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Where should I start? (possible ADD related issue)


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I just had a meeting with DS's 2nd grade teacher to discuss some concern for next school year. DS has been inattentive since he started school. Some teacher handles better than the other but the issue does not go away with his age. Teacher mentioned that he has lots of internal distriction than external. His mind goes off when he is reading. He does pretending play by himself in his mind. It happens at home as well. When I ask him to brush his teeth, he will still plays in my room for his pokemon battle (in his mind) by himself after 10 minutes. Teacher has tried several stretegies to try bring up his attention in class. When he is focus, he learns it really well. However, once she goes away to work with other students, his mind goes off again. He also has hard time to complete the task/test without reminder or redirection. He gets anxiety when he gets wrong or the last one to finish the works. We believe it's time to seek for further evaluation.

Teacher suggested we can talk to pediatrcian to see if it's medical condition (ADD, allergy or something else). If it's medical condition, we will have to seek for therapy or medical treatment. If it's not a medical issue, then child study team in school will conduct full evaluation to determine his strength and learning style so they can come up with recommandation and plan for school setting. The child study team will start to observe him next schol year. I am wondering if I should take him for evaluation before that. Should i go to pediatricain, pyscholoist, pediatric neuroologist or pyschiatrist to determine if it's a medical condition? I have requested the pyschological testing at local children hospital but the wait time is 6 months+. I also email one of the neuropyschological clinic and they will do full evaluation for $3000. They do not accept insurance and I will have to claim as out of network benefits. Please point me a direction to start with. Thanks.

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I have a child like that.  She was so distracted she would get off track while reading a sentence.  For her it was ADD and medication has made a world of difference.

 

I think you could do both.........get him on the list for the school to do some testing as well as contact your pediatrician to get the medical stuff started.

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Our ped is currently on leave till next week. Last time as I spoke to her, we mentioned the inattentiveness to her and she said observe for another year in 2nd grade and go for evaluation if it does not improve. It does not sound like she will do the diagnose. Does pediatrician do the evaluation as well? or should I go for psychiatrist?

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I would start with a full neuropsych evaluation, including IQ testing.  There are a number of issues (or non-issues) that may look like ADD that ought to be ruled out first.  Personally, I would want more expertise than a ped can provide in this area.

 

(FWIW, I have one who thinks about a lot of other stuff, in his mind, rather than working on something too hard or too easy or boring or both hard and boring, LOL, or something that involves a lot of handwriting.  In his case, he does not have ADD.)

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As i spoke to teacher this morning, school wants us to speak to pediatrician to rule out any medical issue like ADD/ADHD or allergy. Then school child study team will perform the full neuropyschological test if no ADD is found. Should i go private route for neuropys test8ng during summer before school starts? It will be out of network cost.

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 It does not sound like she will do the diagnose. Does pediatrician do the evaluation as well? or should I go for psychiatrist?

 

For just ADHD evaluation, our psychologist does the evaluation and we didn't need a referral from our pediatrician.  We checked with our insurance to make sure that we don't need the referral.

My school district would do a free ADHD evaluation.   A request would have to be put in by the parent though directly to the school district office. 

 

(FWIW, I have one who thinks about a lot of other stuff, in his mind, rather than working on something too hard or too easy or boring or both hard and boring, LOL, or something that involves a lot of handwriting.  In his case, he does not have ADD.)

 

Same here with my 8 year old :lol:

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Our insurance does not need referral for specialist. For out of network neuropys, we have 70% coverage.

 

For the best outcome, full NP evaluation will be the most ideal, correct? Does it need to involve with teacher or school for the interview? I am afraid if I go for it privately, then they will delay the child study team interview in September.

 

I am also afraid of mislebal as well. Normally ped or pys will base on interview or questionnaire to rule out ADD/ADHD. What if he has something else like wapiti mentioned above?

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I am also afraid of mislabel as well. Normally ped or pys will base on interview or questionnaire to rule out ADD/ADHD. What if he has something else like wapiti mentioned above?

My 8 year old has been evaluated. My friend's son has also been evaluated. Her son's first evaluation was inconclusive so the psychologist had a second session just to be sure. After the 2nd session, the psychologist conclude that there is insignificant grounds to suspect ADHD.

 

I would honestly ask around for recommendations but I won't assume any psychologist is going to mislabel an active child who daydreams because he is bored. It is also possible to seek a second medical opinion.

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My 8 year old has been evaluated. My friend's son has also been evaluated. Her son's first evaluation was inconclusive so the psychologist had a second session just to be sure. After the 2nd session, the psychologist conclude that there is insignificant grounds to suspect ADHD.

 

I would honestly ask around for recommendations but I won't assume any psychologist is going to mislabel an active child who daydreams because he is bored. It is also possible to seek a second medical opinion.

