Usual cost for ADHD Testing

[goldberry]

I'm about ready to take the plunge and have my DD professionally tested. The doctor I talked with says $125/hour, usual ADHD testing is 3 hours ($375) and ADHD plus cognitive processing is 5 hours ($625).

 

Is this usual? I would think I would want the cognitive processing as well as long as I am doing this.

[Renee in NC]

All it cost us was a $50 copay with the insurance because ADD is a medical problem.

[asta]

I'm about ready to take the plunge and have my DD professionally tested. The doctor I talked with says $125/hour, usual ADHD testing is 3 hours ($375) and ADHD plus cognitive processing is 5 hours ($625).

 

Is this usual? I would think I would want the cognitive processing as well as long as I am doing this.

 

Someone is snowing you. That isn't the right term, but it's all I can come up with.

 

I don't know how old your daughter is, but an ADHD eval takes about 5 minutes by a competent psychiatrist.

 

If your DD is a teen, the Pdoc will ask her a series of questions, and maybe have her answer some questions on a Xeroxed form. If she is little, he or she will ask YOU those same questions while watching what the kid is doing in the office. It isn't rocket science.

 

I can't speak to what is involved in a cognitive processing exam. Kid had a WISC test, and they looked at his processing during that (because he was only 7), but still, they only charged $125 for that - and that was at a psychologist.

 

 

a

[Lady Florida.]

It only costs us our copay of $15. There are supposed to be different people filling out the checklist. Did they tell you that? That can be tricky with homeschooled kids, unless they have extracurricular activities or outside classes. Our son had been in preschool, so we were able to give one to his teacher. At the time he wasn't in any outside activities though. Dh and I each filled one out, but did not discuss our answers with each other.

[Aubrey]

We originally payed between $200-300 for a short test, which was really...unsatisfactory.

 

Since then, I've known of 3 people who were diagnosed during an office visit. (Not sure if the dr was a specialist or not, though, but copay was all that applied.)

 

However, 2 of these 3 people have since been referred for further testing, both in the neighborhood of $500, due to blood tests, among other things.

 

HTH--I actually have no idea what's right or not.

[lakotajm]

Are you serious?! What a racket. I thought that the ADHD diagnosis used to be a simple subjective checklist. Hence, if you "felt" your child was ADHD, he "was". Has this changed that drastically? And what is the research-based reason for the change-i.e.-what have they supposedly now discovered about ADHD that allows them to now be able to objectiviely measure it (and charge an arm and a leg to boot.) Or is it just another example of doctors, specialists, pharmaceutical companies and insurance capitalizing on parents' concerns?

 

Brings us back to the debate about the causes of ADHD and other modern ailments youth now have. It seems to keep cropping up that our modern lifestyle is often the cause of these maladies. Maybe off topic, except that the cure may simply be lifestyle alterations-in some instances. ADHD, I think, would only partly respond, considering that the damage may have been done early enough in their life that they are now neurally wired that way. But interesting, nontheless. Reminds me of the recent studies showing that teenagers are not quite as innately lazy as we modern folks think. They found that they are sleepy due to lack of sunshine and also that if they put off school for just a half hour, they perform better. Just some food for thought.;)

 

Lakota

[Carrie12345]

I wouldn't take the word of a 5 minute evaluation for my child (I was willing to do so for myself, but I'm more careless with myself than I am with my children in many ways!), but I wouldn't buy into the hourly rate business, either.

 

We've gone through extensive testing with my ds (neuro, physical, educational, etc) and it always been a matter of copay + deductible (if applicable, after billing) just like any other doctor visit.

[goldberry]

What a variety of responses! I guess myself, I might be a little worried if my DD was diagnosed in 5 minutes, or based only on my assertion. Surely there is more to it than that? I would assume there have to be some kind of actual indications of the way their brain is working.

 

If all there is to it is checking off lists, then you can do that on the internet. I thought that was just to give you an idea if ADD was LIKELY to be the problem.

[Garga]

Our doctor had us fill out a form and asked for a teacher to fill out a form. We had the children's pastor (who sees my son a lot) fill out the form in the place of a teacher.

 

We filled out the forms, took them to the pediatrician, she asked a few questions, gave us an Rx and the next morning, we had a much calmer child. Still smart and inquisitive and all the good things, but he was just able to control those impulses and crazy-hyperness.

