Best route for ADHD evaluation?

[macchiatto]

So I'm thinking it's finally time to get "Oliver" (our supposedly typically developing twin) a full ADHD evaluation. He is likely mild/borderline so I want someone who really knows what they're doing. (I talked to the pedi about this at their 7 yr well visit. She had me start with a Vanderbilt. I expressed plenty of concerns on the parent version but the teacher's only "flag" was "extremely easily distracted." I never bothered turning it in since I knew it wouldn't go anywhere.)

His 3rd grade teacher has had more concerns and he just seems to be struggling more as he gets older and expectations get higher with impulse control, disorganization, constantly talking and interrupting, channeling his high energy, etc. He's also expressing more frustration with his own behavior. I'd love to get a robust assessment that's not going to miss a milder case. Anyhow, what route would you go for this? Devel pedi? Child psychologist? Or ... ? I could also ask Leo's counselor for suggestions.

[akafred]

Well your situation may be different because you have an "in" with a dev pedi since you have a son with ASD, but personally I had a terrible experience with a dev pedi (nurse practitioner; never got seen by the actual dev pedi). Not that that the NP was bad, but she just kept tabling my concerns and when I pushed hard she let the psychologist there see DD but she (psych) had already decided not to evaluate DD without ever meeting her. Anyway, what was appropriate for us was a child psychologist. Another option is a neuropsych eval. Most likely you'll need to redo the Vanderbilt and then the evaluator will do BASC-2/BASC-3 and/or Conners. And possibly WISC-2 or another IQ test as well (a neuropsych would probably do this).

[auntie]

Does the dev pedi head a team? If so, that would be where I would start. DS's dev pedi specializes in ASDs and sees a lot of kids with ADHD- some sibs of those on spectrum. He's also a "Behavioral Pedi". Ideally, this person has "in-house" or could turf you to a good neuropsychologist for an eval. You could also pull the trigger on an evaluation with the LEA to start the process towards an IEP/Section 504 plan.

In your situation, because you have to be an advocate for Leo as well, I would probably do the private eval first and bring the reports to the school to streamline the process. This tends to keep the district honest, for lack of a better word. The down side is that we're fast approaching the second report cards when many teachers/parents pull the trigger on an eval after taking a wait and see strategy. This means staff can get overwhelmed as they also have to start the transitional IEPs for kids going to middle school and coming from preschool. So maybe now would make more sense. Hard to say.

Generally, you'll want an IQ test and achievements tests to tease out the possibility of a SLD. (not fool proof but worth doing) Most schools tend to use Conners rather than Vanderbilt. A BASC (parent, teacher and student) and long-form Vineland (parent and teacher) will give a sense of where he is in terms of social, emotional and communication skills- as a sib of a kid on spectrum he's at risk for some atypical results- more so if they are identical twins. In some kids, ADHD is a kind of "immaturity" that does improve over time. He should also be observed in the classroom as well as during a less structured part of the day.

Probably the most critical piece, as he prepares for the intermediate grades, is an assessment for executive function skills. D-KEFS is a good option.

[macchiatto]

Thank you for your replies, akafred and auntie! They were helpful as I was exploring my options. He has his eval tomorrow! (For reference they are fraternal twins btw.)

[auntie]

Good luck today. I hope you get some answers quickly.

As a fraternal twin, he would have similar risks as any full sibling perhaps slightly elevated by the shared pregnancy factors around mom's health and environmental exposure.

[macchiatto]

Jan 5, 2018 6:05:43 GMT -5 auntie said:

Good luck today. I hope you get some answers quickly.

As a fraternal twin, he would have similar risks as any full sibling perhaps slightly elevated by the shared pregnancy factors around mom's health and environmental exposure.

Thank you. That makes sense!

[auntie]

How'd it go?

[macchiatto]

Jan 6, 2018 9:37:56 GMT -5 auntie said:

How'd it go?

It was kind of you to check back in; I'm sorry I missed it. I clearly haven't been here in way too long!
He did end up getting an ADHD Dx ... like his twin's ASD Dx, it was pretty close to the border and probably could have  gone either way depending on the clinician. We followed up with counseling to work on strategies and that was really helpful. 4th grade was tough at first (especially high expectations for organization and he was always forgetting things, bringing home the wrong items for homework, etc.) but that gradually sorted out. He has matured a lot in the past year or so.