 

 

Thanks. Do you mind to share what they actually found at the end for your 8yo? My son does not have hyper behavor, but mainly inattentiveness. He actually gets tired easily than his peers. When he is tired, he cannot focus at all.

 

 

 

My son's social skill therapist has recommanded one doctor who is pediatrician and pediatric neurologist. She used her for one of her ADHD sons. School pyschologist will also observe him at next school year to determine if he needs full evaluation. I am not sure if he will do the ADD evaluation for him before that.

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Do you mind to share what they actually found at the end for your 8yo? My son does not have hyper behavor, but mainly inattentiveness. He actually gets tired easily than his peers. When he is tired, he cannot focus at all.

 

We are still in the middle of evaluations so I am not sure what he will actually end up being diagnosed as.  So far ADHD and autism were ruled out as highly unlikely. He is very affected by sound so we are going for the SPD evaluation next.

For tiredness, has your child's iron level been check?  There was a time when my 8 year had frequent blood tests because he was anemic and he has some food digestion issues. 

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We are still in the middle of evaluations so I am not sure what he will actually end up being diagnosed as.  So far ADHD and autism were ruled out as highly unlikely. He is very affected by sound so we are going for the SPD evaluation next.

For tiredness, has your child's iron level been check?  There was a time when my 8 year had frequent blood tests because he was anemic and he has some food digestion issues. 

 

Yes, my son has anemia but not because of iron. His red blood cell is slightly smaller (68/72). We followed up with blood test since he was 1yo. Even add iron supply, the lab number was still unchanged. And it's not genetic. Both my husband and I do not have anemia. He is tested low on Vit D though. I just recently started to add the Vit D supply for him.

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 He is tested low on Vit D though. I just recently started to add the Vit D supply for him.

 

Mine also tested low for Vit D.  Now I am wondering how common that is for Chinese.  I am anemic and my boy's blood test results did improve after iron drops and Vit D drops.  My hemoglobin level also improve whenever I take iron supplements. Cardio sports like swimming helps in our case.

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Our insurance does not need referral for specialist. For out of network neuropys, we have 70% coverage.

 

For the best outcome, full NP evaluation will be the most ideal, correct? Does it need to involve with teacher or school for the interview? I am afraid if I go for it privately, then they will delay the child study team interview in September.

 

I am also afraid of mislebal as well. Normally ped or pys will base on interview or questionnaire to rule out ADD/ADHD. What if he has something else like wapiti mentioned above?

 

I agree with asking around for recommendations. Our pediatrician refused to diagnose, but she did so because she was concerned that my son might have additional diagnoses. She was being thorough. He was diagnosed with anxiety at the same time he received his ADHD diagnosis. A psychologist did the evaluation and diagnosis. We had to fill out questionnaires, but the evaluation also included two mornings of testing and observation. Our son was diagnosed with ADHD, Inattentive Type. That diagnosis does not require hyperactivity and does include focusing problems.

 

The psychologist wanted to do some in classroom observations, and the school completely flipped out over the idea of a stranger coming into the school. The school counselor did her own observations and provided information to the psychologist, so we still got what we needed. 

 

I recommend trying to find out how the school would handle a private evaluation. Our school system technically provides evaluations, but because the wait is so long, they encourage anyone who can to get a private one done. If getting a private evaluation wouldn't cause a problem (other than the obvious financial burden), I'd recommend getting one. Schools have the incentive to only find problems that they understand and/or can handle. I'm not saying that all schools would go in that direction; however, schools vary greatly in how willing they are to work with students and make accommodations. Before homeschooling, I worked with a school that was mostly supportive and two that went from indifferent to almost hostile.

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Mine also tested low for Vit D.  Now I am wondering how common that is for Chinese.  I am anemic and my boy's blood test results did improve after iron drops and Vit D drops.  My hemoglobin level also improve whenever I take iron supplements. Cardio sports like swimming helps in our case.

 

It looks like very common. My brother 's older son also has same problem but gets improved when adding iron drop. My Chinese coworker's sons both are anemic but older one out grow of it now (he is higher school senior). My son's school has been doing a good job promoting healthy life style. They have walking club during recess twice a week and now offer children yoga as well. He also goes swimming once a week but it is indoor pool though.

 

My son same is sensitive to sound as well. He feels extra exhausted after staying in noisy place for a while. Last time when we went to circus, he first was excited but wanted to leave after first half of program because the music is too loud.

 

I just spoke to DH and he is unhappy about me getting a out-of-network doctor. It's not like we cannot afford it. He just does not know how hard I tried to find a trusty pys/neuropys. Most of our network doctors are in medical center or local hospital so the wait time is long.

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My son same is sensitive to sound as well. He feels extra exhausted after staying in noisy place for a while. Last time when we went to circus, he first was excited but wanted to leave after first half of program because the music is too loud.