 

If your kid has ADHD, it's pretty obvious, especially when you see your kid around other kids in a setting where they're required to be somewhat quiet or to pay attention (which is why they ask for a teacher form.) It's really not that hard to dx. It doesn't take much longer than the 5 minutes other posters have mentioned.

 

What sort of results would come from all the tests they're recommending? What exactly are they looking for with all that? Something besides ADHD? What exactly is cognitive processing?

[Lady Florida.]

It's more than just a checklist. Certain criteria must be met. For example, the behavior must be considered inappropriate for the developmental level. People will say, "Well all kids do that. It's part of being a kid." Yes and no. At some point "that" becomes inappropriate for a particular age/developmental level, and the child with AD(H)D is unable to realize it.

 

Also, at least some of the behaviors must be present before age 7, show themselves in 2 or more settings, and interfere with normal life (school, work, social situations all qualify as normal life).

 

When looking at a possible diagnosis, a professional will (or should) review the checklist, observe the child, and talk to the parents.

 

It still shouldn't cost that much, but I don't know your insurance situation. Maybe that's what it really costs. It is a medical condition though, so any insurance policy that covers say, depression or anxiety, should cover ADHD testing.

 

BTW, my son was diagnosed as having ADHD, combined type, moderate. So he has the inability to focus along with that lovely thing called lack of impulse control (what the H REALLY means)!

 

Sorry about the toy company website, but it was the best link I could find to the full checklist and not a summarized version.

http://www.turnertoys.com/ADHD/APA_diagCriteria.htm

[Renee in NC]

What a variety of responses! I guess myself, I might be a little worried if my DD was diagnosed in 5 minutes, or based only on my assertion. Surely there is more to it than that? I would assume there have to be some kind of actual indications of the way their brain is working.

 

If all there is to it is checking off lists, then you can do that on the internet. I thought that was just to give you an idea if ADD was LIKELY to be the problem.

 

Technically, ADD is diagnosed when you meet certain criteria as laid out in the DSM. They are yes/no kind of questions. For my ds, it was a 30 minute appointment, but we had already had cognitive testing done and (most importantly) he exhibited explosive rage, sensory issues (as diag. by the OT), and a low processing speed. That, coupled with my descriptions of his behavior, led her to "prescribe and see." It was apparent day 1 that the stimulants were the difference between normal and out-of-control. For my ds, the problems far exceed what most people think of as ADD - there is most likely temporal lobe damage caused in infancy, but we'll leave that to the neuropsych.;)

 

My oldest ds was tested more extensively, but IQ and achivement tests were done as well. We had already done that, so that may be another reason for the easy. All I know is that without meds, ds is mildly mentally retarded and exhibits extreme rage/aggression, with them he is/does not.

[asta]

Technically, ADD is diagnosed when you meet certain criteria as laid out in the DSM. They are yes/no kind of questions.

 

Yes. From the above mentioned link:

 

Diagnostic Criteria for ADHD Reprinted with permission from the Diagnostic and Statistical Manual of Mental Disorders, 4th Ed. (DSM-IV). Copyright 1994. American Psychiatric Association.

 

A. Either 1 or 2

1) Six (or more) of the following symptoms of inattention have persisted for at least 6 months to a degree that is maladaptive and inconsistent with developmental level:

Inattention

a) Often fails to give close attention to details or makes careless mistakes in schoolwork, work, or other activities

b) Often has difficulty sustaining attention in tasks or play activities

c) Often does not seem to listen when spoken to directly

d) Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (not due to oppositional behavior or failure to understand instructions)

e) Often has difficulty organizing tasks and activities

f) Often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (such as schoolwork or homework)

g) Often loses things necessary for tasks or activities (eg, toys, school assignments, pencils, books, or tools)

h) Is often easily distracted by extraneous stimuli

i) Is often forgetful in daily activities

2) Six (or more) of the following symptoms of hyperactivity-impulsivity have persisted for at least 6 months to a degree that is maladaptive and inconsistent with developmental level:

Hyperactivity

a) Often fidgets with hands or feet or squirms in seat

b) Often leaves seat in classroom or in other situations in which remaining seated is expected

c) Often runs about or climbs excessively in situations in which it is inappropriate (in adolescents or adults, may be limited to subjective feelings of restlessness)

d) Often has difficulty playing or engaging in leisure activities quietly

e) Is often "on the go" or often acts as if "driven by a motor"

f) Often talks excessively

Impulsivity

g) Often blurts out answers before questions have been completed

h) Often has difficulty awaiting turn

i) Often interrupts or intrudes on others (eg, butts into conversations or games)

B. Some hyperactive-impulsive or inattentive symptoms that caused impairment were present before 7 years of age.

C. Some impairment from the symptoms is present in 2 or more settings (eg, at school [or work] or at home).

D. There must be clear evidence of clinically significant impairment in social, academic, or occupational functioning.

E. The symptoms do not occur exclusively during the course of a pervasive developmental disorder, schizophrenia, or other psychotic disorder and are not better accounted for by another mental disorder (eg, mood disorder, anxiety disorder, dissociative disorder, or personality disorder).

