What Dr/Eval to See First?

[Paige]

I want to take DD back to a different doctor for a more thorough evaluation for LDs or other possible issues. We have found a reasonably priced neuropsychologist  who can give her that kind of eval, but doesn't work with insurances and can't prescribe medication. We can get a referral for a child psychiatrist who can prescribe and the insurance would pay for everything, but in our experience, psychiatrists haven't done thorough testing before wanting to medicate. Who would you see first? She had a quick psych assessment several years ago and her results were mostly normal.

 

She has issues with anxiety and freezing up. She has panic attacks or phobias. I can't tell whether her panic attacks are related to specific phobias or the general anxiety she has all the time. She has ongoing problems with understanding language both written and oral, but a lot of her mistakes seem to come from a lack of confidence and over thinking. She will do her work correctly, erase it, then draw sad faces and cry. Or she won't follow directions (whether for lack of reading or understanding, I don't know) and get everything wrong and then give the correct answer verbally as we go over it. She can read long novels well and do long division and 3 digit multiplication easily but cannot reliably remember how many months there are in a year or what the letter a says. She's 10.

 

Who would you see first? I'm prepared to see both, but I'd rather not. Her anxiety makes seeing a doctor at all stressful for her. 

 

[PeterPan]

Has she had counseling for the anxiety?  Doing some counseling first would not *preclude* later doing the full neuropsych eval. Have you looked into CBT?  (I'm not up on all the therapies for anxiety.)

 

Maybe with some CBT she'd be in a better position to accept the neuropsych eval?

 

Did you ask the neuropsych what he thinks?

[OneStepAtATime]

No solid advice but  :grouphug:  :grouphug:  :grouphug:

[Crimson Wife]

The anxiety may very well throw off the results of the NP exam, so I'd be inclined to try counseling, and if necessary, consider medication before seeing the NP.

[Paige]

She had a series of about 6 counseling sessions for anxiety 2-3 yrs ago. The counseling increased her anxiety. She gets nervous with doctors and strangers so we decided it wasn't helpful and wouldn't be helpful at the time even with someone else. We weren't open to the idea of medication back then. I think she'd do better with a doctor now but it's hard to predict how she'll react. Sometimes things I think she'd have no problem with cause her to panic and other times she is completely fine with something I thought would be difficult for her. 

[Innisfree]

We're currently in the midst of evals for my dd, who also freezes up, shuts down, and I think has some anxiety though it presents as anger.

 

I completely agree with you about the psychiatrist tending to default to medication before thorough testing. That was our experience.

 

The neuropsych office we're dealing with has people with a number if specialties: emotional difficulties, learning issues, autism spectrum, etc. We knew emotional issues were big, and they said they'd do specific testing to see what's going on in that realm first.

 

We also got a fairly quick answer that yes, she is on the spectrum. So, given that and the emotional testing, we're going to take it one step at a time. All the emotional/psychological stuff first, then see how she's doing. She's responding very well to these people, so maybe they'll be able to go straight on to learning disability stuff, or maybe we'll take a break, start ABA therapy, and then go back for more testing.

 

So maybe you could find someone to do some targeted testing to figure out the best way to tackle anxiety first, then move on to academics?

[Ottakee]

We started with a ped. psych who sent us on for the full neuropsych testing (and a bunch of medical testing) before she started meds.  Most likely you will need both.  A good full physical where they check all of the basic blood work---CBC, liver and kidney function, thyroid, vit b and d levels, blood sugars, etc. is also helpful to have.  Occ. there can be something that needs to be addressed first before meds but even if not, it gives you a good baseline before starting meds.

[Innisfree]

If counseling didn't help the anxiety, then it sounds like you really need to know where that anxiety is coming from and how to address it first. Otherwise, yes, it could throw everything else off. So instead of thinking about treating the anxiety first, think about diagnosing its cause first.

 

???

 

I'm new to solutions here, though not to the problems, but that's the direction in which I'd be thinking.

[SandyKC]

It's a chicken and egg kind of question to me... I've known of plenty of kids who had anxiety because they had significant learning disabilities that weren't being dealt with in a functional way, in which case it'd seem wise to have the neuropsych eval first.   However, as many others have said, having anxiety can affect the testing, but you may not be able to "fix" the anxiety without having the testing to know what needs working on.

 

If it were me, I'd probably talk to the neuropsych about what kinds of steps or measures he can put in place to help with the anxiety first... Maybe an initial, just meeting each other session. Then maybe shorter testing sessions with encouraging discussions with your child.  The goal would be to have the testing outcome be as valid as possible by reducing anxiety.

 

If at all possible, I wouldn't really consider one before the other, but proceed with both.. Get the evaluation scheduled, make an appointment with a counselor, and just get started.  Either way--if you did one "first" you'd probably need the other anyway, so a delay just delays your ability to fully help your child.

 

Hugs!  It's difficult to balance things and costly to pursue answers, but our kids are sooooo worth it!

[PeterPan]

And just in case this is starting to feel like people are saying you're causing your dc's anxiety by not handling her correctly or something, here's a webinar on physical causes of anxiety that aren't necessarily connected to an LD.  Addressing Anxiety & OCD in ...  

[sbbulliv]

I just saw a seminar with Lynn Lyons on anxiety. Her book might be helpful. I think it is called Anxious Kids Anxious Parents. One of her points is that when kids avoid things because of anxiety, the anxiety wins. So don't let your child avoid treatment because she is anxious. They can't help her if she doesn't show up.

 

I second Crimson Wife- MD first then NP.