Not Sure about Diagnosis- OCD/Anxiety/ADD

[Paige]

Background- My DS (10) has been seeing a psychiatrist for a few months. He was having a really hard time dealing with our move and ultimately started acting depressed and saying he wanted to hurt himself. DS has always been quirky and has had issues in the past but until this summer it was all stuff that wasn't significant enough to negatively affect his life. He saw a Dr when he was 6 who said he was OCD/ADD/and anxiety. We didn't treat him and weren't fully on board with the diagnosis. We did a trial w/meds, it didn't go well, and then the Dr wanted to try different meds and change his diagnosis based on which drug worked. :001_huh: We didn't go back after that and he hasn't seen anyone or needed any help since then until Nov.

 

So, this new Dr has also diagnosed him with OCD and anxiety. I get the OCD. DS gets intrusive and persistent thoughts and his mind gets stuck on ideas that he can't dismiss. It's obvious, but not usually anything we can't work with. I don't get the anxiety. DS just doesn't seem like an anxious kid to me. I think the real issue is ADD. I know...so overdiagnosed, but DS just fits it IMO. I used to think he couldn't be ADD but it seems to get more apparent the older he gets. He reacts emotionally like a much younger child would, he forgets everything and has a horrible short term memory, he is very smart but does poorly on his work because he misreads directions and does the wrong problems, he takes forever to do anything, has to be isolated from his sisters if I expect him to do any work. It is just non-stop me trying to keep him on task all day and reminding him to do basic stuff. I told the Dr that I thought that this was really his problem and he said that he thinks DS just seems inattentive because he is OCD and anxious about other things. I think he may appear anxious because he anticipates failure and getting in trouble for not performing well because he can't pay attention and remember or control his impulses. The Dr won't prescribe an ADD med because he thinks it is unnecessary and will make his OCD/anxiety worse.

 

I'm getting frustrated because while DS is no longer throwing fits and talking about killing himself, he is driving me (and everyone else) crazy with what I see as serious ADD symptoms. DS was a perfect, mellow, super cooperative, and friendly toddler and preschooler. He wasn't hyper at all and the Dr says this indicates he doesn't have ADD. Would you insist on a 2nd opinion at this point, wait it out and trust the Dr., or something else? DS gets in so much trouble for not following directions and he is not defiant- he's just spacey, and DS is so frustrated with himself. I filled out an assessment for aspergers and I think ADD at his psychologist's office so maybe that will help. DS sees the psychologist in addition to the psychiatrist to help him work through his anger, sadness, and OCD issues but he's only seen him twice so far. The psychologist hasn't given his opinion after his evaluation yet, but he can't prescribe drugs.

 

If your child has OCD and anxiety, did he or she show ADD like symptoms? DS does not have any ritualistic behaviors. He just gets stuck on an idea or thought- usually not a good or true one- and it might persist for months or even years.

Edited February 15, 2012 by Paige

[MomatHWTK]

I read the book The Bipolar Child and basically came away with the impression that often finding the medicine that works does make the diagnosis. A child may be bipolar but look ADD, but when put on an ADD medicine they will react differently than an ADD only child would. The same is true with ADD, OCD, depression, anxiety and various other conditions. Many of the conditions occur together (comorbid I think they call it in the research journals), some of them mimic each others' symptoms.

 

Also, the medications often treat symptoms and the therapy modifies behaviors, so the actual condition may not matter for initial treatment purposes. In the long run, you may figure out what's going on, but I've not found it to be a quick answer. We still don't have a final diagnosis for our child after a year of work with a phychiatrist and therapist. BUT, we are making progress in modifying some behaviors and we are finding some medications that make improvements in his day to day life. We are closer to knowing the full picture and have some answers.

 

If you aren't comfortable with your doctors, then you have to find a set that you are comfortable with because you will be a team for some time to come. But, it also helps if you do a little investigating here and there. I do recommend The Bipolar Child just because it offers a good summary of the various medications and treatments for bipolar and the other conditions. I also have a book about Aspergers by Tony Attwood, but I've not read it yet so can't offer a recommendation. The book was recommended to me by someone on an Aspie support board.

