child for not thinking about what they are going to do, and the kid isn't capable of doing that.
  You said that, " I'm a fairly well read parent, who has always read up to date advice on parenting topics."  And everything that you listed is correct and should work - with a child who does not have ADHD - well, they are also really helpful with an ADHD child, but its gotta be done super strong and super consistent and - well you get the idea.
   I am glad you are going to see a child psychologist because they will give you a lot more information than the pediatrician you are probably seeing.  Do realize that when a child is started on meds, its a trial and error thing.  The doctor starts low and waits for the parent response.  Do communicate with your doctor what is going on.  There is a lot of tweaking  that usually has to be done before the right combination is found.  Many times a pediatric psychiatrist is much more experienced at handling this than a pediatrician.
   So what to do.  I really think that based on your post, you really need more information on working with an ADHD child.  A book I recommend a lot when posting on the ADHD forum is, "The ADD/ ADHD Answer book," by Susan Ashley.   It will answer a lot of your questions.   For example she says on p. 124 -' AD/HD children are unfortunately frequent rule breakers, not because they don't care about the rules, but they forget hte rules or cannot resist the impulse to break the rules... "
   On page 126 she says, " Because ADHD children engage in so many inappropriate behaviors, it is impossible to set a consequence for them all. ... You must determine which behavior and tasks you believe are the most important.  You have to choose your battles."   And I am tired of typing.  The book will help a lot.
   I also think that the medication could be changed to help him sleep.  Kind of curious about his sleep time.  Has this always been a problem or only after he started his meds? For example I had one member who posted me and said,"mamacodi
Oct 07
The concerta in young children with ADHD is supposed to cause a drowsy effect and help them to sleep thru the night. He was not going to sleep until almost midnight and getting up at 5:30-6am daily. No matter how much we ran him out during the day. So the dr. wanted to have us try this. And it is working. He is thankfully sleeping at night. If you looked up Concerta you will find that it is a blood pressure medication. But when you read further into it, it makes sense. Believe me I thought it was odd too until I researched it more. But like I said given his professional history he is well accredited to so we trust our child's health with him. He also makes sure that he is check monthly. So that is a plus.
  The point being that I would have thought it would have made it worse.  It is not uncommon for kids to take meds to help them sleep.  Melatonin can be effective, but is kind of uncertain.  However, I would not trust a pediatrician (unless they are really experienced with ADHD kids) to make recommendations on this.  So I do think that you could look into other ways.  Main point being - talk to your doctor!!!  Let him know what is going on.
   Finally, besides getting the book I recommended - there are a lot of web sites with info (which I think you could use a bit more of).  One site which I don't recommend a  lot because it has so much information - I think that you will find useful.  At least your post suggests that you don't mind spending time on such an important subject.   Go to this site.    http://www.healing-arts.org/children/ADHD/index.htm
   Finally, I do watch all the posts over on the ADHD forum.  Not so much over here.  Please post over there if you have any more specific questions.  Hopefully, some of the members here might have some bedtime ideas.  Best wishes!