Teasing apart low IQ & LDs vs ADD

[Hilltopmom]

Dd, 14, has a diagnosis of borderline IQ, probably dyscalculia (definately, IMO), low working memory, & low processing speed.

Also,depression & anxiety, & prior struggles with eating disorders.

 

We'll update testing with a neuropsych next year (have to pay oop & no one good here to do it, so next year will be 3 years since her initial school district eval)

 

I'm starting to think that she also has ADD (no hyperactivity) going on. Really, she brought it up. She's old enough to google herself, sigh.

I thought the difficulty concentrating on schoolwork was just due to her other issues. She's wanting to try meds for ADD.

 

How would the ped differentiate between everything else she has going on & ADD?

I'm willing to trial meds, they've been life changing for the depression.

 

She already drinks coffee, btw & I do know that ADD presents differently in girls... I just never connected it to her.

Anyone have a good link to the checklists Drs use for diagnosis?

 

Thoughts? Thanks

Edited April 24, 2017 by Hilltopmom

[kbutton]

I believe our ped uses a shortened version of the Vanderbilt scale (I think the long one has some ODD and OCD questions as well, and I think this is the long one): http://www.nichq.org/childrens-health/adhd/resources/vanderbilt-assessment-scales

 

Low processing speed and low working memory (or unstable versions of these) are things they expect to see with ADHD, including inattentive subtype. That would be one indicator that she is on to something. With all her issues, she sounds pretty self-aware to be googling herself. It might make your job harder, but it's pretty cool that she is using that level of metacognition. 

 

I think I would want to know if she has racing thoughts, lots of simultaneous thoughts, if she hears/watches things that we normal tune out (clocks ticking, birds playing in the trees, etc.), if she needs to keep telling herself to focus and stay on task. I would also kind of watch to see if she falls apart with multi-tasking familiar things. No one truly multi-tasks, but can she handle a brief interruption and then return to task? For instance, if you ask her what she wants for lunch while she's finishing up an assignment, is it a big deal? When she's doing tasks appropriate to her capabilities and LD's with the right support. does she still struggle to process things simultaneously (for instance, filling out a listening guide while watching a video)? Those are things that fluster the people I know who have inattentive ADHD. Oh, and latching onto details that might not be important at the expense of ones that are. I know a couple of people that "rewrite history" a lot. You can poll twelve people present, and 11 will agree, but that one individual missed cues, etc., and they have a completely different take on the cut and dry facts of who said or did what. 

 

https://www.additudemag.com/how-adhd-inattentive-type-looks-a-lot-like-learning-disabilities/

HTH

 

[Crimson Wife]

Teasing apart difficulties with attention, auditory processing, and working memory is VERY difficult. Also, I would question the validity of the "borderline" IQ score if it's from a standard PS school psychologist rather than a neuropsych. The difference between the IQ score we got from the school psych and the NP was >2 standard deviations. The lowest subscore on the testing that the NP did was higher than the highest subscore on the school psych's testing.

[AimeeM]

Teasing apart difficulties with attention, auditory processing, and working memory is VERY difficult. Also, I would question the validity of the "borderline" IQ score if it's from a standard PS school psychologist rather than a neuropsych. The difference between the IQ score we got from the school psych and the NP was >2 standard deviations. The lowest subscore on the testing that the NP did was higher than the highest subscore on the school psych's testing.

This.

And even with a great neuropsych, they can be difficult to tease apart.

 

Part of our ASD evals (done with a wonderful psych, with over 30 years experience administering these evaluations) was IQ testing. Between rigidity issues, language processing issues, and other language delays (receptive and expressive), it seems almost impossible to get a truly valid IQ score. DS4 refused to participate for parts of the testing, and at one point, during his own, DS7 simply declared, "I'm done," and stopped participating. Both also have rigidity issues and language delays (receptive, expressive, processing issues, etc.). The psych strongly suggested, especially for DS7, that we re-evaluate in a couple years.

[maize]

Teasing apart difficulties with attention, auditory processing, and working memory is VERY difficult. Also, I would question the validity of the "borderline" IQ score if it's from a standard PS school psychologist rather than a neuropsych. The difference between the IQ score we got from the school psych and the NP was >2 standard deviations. The lowest subscore on the testing that the NP did was higher than the highest subscore on the school psych's testing.

We also saw a big difference in IQ scores between school and private testing.

[imagine.more]

I'd also question the IQ score if she's self-aware enough to google her own symptoms of her own volition. DD15, with an IQ of 69 but possibly higher would never think to do that. It might be partly personality but it seems kids who truly struggle with low intelligence don't even think to google themselves or think in depth about their own self.

 

As for the ADHD, I agree that low working memory often goes along with ADHD so there's definitely a possibility. Depression can also be comorbid with ADHD. The pediatrician can still diagnose ADHD even with other issues. It's worth checking.

[coastalfam]

I would think you would need more than a pediatrician to look at the full picture for the purpose of meds. I have ADD, non hyperactive, and incidentally, I also had eating disorders and depression as a teenager, and I still have generalized anxiety disorder. From personal experience, medication for ADD can cause some side effects that made it difficult for me to tell if it was exacerbating anxiety, but also my anxiety and depression is a bit relieved by ADD medication, because it takes away the burden on constantly being behind in things, feeling like I'm no good and failing, etc. I currently don't medicate for either my ADD for GAD mostly due to motherhood/breastfeeding. etc. One way to tease things apart without doing medication is to get her really physically active, if that is possible without exacerbating prior eating disorder behavior. Exercise can relieve ADD to a great extent and help reveal if it plays a part in her challenges. Otherwise, I really think you need to find a child psychiatrist, and not just a pediatrician, to go forward with proper diagnosis and medicating appropriately. I have a son on anti-anxiety medication through our pediatrician, but I personally would not go through the ADD medication process with a pediatrician. It can be much more tricky, especially with your daughter's eating disorder history, and the very common side effect of weight loss with ADD medication. In addressing low IQ, I think a qualifies child psychiatrist might be able to pick that apart as well.