ADHD diagnosis questions

[fluffycookie]

Specifically who made the diagnosis - your pediatrician or a specialist?  DS is on an IEP this year and is doing really well, but his concentration and constant fidgeting is still causing issues - his teacher said that he gets distracted easily and needs constant reminders/instructions to repeat the task that he's working on.  All of his IEP reports from last year mention the attention issues, but don't specifically say ADHD nor has the school ever requested that he be evaluated outside of the school.  He has his physical this month so I am going to discuss it with his pediatrician. Unfortunately when it's something that he enjoys or likes he can focus with no issues and his memory recall is awesome, but it again when it's something that interest him. MH is against medicating, but I don't want him to continue to struggle if it is ADHD.  He loves school and enjoys going, but the special ed coordinator has made comments before about being concerned that as he gets older if he continues to struggle he may get frustrated and not enjoy school.  

ETA he has no behavioral issues at home or school, school actually says that he is very helpful.  He sleeps well at night (in bed by 7:30 sleeps until about 7:30 am) and when he goes to bed he's asleep within minutes.

TIA!

[meme04]

A child psychologist made our diagnosis. He did a lot of tests over a few sessions to determine her diagnosis! We did choose to medicate and her attention with school work has improved so much! Good luck!!

[amberlyrose]

This sounds like me as a kid. I was actually really good in school, but if homework took more than 2 minutes, I'd quit. The biggest clue to me as an adult is my tendency to hyper focus and not recall anything I had actually read. I didn't get diagnosed until I was 27.

[hopecounts]

I would see a specialist (psych)
Schools will rarely suggest testing because it can put them on the hook for the cost.
they typically do what yours is doing which is strongly hint and point out attention issues and hope the parent gets the idea.

[whereintheworld]

Child psychologist/psychiatrist team made our diagnosis for my them-5.5-year-old. He was diagnosed in the 99th percentile of ADHD-impulsive/hyperactive presentation.

He's been medicated this school year and it's made a world of difference.

[cbwm1]

Our pedi made Will's diagnosis, and we were comfortable with that. We had an appointment with a developmental pedi, but it was 6 months away and it was clear that we needed to do something ASAP.

The pedi was very cautious about it, and sent several assessments and questionnaires home for DH and I to fill out, as well as anyone who interacted with him regularly (teacher, OT, SLP, learning behavior specialist, etc).

Not all regular pedis take that much caution though. They'll dole out Adderall like it's NBD, which is not okay.

[marvine]

Ours was through our pediatrician's office. They have a therapist come in a few times a week. We filled out an assessment, as did his teachers. Then the therapist went over everything and did the diagnosis, and then the pedi was brought in. We did ultimately choose to medicate him (which has helped him A LOT!), and now the pedi is the one who does the med review every 3 months.

[ijack]

I wasn't diagnosed until I was 30 and it was by a psychiatrist.

[esdreturns]

My son's pedi diagnosed him and we are also taking him to a neurologist (at the pedi's request).

[MDmomof2]

We had my son (then 4.5) evaluated by our county's Early Intervention services. His preschool referred him. Shockingly, he was not diagnosed with ADHD, but a social and emotional delay. He was able to sit for nearly an hour and complete the testing and they said that while the range of normal is quite broad in young children, his ability to sit still for that long led them to believe that he didn't have ADHD and probably wouldn't be diagnosed as he got older and the criteria narrowed. He still has little ability to focus. Just this morning I asked him to brush teeth and he went into the bathroom and washed his hands!

[whereintheworld]

May 3, 2016 12:01:00 GMT -5 MDmomof2 said:

We had my son (then 4.5) evaluated by our county's Early Intervention services. His preschool referred him. Shockingly, he was not diagnosed with ADHD, but a social and emotional delay. He was able to sit for nearly an hour and complete the testing and they said that while the range of normal is quite broad in young children, his ability to sit still for that long led them to believe that he didn't have ADHD and probably wouldn't be diagnosed as he got older and the criteria narrowed. He still has little ability to focus. Just this morning I asked him to brush teeth and he went into the bathroom and washed his hands!