Get some ear plugs and just dump in your handbag for just in case. I have the 3M Tekk ones which are easy to carry around. My boys enjoy watching live fireworks with their ear plugs on. My 8 year old even put ear plugs on at the library when it was too noisy.

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I am finally able to get an appointment in August to see developmental pediatrician from Children Specialized Hospital. They have all other specialized doctors there (pediatric neuroloist, speech language pathologist, neuropyschologist) so they can perform additional evaluation if needed. I was wrongly requesting pyschological evaulation at first which will take 6 months or longer to get the appointment.

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Although an evaluation is always a good idea, it is also reasonable to try out various interventions while waiting on the big evaluation.  To be honest, we went for the big evaluation from a world famous prof in the greater Washington DC area.  Some of it was helpful; she did catch the language disorder and recommended Lindamood, and she picked up on her kids impairments with fine motor coordination.  OTOH, she specifically recommended AGAINST Fast Forword which was THE most useful thing for both her CAPD and to a lesser extent her ADD, but she wholly missed the visual processing disorder and the sequencing issues.  The IQ test never got completed, because I was looking in on it through the mirror room and realized that the final score would be somewhere in the 70s and give her a dx of PDD which could do her no good at all.  So I stopped the test and we went home. (Prof was not pleased.)  Incidentally by age 19 after vast amounts of academic and therapeutic remediation her ACT scores placed her at exactly 100. IQ changes both for better and for worse.  Any way, I would try interventions while waiting for a workup. In my experience you have to kiss a bunch of frogs to find a handsome prince, but when it is your kid;s future at stake you pucker up early.  I have metaphorically kissed numerous interventions, some of which were definite frogs.

 

First, I would get an auditory evaluation by an audiologist  experienced and knowlegeable in childhood CAPD.  Instead of just having her sit in the soundproofed hearing booth and press a button whenever she hears a tone which will (if she is correct, cause the audiologist to turn on a device causing a pair of stuffed rabbits to bang castanets etc), this exam ALSO involves listening to a standard list of words read in increasing amounts of background noise.and push the button only when she hears the target word.  CAPD kids can handle the former but not the latter.  They are FINE one on one, but are distractable in background noise, (e.g. a normal, well behaved first grade classroom with occasional coughs, foot shuffling, chalk squeaking and teacher droning voice.) They can't separate the signal from the noise. If he has CAPD I would get him Fast Forword.  Also, please see my other post on interventions I found useful and otherwise on "The Listening Program" today.

 

 

Second, I would get a baseline on his ADD.  I suggest using the circle e method.  Take an old, non English language book - I used an elderly German dictionary - and have her circle as many e's as she can in the space of 2 minutes without lifting the pencil from the page except at the end of the lines. Tot up the scores of errors (skips and wrong letters over the total number of e's in the selection.) Off Adderall she would have 5-6 skips/errors per page on a consistent basis. On Adderall she would have 1-2 which is normal.) After Interactive Metronome and off Adderall she consistently got 1-2 errors even months after the intervention, and we were able to permenantly discontinue the med. Thyere was no improvement on TLP which she did about that time. I didn't use this method when dd1 was doing Fast Forword and dd2 never had ADD so I don't know how much my dd1 benefited from Fast Forword.  However, DD1 definitely did benefit from Interactive Metronome. 

 

 

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Thanks for great advice. I will make a note and consult doctor when we go for appoitment, I will find some time to try circle e method. Normally he is pretty good at word search or hidden picture activities.

 

In regard of early intervetion, the school is offerring reading support (30 mins/ 5x per week/Wilson Reading) and writing instruction review (30 mins/2x per week/small group tutoring). I am also doing dancing bear with him at home and will do reading assistant for fluency once dancing bear is done. We also have OG tutor comes to us once a week and will increase to twice in summer. His reading issue is mainly at applying the rules in actual reading, but not phonemic awareness. He needs overteaching to make it automatic. His social skill therapist also suggests language evaluation as she feels that he is slower on the expressive language. He needs longer time to retrieve the idea/words/language that he knows. We are not sure if it's masking by his bilingual background.

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  • 2 months later...

We had the appointment today. Developmental pediatrician gave us dx of minor ADD (mainly inattentive). She recommended behavior therapist to get the coping skills for focus issue. She also did basic academic screening and did not find any learning disability. His math is above grade level, reading above 2nd grade level (while school assessed him 6 month behind) and spelling is at high 2nd grade level (he just finished 2nd grade). The result is very similar with DORA test we administrated early last month but slight off from what school assessed him especially on reading. Doctor mentioned that we can request 504 to accommodate him for testing time and assignment time if he continues having trouble with that in 3rd grade.

 

Next step, child study team will monitor him for next school year and we should be contacted for meeting by end of Sep to see if full evaluation is required.

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