Deciding where to go for Evals (suspected ADHD)

[kirstenhill]

I'm ready to seek out evals for DS6 -- My main suspicion/concern is ADHD.  I have had my suspicions for a long time, but now that he is six, and I feel like some issues are getting worse and not better, I am more convinced that he isn't "growing out of it". 

 

I'm not really seeing learning issues yet per se -- I work hard to keep his lessons short and interesting, and he is doing great for a Kindergartener (I'm sure it would be a different story if he had to be in a classroom all the time).  But we see a lot of other behavior/impulsivity issues, and he has a hard time with appropriate behavior when he is in a classroom situation (church, co-op, etc).

 

We live in a large metro area, so there are tons of results for searches for ADHD evaluations, neuropsych evaluations, etc.  I'm seeing three main paths -- the behavioral health/child psychiatry department of the large clinic network where we currently see our primary care physician, the Psychiatry clinic at the large university nearby (They have a "attention and behavior disorders" specialty clinic), or a private clinic (google searches have turned up quite a number, some of which seem to be covered by our insurance and offer adhd evals or neuropsych services generally).

 

How do I evaluate which path would best fit us?  I only know one family IRL who has openly talked about getting an ADHD eval, and they used a private clinic.  I'm sure there may be more, but I am not eager to post a request for advice on Facebook about this or anything like that, at least not at this point.   I am not even quite sure what questions to ask (besides maybe cost and wait time to get an appointment) - are there going to be significant differences in the type of evaluations they will want to do if I just ask to have DS evaluated for ADHD?

 

Thanks for your help.  :-)

 

 

[PeterPan]

What are you wanting to change as a result of getting the evals?  At 6 the psych might not even give you the label.  Psych 1 said provisional ADHD on ds6.  Psych 2 refused to confirm it, saying there was impulsivity but not inattention.  (You sound like you have both.)  Psych 3 is spending more time.  

 

Three psychs, no label yet.  So I go back to asking what you're wanting to change?  You want meds?  Go to your ped, since that's where you'll end up anyway.  You have learning issues?  Go ahead and get full evals.  It's definitely good to do them at some point, because you get fuller information to teach him better.  However if right now your teaching is going ok and you just want meds, I'd talk with the ped.  If you don't want meds, well I'm trying to figure out what you're hoping will change?  If NOTHING else is going on (no auditory symptoms, no sensory, no pain with writing, etc.), yeah sure you could assume ADHD and just go ahead and make some changes.  If you're going to plunk out $2K+ for evals, you might as well do it when the psych will go ahead and give you something beyond provisional.  There are some good reasons to eval now, but there are also reasons you could wait a bit or start with your ped instead.

[Ottakee]

I would talk to your ped first about their suggestions on where to go for evals, etc.  I would though suggest that esp. at a younger age that you find a specialist and go there for a full eval and to start meds if needed.  They will have much more experience with the meds, side effects, etc. than your ped will.  Once the meds (if you use them) are figured out, it is likely that your ped can monitor them and give refills.

 

Sometimes there are other things that look like ADHD or go along with ADHD and I prefer a specialist to help tease it out.  Your pediatrician though likely will have ideas on who is really good with kids his age.........and that your insurance will cover.

[kirstenhill]

Part of the problem with knowing who to talk to is that we've been seeing a family practice doc for the past two years (we had a pediatrician before that, but had to switch clinics due to insurance network changes -- previous clinic was no longer going to be considered in-network), and to be honest I've not been super pleased.  We'll probably switch the next time it comes around to have everyone in for well child checks (I have all 4 kids go at the same time in the summer each year).  But when I brought up some concerns I had about DD last year, the family practice doc really blew me off.  I still think my DD could benefit from some counseling related to anxiety issues, but now every time I have discussed it with her she reminds me that "the doctor said I am fine."   :glare:   So, it really makes me feel like this doc won't take me very seriously if I discuss what I am seeing with DS.  I guess I could just seek an appointment with some kind of Pediatrician right now?  I just figured it would be a waste of time if they were just going to tell me that we had to get a psychiatric evaluation done to have a diagnosis.   Are you saying that a Ped might be likely just to give us a diagnosis right there without further testing?

 

He does have some weird sorta auditory issues -- like he is constantly "mishearing" us and thinking he heard us say something funny that doesn't make sense.  I have attributed it more to lack of attention than anything else -- but ???. 

 

I guess what I am really looking for is support and counseling to know how to deal with DS -- I can read books and websites about it until I am blue in the face, but I don't know FOR SURE that what I am seeing is ADHD and not me having parenting issues or him just being slow to mature.  Or maybe I am seeing this wrong and there is some different diagnosis that would fit better than ADHD.  I want to have the door open to medication in the future, even if that is not where to start.    I feel like just the regular "parenting advice" that works pretty well with my other kids is a big fail with DS, and I need some ongoing support to know how to deal with his behavior.  I've always assumed that getting some type of evaluation and diagnosis was what I needed to get the help I feel like I need, but maybe there is some kind of counselor I can see who would help me figure out how to deal with DS regardless of whether he has an official diagnosis?