ADHD is a lot more than just about focus. My son's presentation is impulsivity, so he has very pool self-regulations with his emotions and impulses.  He can focus on preferred activities like Lego and art, but he struggles in other areas. I'd be looking for a second opinion if their only benchmark was that he could sit long enough to complete the testing.

[MDmomof2]

May 3, 2016 12:05:18 GMT -5 whereintheworld said:

May 3, 2016 12:01:00 GMT -5 MDmomof2 said:

We had my son (then 4.5) evaluated by our county's Early Intervention services. His preschool referred him. Shockingly, he was not diagnosed with ADHD, but a social and emotional delay. He was able to sit for nearly an hour and complete the testing and they said that while the range of normal is quite broad in young children, his ability to sit still for that long led them to believe that he didn't have ADHD and probably wouldn't be diagnosed as he got older and the criteria narrowed. He still has little ability to focus. Just this morning I asked him to brush teeth and he went into the bathroom and washed his hands!

ADHD is a lot more than just about focus. My son's presentation is impulsivity, so he has very pool self-regulations with his emotions and impulses.  He can focus on preferred activities like Lego and art, but he struggles in other areas. I'd be looking for a second opinion if their only benchmark was that he could sit long enough to complete the testing.

This is interesting. He does have trouble regulating his emotions and behaviors, which is what got him the social and emotional delay diagnosis. He enters Kindergarten this fall (he has a Dec. birthday so he's 5 already) and I'm concerned about his behavior there. On the one hand, his preschool is VERY familiar to him and he has been with the same kids so long they are more like siblings than classmates in many ways. A change might be good for him. On the other hand, he is very comfortable at preschool and I wonder how he will feel when the environment changes. He just got a new therapist through early intervention (his last one went out on maternity leave) so I will talk to her to get her perspective.

[whereintheworld]

May 3, 2016 12:09:58 GMT -5 MDmomof2 said:

May 3, 2016 12:05:18 GMT -5 whereintheworld said:

ADHD is a lot more than just about focus. My son's presentation is impulsivity, so he has very pool self-regulations with his emotions and impulses.  He can focus on preferred activities like Lego and art, but he struggles in other areas. I'd be looking for a second opinion if their only benchmark was that he could sit long enough to complete the testing.

This is interesting. He does have trouble regulating his emotions and behaviors, which is what got him the social and emotional delay diagnosis. He enters Kindergarten this fall (he has a Dec. birthday so he's 5 already) and I'm concerned about his behavior there. On the one hand, his preschool is VERY familiar to him and he has been with the same kids so long they are more like siblings than classmates in many ways. A change might be good for him. On the other hand, he is very comfortable at preschool and I wonder how he will feel when the environment changes. He just got a new therapist through early intervention (his last one went out on maternity leave) so I will talk to her to get her perspective.

Here's a great checklist for ADHD-impulsive:

No single test can confirm that your child has this type of ADHD. Your doctor will first try to rule out other things that can cause hyperactivity. It could be stress or emotional issues. Sometimes vision problems or learning disabilities can make it hard for a child to sit still.

The doctor will also look for at least six of these symptoms of hyperactivity and impulsivity:

Fidgeting (not being able to sit still)
Doesn’t seem to listen when spoken to
Nonstop talking
Trouble doing quiet tasks, such as reading
Touching and getting into everything
Running from place to place
Banging into people or objects
Acting like he's "driven by a motor"
Constantly jumping or climbing -- on furniture and other inappropriate places
Not having patience
Blurting out comments at inappropriate times
Interrupting conversations or speaking out of turn
Trouble waiting for a turn or standing in line

Many children who like to run and jump may be high-energy. But that doesn’t mean they are hyperactive. To count as ADHD, symptoms have to be on the extreme side and have to cause problems in the child’s life. Also, they have to have been doing this for at least 6 months.

[karmasabiotch]

Child psychologist

[auntie]

May 3, 2016 10:06:06 GMT -5 fluffycookie said:

Specifically who made the diagnosis - your pediatrician or a specialist?  


Aside from my next door neighbor? J/K.  An MSW employed as a school psychologist and another school psychologist gave educational dxs through the LEA. He was also dxd privately by a psychologist, a dev pedi and, most recently, a psychiatrist. Not something I would trust to DS's PCP pedi. 


