Diagnosing ADHD in the Homeschool Population

[Tokyomarie]

One of the DSM-IV criteria for ADHD is that behaviors must be observable in multiple environments. When a student's primary educational environment is home, it seems that it presents some extra challenges for getting a definitive diagnosis.

 

If your child has always been schooled at home, and, especially was schooled at home during the time you were seeking an opinion on whether your child could have ADHD &/or other behavioral or learning disabilities, what has been your experience with medical professionals actually being willing to make a call?

 

Have you experienced professionals who intimate that the child's behaviors are simply from having Mom be both teacher & mom? Have you experienced a professional who acknowledges that the child is likely ADHD but won't make the call because they don't have rating scales from outside teachers?

 

Have you had a professional who seems to think there is something going on but the child's profile doesn't fit the usual profile of an ADHD child who goes to school in a classroom?

 

I had an experience this week with some professionals that I'm trying to process & I'm not sure how I should interpret the experience.

[EKS]

Our doctor was willing to diagnose our son with ADHD. It is very difficult as the checklists say things like "compared to other children his age...". I don't know any other children well enough to make that call. My son seems to be very spaced during school time but maybe all children are like that.

 

The other problem is that kids with ADHD simply do better in a one on one teaching situation. So as a homeschooler, my son seemed positively with it. He makes excellent academic progress each year and he isn't really bothering anyone (except me).

 

Somehow, I don't think any of this answers your question.

[Orthodox6]

We have had no trouble with p-docs acknowledging this in two of our dc thus classified. They gave us the criteria forms and told us to do the best job that we could in answering the questions. We could supply observations from Sunday School class environments and from sports team environments, as well. As I was both "Mom and Teacher", I was asked to distinguish carefully between "school time" behaviours and "out of class" behaviours. I could do this, so doctors were satisfied.

 

Your experience sounds to have been different, and not helpful to you. I hope things work out usefully for you and your child(ren).

[littleWMN]

My oldest was in outside classes and her two teachers in that also filled out profiles (which looked very much like mine).

 

My 5 year old, it was first suggested by a psychologist that she had adhd and she explained all thre reasons why after her testing with her (and she was RIGHT! we just hadn't seen past her other issues to see it!). No one else was involved.

[Sushi's Mom]

My daughter was seeing a psychologist for anxiety disorder for about 3 months. My own doctor told me I had ADHD, which I mentioned to my daughter's doc. He then told me that she also has it. I think over the three months he spent enough time talking to the two of us (I stayed in the appointments with her) that he was able to make a diagnosis.

Edited July 25, 2011 by Sushi's Mom

[rafiki]

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[AHASRADA]

We were given both the parent and teacher forms, and asked that I (the teacher) fill out the teacher form, and my dh use the parent form.

 

The evaluator determined that ds was borderline ADD, and even admitted that, if he were having difficulty in more areas, he would likely be diagnosed. In his current situation, however, she could not do so.

 

So they were basically telling us that yes, he does have ADD symptoms, but because his individualized learning environment does not present him with as many challenges as public school would, his life is not disrupted enough by his issues to warrant a diagnosis. To me, this is like saying a diabetic is only diabetic when he has sugar in his blood stream, or an addict is only an addict when his substance of choice is present in his environment. :confused:

 

Anyway, these were PhD students doing a psychoeducational evaluation, so I cut them some slack. We got what we wanted, which was suggestions on how to help dc manage his distracted behavior.

 

I don't know if this helped, other than the relief in knowing we have also BTDT.

[Tokyomarie]

Our doctor was willing to diagnose our son with ADHD. It is very difficult as the checklists say things like "compared to other children his age...". I don't know any other children well enough to make that call. My son seems to be very spaced during school time but maybe all children are like that.

 

The other problem is that kids with ADHD simply do better in a one on one teaching situation. So as a homeschooler, my son seemed positively with it. He makes excellent academic progress each year and he isn't really bothering anyone (except me).

 

Somehow, I don't think any of this answers your question.

 

I am not a credentialed teacher but I've had a lot of experience around children of different ages and have taught small groups of them in settings other than a traditional school. This child is also NOT my first child. I've raised two girls- who each have had their own intensities & special needs but not at all like my son's needs.