 

Here are some of the materials I looked at when I started researching:

Bipolar Information: http://www.jbrf.org/pdf/CBQ_Development.pdf

Bipolar Questionnaire: http://www.jbrf.org/cbq/cbq_survey.cfm

Scoring Guidelines: http://www.jbrf.org/pdf/cbq_srv.pdf

http://www.psbmed.com/pdf/teenChildBipolarQuestionnaireForm.pdf

Vanderbilt Assessment Tool:

http://www.cap4kids.org/new_york_city/download/ADHDParent.pdf

Scoring: http://www.nichq.org/toolkits_publications/complete_adhd/07Scoring%20Instructions.pdf

 

 

 

 

ETA: It looks like your doctor is not doing any testing? My son was tested for IQ, ADHD, Aspergers, etc. We were able to learn about what areas were working well for him and which ones were not- he has a slow processing speed and high ADHD, but also anxiety and other issues. I would probably try to find someone who can do the testing. Reading online, I see there is some conflict as to whether the TOVA test is accurate at indicating ADHD or not. This was one of the tests DH took. But the therapist also looked to history, in office behavior, school performance, the performance on the other tests, etc.

 

Edited February 15, 2012 by MomatHWTK

[Paige]

ETA: It looks like your doctor is not doing any testing? My son was tested for IQ, ADHD, Aspergers, etc. We were able to learn about what areas were working well for him and which ones were not- he has a slow processing speed and high ADHD, but also anxiety and other issues. I would probably try to find someone who can do the testing. Reading online, I see there is some conflict as to whether the TOVA test is accurate at indicating ADHD or not. This was one of the tests DH took. But the therapist also looked to history, in office behavior, school performance, the performance on the other tests, etc. [/size][/font]

 

You're right- the psychiatrist didn't do any testing. I never even realized that! I guess we were so stressed out at first that we weren't thinking carefully. He just took his history and talked to him for about 30min. I am not sure talking to DS is really the best way to find out what is really going on because DS is not the most eloquent and he will say what he thinks people want or expect to hear. It's frustrating. I'll ask the Dr why he hasn't tested him and if he can the next time we see him. DS was tested when he was much younger and came up as not fitting any diagnosis. He just thinks differently than other people and usually it is no big deal but right now it's making his life difficult.

[SkateLeft]

If your child has OCD and anxiety, did he or she show ADD like symptoms? DS does not have any ritualistic behaviors. He just gets stuck on an idea or thought- usually not a good or true one- and it might persist for months or even years.

 

OCD is an anxiety disorder.

 

No, my son with OCD does not have ADD symptoms. Without medication, he washes his hands and brushes his teeth hundreds of times a day, gets up at night to open and close doors, and has a list of "contaminants" (that prompt hand washing/tooth brushing) a mile long. Even with medication, he still has the compulsions, and will constantly ask, "If I do this, do I have to wash my hands?" but if I say no, he can move on without getting stuck.

 

It's entirely possible to have an anxiety disorder co-morbid with other things, like ADD. I agree with the other posters, in that you probably need to have more comprehensive testing done.

[funnygirl]

These disorders are INCREDIBLY tricky because many of them have a chicken/egg phenomenon; is the anxiety causing the add-like behaviors, or are the add-like behaviors leading to anxiety/OCD?

 

Someday there will be definitive MRI scans or blood work that will prove exactly what we're dealing with. In the meantime though, much of psychiatry (particularly child psychiatry) is a guessing game. The psychiatrist makes the best decision he can given his personal understanding of the information in the DSM IV and his personal understanding of your child (which after 30 minutes, isn't much!) I appreciate the fact that your psychiatrist is aware that add meds can worsen anxiety. This is frequently overlooked, and difficult to tease out once the child is on the meds. So let's give him credit for his conservatism and understanding of the nuances of these meds.

 

Certainly one way of getting at these symptoms is by treating them with meds and watching for results. Your psychiatrist must feel that the anxiety med would be the lesser of two evils as a starting point. He wants to TRY that, and see if it effects the add behavior. So why not go for it? If it works, perfect! If it doesn't (and I assume you'll be seeing him in four weeks) don't be afraid to let him know it's not working.