DS is on an IEP this year and is doing really well, but his concentration and constant fidgeting is still causing issues - his teacher said that he gets distracted easily and needs constant reminders/instructions to repeat the task that he's working on.  All of his IEP reports from last year mention the attention issues, but don't specifically say ADHD nor has the school ever requested that he be evaluated outside of the school.


Did the school do evals around this? Under IDEA he should have been "evaluated for all areas of suspected disability". You can ask for this. The school psychologist could do the evals including questionnaires for teachers and observations in class and during less structured times of day.


 He has his physical this month so I am going to discuss it with his pediatrician.


Your pediatrician could refer you to a good psychologist or psychiatrist for further evals and tx if needed.


Unfortunately when it's something that he enjoys or likes he can focus with no issues and his memory recall is awesome, but it again when it's something that interest him.


Rote memory or recall is no R/O for ADHD. Hyperfocus on preferred tasks is actually a sysmptom of ADHD. (Can also overlap with ASD.) 


MH is against medicating,


Nobody wants to medicate their kid, but sometimes meds can be an important part of the tx plan for kids with an ADHD dx. DS would say his ADHD meds help him be who he really is instead of some ass.


Your DH is kind of putting the cart before the horse.

How does your DH feel about self-medicating which can be a consequence of not treating ADHD effectively? Or of being ostracized for not behaving in ways peers expect? Or about having to work harder than others for poorer results?


but I don't want him to continue to struggle if it is ADHD.  He loves school and enjoys going, but the special ed coordinator has made comments before about being concerned that as he gets older if he continues to struggle he may get frustrated and not enjoy school.  


What's he classified under? What sort of supports and interventions is he getting?

ETA he has no behavioral issues at home or school, school actually says that he is very helpful.  He sleeps well at night (in bed by 7:30 sleeps until about 7:30 am) and when he goes to bed he's asleep within minutes.

Lack of sleep can cause behaviors that mimick ADHD, but being able to sleep well isn't a R/O. 

It's concerning the the school is seeing behavior you aren't. In theory, that means he doesn't have ADHD because it has to be present in multiple situations rather than just one. 

It could be that this behavior is more reactive to a poorly implemented IEP and that you don't see the behavior because the structure and movement at home are more supportive. Or it could be that you have mommygoggles and have different standards for appropriate behavior than the professionals do. 

[hopecounts]

MDmomof2, also hyperfocus like that can be a symptom of ADHD.

[auntie]

May 3, 2016 12:01:00 GMT -5 MDmomof2 said:

We had my son (then 4.5) evaluated by our county's Early Intervention services. His preschool referred him. Shockingly, he was not diagnosed with ADHD, but a social and emotional delay. He was able to sit for nearly an hour and complete the testing and they said that while the range of normal is quite broad in young children, his ability to sit still for that long led them to believe that he didn't have ADHD and probably wouldn't be diagnosed as he got older and the criteria narrowed. He still has little ability to focus. Just this morning I asked him to brush teeth and he went into the bathroom and washed his hands!

There is some controversy around dxing ADHD in children under 6. The best scales for evaluation of ADHD are not normed under age 6. Many clinicians won't "go there" unless the child is so impulsive as to be at risk of harm. 

[Redpoppy]

DS's was his pediatrician. He is in second grade. He sent questionnaires for us and his teachers to fill out. All but DH's scored for ADHD inattentive type. We tried some additional strategies at school like getting him a personal timer that shows the minutes he has left for an assignment. After that didn't help we decided to try medication. His pedi prefers Ritalin for his age since it is not extended release. I'm not sure it is helping but we are a few weeks in and just increased it.

We are going to get him tested for central auditory processing disorder this summer once he turns 8 (minimum age for testing). His SLP suggested it due to his behavior and history of ear infections and mild hearing differences due to holes in his ear drums.

We also had his vision checked just in case. He sees an ENT yearly for a hearing test so that was covered.

[MDmomof2]

May 3, 2016 12:20:07 GMT -5 hopecounts said:

MDmomof2 , also hyperfocus like that can be a symptom of ADHD.

Thank you all for your comments. I was surprised when they said they didn't suspect he would ever be diagnosed with ADHD. I will keep an open mind and perhaps pursue it again based on his behaviors.