 

Code based on type:

314.01 Attention-Deficit/Hyperactivity Disorder, Combined Type: if both criteria A1 and A2 are met for the past 6 months

314.00 Attention-Deficit/Hyperactivity Disorder, Predominantly Inattentive Type: if criterion A1 is met but criterion A2 is not met for the past 6 months

314.01 Attention-Deficit/Hyperactivity Disorder, Predominantly Hyperactive, Impulsive Type: if criterion A2 is met but criterion A1 is not met for the past 6 months

314.9 Attention-Deficit/Hyperactivity Disorder Not Otherwise Specified

Edited December 13, 2010 by asta

[goldberry]

Technically, ADD is diagnosed when you meet certain criteria as laid out in the DSM. They are yes/no kind of questions. For my ds, it was a 30 minute appointment, but we had already had cognitive testing done and (most importantly) he exhibited explosive rage, sensory issues (as diag. by the OT), and a low processing speed. That, coupled with my descriptions of his behavior, led her to "prescribe and see." It was apparent day 1 that the stimulants were the difference between normal and out-of-control. For my ds, the problems far exceed what most people think of as ADD - there is most likely temporal lobe damage caused in infancy, but we'll leave that to the neuropsych.;)

 

 

 

Wow, I'm so glad something was able to help your DS. Can you (or anyone else) tell me what sort of things "cognitive testing" reveals?

[Laurie4b]

Someone is snowing you. That isn't the right term, but it's all I can come up with.

 

I don't know how old your daughter is, but an ADHD eval takes about 5 minutes by a competent psychiatrist.

 

 

a

 

I strongly disagree and would consider that malpractice.

[Laurie4b]

I would ask specifically which tests they are doing. The cognitive testing is very helpful and I wouldn't want an ADHD dx without it. There are certain patterns on the WISC-IV that will show up in ADHD kids, etc. (I would want a WISC)

 

I would absolutely not want an ADHD diagnosis based on checklists only, especially as a homeschooling mother. The whole thing will come down to your interpretation of certain questions on the checklist. I am not a big fan of the checklist diagosis alone--it leads to overdiagnosis and misdiagnosis. But you have only your own children as your basis of comparison. It's also tough to get a good checklist from outside classes unless they meet regularly (like more than once a week). Part of the issue is that it is easier for the human mind to attend to novel stimulus and the once-a-week type co-op classes tend to fit this bill. Also if her symptoms are more subtle, they may not be noticed in a group situaion, particularly with volunteer teachers. (If she is very hyperactive, that will be spotted, but a lot of people won't notice the kind of attention lapses that a lot of ADHD kids have.)

[Laurie4b]

What a variety of responses! I guess myself, I might be a little worried if my DD was diagnosed in 5 minutes, or based only on my assertion. Surely there is more to it than that? I would assume there have to be some kind of actual indications of the way their brain is working.

 

If all there is to it is checking off lists, then you can do that on the internet. I thought that was just to give you an idea if ADD was LIKELY to be the problem.

 

The checklists they use are different than what you'd find on the internet, but I wanted for my ds was a broader assessment than ADHD--yes or no. There are other things that can look like ADD, such as nonverbal learning disability, sometimes Asperger's etc.

 

I would be looking for tests of working memory in the cognitive assessment, for instance; additionally, I'd want an assessment of processing speed. (That will be included in the WiSC IV if that is one of the cognitive assessments being done.) I would also want the assessment to include a measure of impulsivity. There are different tests that include measures of this.

 

Unfortunately, you can actually walk into a ped's office and walk out with the dx and a prescription. That's where the overdiagnosis comes in. And especially since you're homeschooling, it's going to essentially mean that you, the mom, are responsible for the diagnosis. I wanted something more objective than my own best guess for my kid, KWIM?