 

My middle child could appear ADD/spacy, but now that she is an adult, I think I am inclined to believe she just had the appearance of ADD because of her auditory processing difficulties.

 

My son clearly has difficulty staying on task- especially when the task is something that is difficult and/or involves a lot of sequential thinking.

 

I have spent this child's whole school career saying things like, "Focus!" "Look at the paper." "Save that topic for later, we're talking about math right now." and on & on.

 

I think I must have an overabundance of tolerance for unfocused behavior. I had hoped that by now we could get past having it create issues for school, but it's not happening and now he will be going to a classroom school beginning at the end of August.

[Tokyomarie]

We were given both the parent and teacher forms, and asked that I (the teacher) fill out the teacher form, and my dh use the parent form.

 

We went through a full neuropsychological evaluation about 15 months ago. The evaluator's conclusion with respect to ADHD was that he was likely ADHD-Combined type, but he stopped short of issuing a solid diagnosis. Apparently part of the reason is because the evaluator didn't have information from people outside the family.

 

This time, I wanted to consult with an MD about a med trial, but I didn't want to just use our family practice physician- who doesn't really know him anyway, because ds is never sick so he's rarely in the office. And, I'm feeling squeamish enough about the idea of meds, even though I think it's time to try that I wanted to have someone whose specialty is working with these kinds of medications to work with us on a trial.

 

I decided to use the university based ADHD clinic. They have their set practice of doing their version of an evaluation before discussing meds. However, even though I had questions about how to handle some of the paperwork because of the fact that he has previously been evaluated and we homeschool, I couldn't get anyone to give me guidance prior to the actual day of the appointment.

 

So, I made the choice to fill out the teacher version of the rating form and have my dh fill out the parent version. They totally discounted the teacher version I filled out and made me do it all over again on the parent version.

 

Ds had developed a lot of oppositional behaviors that had become entrenched over the years. I believe it's likely that those stemmed partly from his anxiety over doing tasks he found difficult due to his dyslexia & dysgraphia- and those diagnoses are not in dispute. Since we've been working with highly experienced tutors over the last year- one of whom is very much aware of his behaviors and has worked hard to help him develop some different responses- he's lost a lot of the oppositional stuff. Without the oppositional stuff, and with him being older, I think he looks a lot more like ADHD-Inattentive. It's the inattentive stuff that is still tripping us up & that I worry about when he has to accomplish school on someone else's timetable.

[Tokyomarie]

We have had no trouble with p-docs acknowledging this in two of our dc thus classified. They gave us the criteria forms and told us to do the best job that we could in answering the questions. We could supply observations from Sunday School class environments and from sports team environments, as well. As I was both "Mom and Teacher", I was asked to distinguish carefully between "school time" behaviours and "out of class" behaviours. I could do this, so doctors were satisfied.

 

Your experience sounds to have been different, and not helpful to you. I hope things work out usefully for you and your child(ren).

 

I tried the tack of answering as carefully as I could concerning school time behaviors compared to out-of-school behaviors. But, they just seemed to feel that I could not possibly be objective enough to note differences. I realized after I got home & was processing the day that they made no attempt to have me describe what it is like to teach my son, nor how his specific behaviors have changed over the years. For instance, in the younger grades, he used to chronically drop his pencil and have to retrieve it, was constantly hanging over the edge of the chair and/or tipping it over, anything that entered his mind came out of his mouth, etc.

 

But between constant efforts at training him and things changing once he got through puberty, his behaviors are different. For instance, within the last year, we finally made progress on him not getting up out of the chair and walking away when I'm in mid-sentence trying to teach him something. I think the professional's view was that I "let him get away with this behavior" that wouldn't be tolerated in school. Well, short of handcuffing him to his chair, we were NOT making any progress until some level of maturity clicked in. So he looks less impulsive, but the inattention & lack of focus is still frustrating.

Edited July 25, 2011 by Tokyomarie

[merry gardens]

Our family doctors have never mentioned ADHD, however I made an appointment on my own to have DS evaluated by a Neuropsychologist who specializes in learning disabilities. Based upon his various testing, there was no doubt DS has ADHD...We have always homeschooled. My older two score quite well on standardized tests, despite their challenges. None of the kids have behavior issues. Because of this, not everyone is able to identify their challenges.