 

In the meantime, keep a daily (even hourly) chart of ds's behaviors and anxieties. Make it specific. That way when you return to the psychiatrist, you'll have objective data to share with him.

 

Unfortunately, it's all just a whole lot of trial and error. I know I for one have BTDT more times than I can count.

 

So :grouphug:, WINE!, and lots of chocolate!!

[honeymommy4]

Well, I thought ADD was the low-activity type. I had TONS of anxiety issues with DS as a toddler/preschooler, though and didn't know what it was. He is very similar to me in the ADD perspective and similar to my Mom in terms of the OCD. but my mom is diagnosed with bipolar. I have ADD.... I've had depression, in the past, too.

 

i don't know. DS has only been diagnosed first with ODD and now OCD/Anxiety, with a tendency toward ADD> We have not done any meds just diet modification.

 

I totally get where you are though - where your entire day is smoothing over "problems" or issues they have with other siblings - whether it being moderating them or just stopping the fights, etc. Once my DS gets started, he tends to be like that all day. It does take up so much time and my energy, too.

 

Now he is getting older and starting to feel more lonely with homeschooling. Doing more diet modfication help with his moods but i worry that in the long run homeschooling is going to bring him down more.

Not sure what to do so looking on here for advice threads.:001_smile: :grouphug:

[ssavings]

OCD is classified as an "anxiety disorder" in the DSM.

 

OCD without compulsions (handwashing, hoarding, etc.) is called "pure obsessional" OCD (I've heard it called Pure O for short). My DH has Pure Obsessional OCD (he also has an overlapping case of OCD with compulsions, but two different issues). He fixates on one thing, and the thought comes back over and over. In pure obsessional OCD, rather than a visable compulsion(like, for example, using obsessive hand-washing to neutralize obsessive anxiety about germs) to neutralize the anxiety, excessive and obsessive dwelling on the anxiety becomes the neutralizing behavior.

 

Both my DH and my DS have various issues of inattentiveness due to OCD. It happens when they are particularly fixated on an obsessive thought - they simply CANNOT get themselves to let go of that thought to concentrate on something else. However, it is not as consistent as you are describing.

 

My DH was diagnosed a with OCD based on symptoms, without testing. DS had testing, but they were looking for other things, too.

 

It's not uncommon for ADD to be a co-morbid disorder with other issues. If that's what you think is happening, then certainly pursue it further - maybe a developmental pediatrician or a neuropsychiatrist, who could do further testing.

 

..... I hate to say this last part, because I know it's not what you want to hear, but.... I'd also spend some time considering the OCD/anxiety diagnosis... two different psychiatrists, at two different times in his life, both diagnosing him with the same thing makes the diagnosis seem more likely correct, to me than if one doctor diagnosed it (b, obviously, OCD does not rule out a co-morbid ADD). ..... Again, my intention is not to offend, just to offer an outside perspective....

 

Edited to add: I don't know a ton about ADD meds, but I know that they are USUALLY stimulents. I know that DH was told to avoid stimulent medications because they can trigger anxiety, which increases OCD symptoms symptoms to a whole new degree of terrible.

:grouphug:

Edited April 14, 2012 by ssavings

[Finnella]

A child doesn't have to have hyperactivity to have ADHD. There is also ADHD: Inattentive Type, which is one of my DS's diagnoses. He also has anxiety, so one kid can have both.

 

If it turns out he does have ADD and anxiety, Ritalin and other stimulants used to treat ADHD will almost certainly make his anxiety worse. Our pediatrician tried a very low dose of one of the stimulants when my DS was in 3rd grade. Shortly thereafter, he announced to his 3rd grade class that he was going to kill himself.

 

Straterra is one of the few drugs for the Inattentive type of ADD, and it often does not aggravate anxiety. My DS has been on it for several years now, and it's been a big help.

 

Before our pediatrician tried any medications, she referred us to a psychologist for thorough testing and to confirm her diagnosis of ADD. She also mentioned that the ADD could be accompanied by other things, for example, bipolar. Or, in our case, anxiety. So I agree with other posters about an evaluation.