[Renee in NC]

Wow, I'm so glad something was able to help your DS. Can you (or anyone else) tell me what sort of things "cognitive testing" reveals?

 

He had the WISC-IV done and the WRAT (achievement test.) It gave us an overall IQ, with working memory and processing speed results. His results were *not* valid, but now we know that he walked around in a fog most of the time - he couldn't answer a question because by the time she would get to the end he would've forgotten the beginning. No wonder he tested so low!

[goldberry]

The checklists they use are different than what you'd find on the internet, but I wanted for my ds was a broader assessment than ADHD--yes or no. There are other things that can look like ADD, such as nonverbal learning disability, sometimes Asperger's etc.

 

I would be looking for tests of working memory in the cognitive assessment, for instance; additionally, I'd want an assessment of processing speed. (That will be included in the WiSC IV if that is one of the cognitive assessments being done.) I would also want the assessment to include a measure of impulsivity. There are different tests that include measures of this.

 

Unfortunately, you can actually walk into a ped's office and walk out with the dx and a prescription. That's where the overdiagnosis comes in. And especially since you're homeschooling, it's going to essentially mean that you, the mom, are responsible for the diagnosis. I wanted something more objective than my own best guess for my kid, KWIM?

 

Thank you, that's kind of what I was thinking.

[QueenCat]

 

Unfortunately, you can actually walk into a ped's office and walk out with the dx and a prescription. That's where the overdiagnosis comes in. /QUOTE]

 

:iagree: ADHD and ADD are way overdiagnosed. A good ped will not diagnosis your child in 5 minutes. A really good ped will refer you to a specialist. And that costs money but you are likely to get a more accurate diagnosis, with better suggestions on therapies and meds.

[TravelingChris]

By the way, the checklists are very long and include a lot of behaviors that are not part of ADHD. This is partly done to make sure there is no other reason and also to help distinguish the types of ADHD. I have the checklists right here since my dd is a senior and needs a comprehensive evaluation to get disability services at college. She doesn't need much- a single room, no evening classes in subjects that are analytical (she can take choir but not most thinking subjects), and spelling checkers allowed (she also has a spelling problem and some memory issues). Looking at the lists (I haven't filled one out yet) some things are so much like her but others that many ADHD people have difficulties with aren't. SHe has no issues with not doing work. She does all her work (she is also medicated from early morning to early evening), but she is typically ADHD that she may forget to take said homework to class.

[goldberry]

Well, I called another place that is one of the few that my insurance MIGHT cover. They told me they would make an appt for me with a general behavioral therapist and I could request an ADHD evaluation.

 

It was a bit of an odd conversation though, so I don't know if it will be what I am looking for. I guess if I don't feel its sufficient I can still go and pay for it somewhere else. It's alot of money, but if it is actually useful results we would be willing to try to come up with it.

[Carrie12345]

By the way, the checklists are very long and include a lot of behaviors that are not part of ADHD. This is partly done to make sure there is no other reason and also to help distinguish the types of ADHD. I have the checklists right here since my dd is a senior and needs a comprehensive evaluation to get disability services at college. She doesn't need much- a single room, no evening classes in subjects that are analytical (she can take choir but not most thinking subjects), and spelling checkers allowed (she also has a spelling problem and some memory issues). Looking at the lists (I haven't filled one out yet) some things are so much like her but others that many ADHD people have difficulties with aren't. SHe has no issues with not doing work. She does all her work (she is also medicated from early morning to early evening), but she is typically ADHD that she may forget to take said homework to class.

 

This is why a comprehensive eval is important for ps kids, too. A generic "ADD IEP" isn't going to help anyone, since every ADD'er is going to need different accommodations and/or support based on their own unique difficulties.

 

For homeschoolers, that's obviously not AS MUCH of an issue, since we tend to know our kids better than the average ps teacher, but we can still benefit from information more specific than "Yeah, the kid has ADD".

 

With all of the research we tend to put into finding the "right" math program and "best" pencils, I'm not sure why we wouldn't want to dig for more information about how our kids' brains work.

[goldberry]

With all of the research we tend to put into finding the "right" math program and "best" pencils, I'm not sure why we wouldn't want to dig for more information about how our kids' brains work.

 

Amen.