This is a very interesting thread. My children' don't have behavior issues, but I've suspected for a long that if they were at a public school some might have an ADHD diagnosis--and for a long time I thought that it would be a misdiagnosis because they have some other things going on. I've hesitated to use professionals because when I first saught help early, people kept seeing a well behaved child who had some speech problems but nothing far enough from the norm to get their attention.

 

I'm really now thinking that my ds may have ADHD along with dyslexia, so I went and looked up parenting strategies/behavior modifications techniques for dealing with ADHD. Just about every suggestion I read looked very similar to how my husband and I already parent our children. :001_huh:

 

So..how do they diagnosis mild-moderate ADHD a child who has always been homeschooled with teaching methods to accomodate him and who has been parented with techniques appropriate for children with ADHD?

[Tokyomarie]

So they were basically telling us that yes, he does have ADD symptoms, but because his individualized learning environment does not present him with as many challenges as public school would, his life is not disrupted enough by his issues to warrant a diagnosis. To me, this is like saying a diabetic is only diabetic when he has sugar in his blood stream, or an addict is only an addict when his substance of choice is present in his environment. :confused:

 

I've hesitated to use professionals because when I first saught help early, people kept seeing a well behaved child who had some speech problems but nothing far enough from the norm to get their attention.

 

I'm really now thinking that my ds may have ADHD along with dyslexia, so I went and looked up parenting strategies/behavior modifications techniques for dealing with ADHD. Just about every suggestion I read looked very similar to how my husband and I already parent our children. :001_huh:

 

These are the kinds of things I was thinking about. I'm thinking about a child whose parents have exerted tremendous amounts of effort in order to promote healthy attachment, good behavioral training, lots of one-on-one in academics, and reasonable accommodations for challenges with said academics. And therefore, perhaps, in outside settings, unless the task requires major amounts of focus & concentration and/or the kind of sustained interpersonal interaction that will be hindered by unfocused behavior, the child's profile may not be instantly recognized as classic ADHD.

[rafiki]

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[Tokyomarie]

So when I finally called for an assessment, I truly felt like I had hit a wall with things I could control and wanted professional validation that I was doing all that I could. I was open to any suggestions they may have to help me help my children be the best them they could be.

 

This was where I was at when ds hit 9th grade. Probably the only major thing we as parents could do differently was to limit screen time/video games & my husband was not willing to go as far as I wanted to- partly because it is one major way in which the two of them connect. Otherwise, I taught him with his obvious, but undiagnosed, dyslexia & dysgraphia in mind. I learned everything I could from reading my two favorite forums, participating in some online discussions led by professionals, and reading, reading, reading books. I was simply up against a wall.

 

We got terrific information from the evaluation done in spring 2010 and getting professional help for reading & writing has made a world of difference- and has improved some of the behaviors around school that were coming because of academic frustration.

 

I have never been keen on meds for his ADHD symptoms; that's one reason I have simply chosen to learn on my own about behavioral approaches. But as we've peeled back the layers of the academic difficulties and ds has been able to better communicate what he feels when he's trying to study, I have become more willing to try pharmaceuticals. He will be going into school this fall and will need to be able to function in a more traditional environment. Already, we're stuck with him doing at least the 1st 6 weeks of the program without academic accommodations which I'm not very happy about. I was hoping that we could do an ADHD med trial this summer (we school all summer) & at least have meds on board at the beginning of school, if we felt they were making a difference. Unfortunately, that's not going to happen, either, because the clinic wants to wait until he's been in school a few weeks.

Edited July 26, 2011 by Tokyomarie

[WeeBeaks]

My oldest is ADHD and always homeschooled.

 

One ped has us do the evaluation with me as teacher and DH as parent and took those. He was diagnosed ADHD.

 

We felt better having him evaluated by a different psychiatrist, who referred him for in depth study at the local university using various computerized tests plus several hours of interviews and interaction with him. He was still diagnosed ADHD but they were able to more definitively rule out other things. The psychiatrist we finally chose also spent a couple sessions with him interacting (45 minutes a piece) before he would suggest any diagnosis at all (again ADHD). This psychiatrist also does his own behavioral therapy as well as medication treatment.