 

I also want to be able to tell sunday school teachers, co-op teachers, etc that he has a diagnosis (if he does), because i am kind of tired of getting looked like "that bad parent" because my six year old jumps up in class and starts attempting to climb the wall or whatever thing he did this week.   I've gotten a quite a bit of flack from some church/co-op people even though I am really doing my best to keep him behaving properly.  Another boy at co-op has a diagnosis (not adhd -- another developmental issue) and the mom has been quite open about it, and I notice that people give that kid a ton of leeway in his behavior that no one is giving my DS.  Behavior that looked sorta cute when he just turned 5 looks really immature to people at 6 I guess. 

 

ETA:  If we still did want/need more extensive evaluations, I am also wondering if a Ped wouldn't just automatically refer to someone within the clinic network.  AKA we are XYZ clinic, so please call the Psych department of XYZ large clinc for an eval... rather than looking at the options in an unbiased way to to say, "ABC private clinic does has the best services of this type" -- but maybe that's not the case.  I am wishing there was an unbiased way to figure out the best place to get services if I am going to pay a bunch of money for them, but I can't quite see that there is any way to do that.  

[PeterPan]

Hmm, your last line about behavior that was ok at 5 NOT being ok at 6, and that's what I've been saying is happening to us.  We're now on psych #3...  

 

You might want to start checking on who you'd use for an audiologist eval for APD.  That concerning that he's mishearing things.  My ds was having issues if you were *behind* him, where he didn't seem to hear you (and this happened a LOT!).  That part, for him, was a proprioception thing, an OT issue.  He also just in general seemed to have oddities and it turned out with the full psych testing that his single sentence *comprehension* was very, very low.  When he has more info (a paragraph) his comprehension improves.  

 

Anyways, I did take him to a major state university for testing.  At this age they can't do the full APD testing but they'll do regular audiological and can run some APD screening tools.  Then when he turns 7, if there's reason, they can do the full APD eval.  So I'd definitely recommend pursuing that angle, if only to eliminate it as a concern and narrow the field of what you need to work on.  Here the evals are $35 (at the university).  Privately they're $380.  I'm getting ready to take dd for the same reason, to finally clear the air on whether part of this could be APD or whether it's sensory or what with her.  

 

No, a ped diagnosis doesn't guarantee you he got it right or that it's even the only thing going on.  It's just a starting point if you have NO other reason to suspect ANY other issues and just want meds.  If you want more, you need a psychologist of some kind.  Not psychiatrist but psychologist.  Given what you've described, I'd be moving up the food chain.  

[Storygirl]

My son age 10 has ADHD. Here is what happened with us.

 

1. Brought the idea up with the pediatrician around age six. Pediatrician didn't see it. I didn't agree but didn't push, because at that point we were not considering meds. DS is complex anyway, and I wasn't sure ADHD explained it all (it doesn't, but is part of the picture)

 

2. At age nine, the pediatrician referred DS to a psychologist for anxiety. The psychologist had us do a bunch of screening tools at intake, and she said the scores indicated ADHD. She taught us techniques to help him calm himself, but we decided that we should also consider meds. Around this time we had an educational professional tell us that she noticed some severe attention issues while working with him.

 

3. So we made an appointment with a psychiatrist who specializes in medicating for ADHD. The psychiatrist diagnosed ADHD. By this time, our pediatrician saw that we were serious about pursuing it and said he wanted to be involved. He did his own screenings and diagnosed ADHD.

 

4. We started DS on meds and had to try quite a few before finding the med and dosage that works for him. We also continued to work with the original psychologist for awhile, as well as an occupational therapist (for various issues, ADHD included)

 

5. Although our pediatrician didn't think it entirely necessary, we then had DS evaluated by a neuropsych. Not for the ADHD but because we suspected some other issues.

 

So DS has been diagnosed by several people and has worked with several specialists. It's kind of been a group project, in a (mostly) good way.

 

I guess my advice to you would be to first find a pediatrician that you trust and like, who can give you some solid guidance about what specialists to see. If your family doctor isn't on board, you've got an extra hurdle to jump, which is less than ideal. Our first psychologist actually was the best information/support person for us, as she knew other specialists to direct us to. Look for that person in your own situation; I don't mean a psychologist especially, but a person who is willing to puzzle it out with you.

 

Also, I'll just throw it out there that sometimes sensory issues can look a lot like ADHD. Just something else for you to consider.