[texasmama]

You can go a pediatrician or family doctor and be "diagnosed" with ADHD in order to receive meds. You can also see a psychologist for testing which will include IQ testing and generally some checklists for parents and teachers, as well as an evaluation/interview of the child. It depends on what you are wanting to get out of the testing. Is your end goal medication? Then a pediatrician might be willing to give these. (Not all are, and some testing should be done prior to starting on stimulant meds. Generally an EKG and some bloodwork are done.) If you are trying to determine if there are other issues (learning disabilities, etc), then a full psychological evaluation is needed. The hourly rate you quoted and the time needed for the full evaluation is not out of line with what professional standards would indicate.

[asta]

I would never recommend taking a child to anyone but a Psychiatrist to determine whether or not the child had ANY mental disorder; ADHD, ADD, or anything else.

 

The "checklist" I posted isn't an "internet checklist". It is the official criteria from the Diagnostic Statistical Manual of Mental Disorders, the book that ALL medical personnel must use to officially diagnose a person with any mental disorder.

 

Now, a person may argue about the time involved in getting to that criteria, and the method that each individual doctor uses, but it is certainly not "malpractice" for a psychiatrist to interview the parent, watch the behavior of the child, and see if the child meets the criteria on the list. Some kids and adults meet it, period. Some are iffy, and require more time and testing to make sure it isn't something else.

 

I have met a child who, even medicated, obviously met the criteria. It was obvious within 5 minutes of meeting him - to a non doctor. Your heart went out to the kid, as he had a difficult life ahead of him. He was also co-morbid for bipolar (according to his mom; the kid had had a LOT of care over the years, and dad was a psychiatrist to boot).

 

Some kids are just handed a bummer of a plate to deal with. It doesn't mean a psychiatrist is incompetent.

 

 

asta

Edited December 14, 2010 by asta

[TravelingChris]

Yes, PS kids have to get it too. That is if they need any accommodations in college. FOr colleges, you generally need a comprehensive evaluation within the last three years. The PP poster is right, I accommodated perfectly well in my homeschool but now I need to get the documents so she can have her minor accommodations.

[Lady Florida.]

I have met a child who, even medicated, obviously met the criteria. It was obvious within 5 minutes of meeting him - to a non doctor.\

 

So you've met my son? :lol:

 

Seriously, so many people think medication will completely eliminate symptoms. It doesn't. Nor does it make a child behave, or make a child successful in school. What it does is control the symptoms enough to help put the individual on an even footing with his peers. It's a tool, not a cure.

 

I'm always a bit frustrated with people who say medicating for ADHD turns a child into a zombie. Um no it doesn't. Some of these people have seen my son and had no idea he was on medication. When I tell them, they seem shocked he isn't just sitting there like a vegetable.

[Lady Florida.]

FOr colleges, you generally need a comprehensive evaluation within the last three years. The PP poster is right, I accommodated perfectly well in my homeschool but now I need to get the documents so she can have her minor accommodations.

 

I didn't think of this. Thank you for pointing it out. It will be something to keep in mind for when ds gets closer to college age.

[Dani n Monies Mom]

Six years ago, Dd was in school and the school psychologist sent a checklist home and to the teacher, then dx'ed her without every meeting her. I didn't trust the dx, hence we found our own developmental pediatrician.

 

We got a pre-approval from our insurance, paid about $1500 up front, then filed with the insurance company and got all but $10 back. The visit was at least 3 hours spent in different testing with my dd and was very thorough. It went way beyond ADD. Working memory, processing speed, all those types of things were tested and we learned so much. The doctor spent time with us in coming up with treatments with traditional meds and homeopathic remedies and left the choice to us with follow up home calls for tweaking ect... The experience left us better informed to deal with the school and really address her needs, which, after some trial and error, became homeschool(:, though she's in p.s. high school now.

 

Hope that helps,

Ava

[goldberry]

I guess in thinking about motivation for testing, number one I want to know specifically what is going on so I can best address what it is. Whether that includes meds or not, I'm not sure, I guess it depends on how things develop. I am not opposed to meds in principle.

 

But number two, and I hope this doesn't sound awful, but I think for myself it will improve my own attitude toward the situation. Right now, as a mentioned in another post, I still sometimes think "well she's just not cooperating" or "she's not making an effort". A serious fault of mine is I am very type-a and can become very critical if I don't watch myself. Therefore, it's easy for me to lose patience with her and then I feel horrible, because I think, well maybe it's not her fault and I'm totally destroying her self-esteem.

 

So honestly, I think that with a diagnosis I would be able to settle into the situation and give her what she needs because my own attitude would improve. Does that make any sense?