He is VERY charming and loves adults and I could see him being very focused on the testing because he wanted to impress the adults there. He is not interested in impressing us at all. We did have his hearing tested.  We never suspected anything was wrong with his hearing but it comes automatically with ADHD testing. It would be terrible if he wasn't listening because he truly couldn't hear us! But, his hearing was fine as we suspected.

[fluffycookie]

Thanks everyone. I have spoken with his pediatrician's office and they are sending forms for MH/I and the school to fill out then they will be reviewed by the psychologist and then we will speak with the doctor and psychologist together for an evaluation and review of the paperwork.

The reason why MH is against medicating is because 3 1/2 years ago DS was put on singulair for his asthma and had a HORRIBLE reaction that included violent outburst in which he hurt himself (essentially roid rage)and could not calm himself down. His pediatrician (same practice as now, but the prescribing pedi left) had mentioned the side effects in passing, but said they were extremely rare and brushed them off when I called. He sees a specialist at a local children's hospital for another medical issue who after hearing the issues told us to stop the medication and thankfully the issues went away.

[auntie]

May 3, 2016 12:56:18 GMT -5 MDmomof2 said:

May 3, 2016 12:20:07 GMT -5 hopecounts said:

MDmomof2 , also hyperfocus like that can be a symptom of ADHD.

Thank you all for your comments. I was surprised when they said they didn't suspect he would ever be diagnosed with ADHD. I will keep an open mind and perhaps pursue it again based on his behaviors.

He is VERY charming and loves adults and I could see him being very focused on the testing because he wanted to impress the adults there. He is not interested in impressing us at all. We did have his hearing tested.  We never suspected anything was wrong with his hearing but it comes automatically with ADHD testing. It would be terrible if he wasn't listening because he truly couldn't hear us! But, his hearing was fine as we suspected.

The way you describe him, an ASD R/O might be appropriate.

Social and emotional immaturity is kind of the core of deficits of ASD. Charming and engaged with adults? check.
Poor self regulation? check. Washing your hands when you've been sent to brush your teeth sounds very like poor auditory processing. 

[juliette21]

I may be projecting here, but it really irritates me when I hear that a parent is against medicating for ADHD. Just as general principle. ADHD is very hard on the child, it affects their whole life. Kids with ADHD have trouble making friends, low self-esteem, anxiety. Not to mention the learning difficulties. I can't imagine what it's like to go through life every day and feel like I'm a failure. Which is exactly what it's like for a kid with ADHD.

It's kind of self-centered to choose not to medicate when many kids with ADHD say they prefer to be on medication. Not directing this at anyone in particular in this thread, but I hear this so damn much and I am tired of it. Therapy and behavior management is a crucial part of managing ADHD, but sometimes the child can't actually calm down or focus enough to employ those strategies without medication.  

[mom2twoboys]

Our pediatrician suspected that he was and so did we. She gave us a referal to a child psychologist to do the formal tests for it. Then us and our pediatrician did a formal plan of attach from the child psychologist's findings.

[fluffycookie]

May 3, 2016 14:16:46 GMT -5 juliette21 said:

I may be projecting here, but it really irritates me when I hear that a parent is against medicating for ADHD. Just as general principle. ADHD is very hard on the child, it affects their whole life. Kids with ADHD have trouble making friends, low self-esteem, anxiety. Not to mention the learning difficulties. I can't imagine what it's like to go through life every day and feel like I'm a failure. Which is exactly what it's like for a kid with ADHD.

It's kind of self-centered to choose not to medicate when many kids with ADHD say they prefer to be on medication. Not directing this at anyone in particular in this thread, but I hear this so damn much and I am tired of it. Therapy and behavior management is a crucial part of managing ADHD, but sometimes the child can't actually calm down or focus enough to employ those strategies without medication.  

I agree with what you are saying, but when you watch your 4 year old kick a door and rip his entire big toenail off and continue raging it is very upsetting and traumatic (I still get upset thinking about that night) and unfortunately that based with the brush off from the pediatrician is coloring my husband's thoughts on medication.  He is on board having all the paperwork filled out and reviewed and meeting with the doctor and psychologist so we will take it one step at a time.  If the doctor and psychologist feel medication is the best option then MH will have to get on board, that is non-negotiable.