ADHD evaluation

[Jen500]

Is there any 'standard' for what is included in an adhd evaluation? I have read that evals can range from just a pediatrician's visit to a full day's workup with lots of testing. What kind of professional is best to go to?

I've made an appt with an MD in psychiatry at a Children's Hospital that I've always had good experiences with; however, it'll be $400 for an 80 min. appt. (The doctors that take our insurance don't have openings until next summer) Can a doctor make an ADHD evaluation in that 80 min?

This is for ds13.  His grades are all over the place and he says he has problems focusing in many classes (ps). His dad most certainly has ADHD but refuses any help. I don't want ds to suffer if there are things he/we can do differently to help.

 

[scholastica]

Usually an Educational Psychologist can do the battery of tests. Also, if you live near a college with a grad school in psychology, they often offer deeply discounted testing to get their grad students experience. They are supervised and trained, just not yet certified. I know many people for whom that was a win-win.

[gardenmom5]

I would NOT regard a pediatrician as a valid diagnostician of ADHD  (or asd, etc.). they are not qualified to diagnose these things - especially not in a 30 minute office visit.    they can suspect, they may or may NOT be correct (mine dismissed all my concerns.  I later learned the local asd parent group despises that large multi-location practice and rec's taking kids elsewhere.), they should refer to a specialist for final diagnosis. 

My son has done two full evals.   first by a team at the medical school's child development clinic.  (included OT, PT, pysch, SLP, vision, and (very basic) auditory as well as developmental peds), second by a psychologist who specializes in kids with LDs, ADHD, ASD, etc.  

there are a number of tests that are administered, and it was eight+ hours of tests by the first team - and two hours by the pysch.   (interestingly - out school district can do the first half of that testing.).   the second set included an IQ test. 

and he's also been eval'd by our school district twice.  (eta: first time included slp, OT, PT, and a psych. since, it's just the psych.)

he's had outside vision therapy as well as diagnosed CAPD by an audiologist. he fought the therapy.  (many overlaps with capd, only diagnosed by an audiologist and generally they won't see kids younger than seven. and that was two+ hours of testing.  they rule out an organic problem first.)

Edited October 25, 2018 by gardenmom5

[gardenmom5]

My son also see a pediatric neurologist. she said it's normal for symptoms to get worse at this age - their hormones kick in and exacerbate the issues.

 

 

[displace]

I have to gently disagree with pp about not using a pediatrician to diagnose.  I would say it depends.  Most pediatricians I know feel comfortable diagnosing and treating Adhd (and it is probably covered by your insurance).  Adhd diagnosis is straightforward for a lot of people (meet criteria 1, 2, 3, and that’s it).  However, a visit should be confirmed with the front staff as it’s usually a long appt and some peds don’t diagnose or treat.  

I would see a specialist if: there’s a concern of something else, like a learning disability, mental illness, behavioral disorder, etc.  Or, possibly see a child psychiatrist if you want to incorporate behavioral therapy with meds in one place (which I’d recommend).  A developmental pediatrician can also diagnose and treat.  Many school counselors who do IQ testing can also diagnose, but not treat medically.  Other reasons to see a specialist would be if you think it may be borderline (not an obvious diagnosis), to help get a correct answer at first.  A neuropsychologist who tests for learning disabilities, cannot treat medically either, unless in some states they have prescription privileges.

You can easily look online at criteria for diagnosis to see if it’s likely.  

Edited October 25, 2018 by displace

[displace]

4 hours ago, Jen500 said:

Is there any 'standard' for what is included in an adhd evaluation? I have read that evals can range from just a pediatrician's visit to a full day's workup with lots of testing. What kind of professional is best to go to?

I've made an appt with an MD in psychiatry at a Children's Hospital that I've always had good experiences with; however, it'll be $400 for an 80 min. appt. (The doctors that take our insurance don't have openings until next summer) Can a doctor make an ADHD evaluation in that 80 min?

This is for ds13.  His grades are all over the place and he says he has problems focusing in many classes (ps). His dad most certainly has ADHD but refuses any help. I don't want ds to suffer if there are things he/we can do differently to help.

 

Also, to address if the doctor can make the diagnosis in one appt, the answer is almost always no.  Most first appts are gathering info, handing out forms or scheduling for testing, and a follow up to go over results is common.  If they need a between appt for testing too, that’s a third appt.  But, it’s possible the office is set up with forms ahead of time or something. I would talk to the front desk and ask how many minimum visits are usually necessary for adhd diagnosis.  They may have a standard reply of two, or you have to see the doctor first, and that may give you a guideline of what you can expect.

There are different diagnosis forms available but also some new computer testing possibilities so each practitioner is different.  It shouldn’t be a daylong eval unless other considerations are possible.  If you give more details we may be able to guide you.

Edited October 25, 2018 by displace

[displace]

https://www.cdc.gov/ncbddd/adhd/diagnosis.html

Criteria for diagnosis.

[Tap]

Both of my older kids were diagnosed with ADHD by their pediatrician but the doctor had us and the teachers fill out a Vanderbilt test.  My husband was on ADHD meds as a kid and it was obvious that both of the older kids had it too.  When we home schooled it was easy to work around, but when they hit high school and needed meds/accommodations that is when I needed a formal diagnosis.  For dd, I remember the teacher results showed that she started the day off under control and as the day went on, her scores plummeted. LOL  Her teachers all loved her (bright and well mannered) but I remember that one high school teacher put a comment  which said he would let her stand up in the back of the room during class to help her focus. I asked dd about it, and she said she always stands in his class because it physically hurt her to sit down by that time of day.  The Vanderbilt scores and other similar comments by teachers made her diagnosis very easy.  

DD and DS both figured out ways to make school more successful for them.  DD20 took PE every term she could and tried to have it mid day if possible. She needs to do her work in a very clean room and have snacks there so she doesn't get distracted by cruising the pantry.   DS19 started college at 15 so he had less seat time, and figured out that he had to do all of his heavy homework 8- Noon so he could focus. He can do later classes, but home work is way easier for him first thing in the morning.  It will take him 3x as long to do homework after lunch, than it does before. 

ETA: The doctor was putting the diagnosis on paper, but not using the actual appointment to diagnose my children  The Vanderbilt was the key, because it was filled out by people who had been around my kids for many, many hours; us as parents in every day life and the teachers in academic settings where they could easily compare their attention span and activity to their peers. 

 

DD11 has a different form of ADD (she is biologically my niece).  She was diagnosed in her psychiatrist with Vanderbilt tests and it was backed up with a full neropsych eval by a children's hospital a year later. The children's hospital was willing to accept the Vanderbilt tests as part of her diagnostic paper work too.  Her ADD diagnosis was less important because it is one of many diagnosis. 

Vanderbilt for teacher 

Edited October 25, 2018 by Tap

[gardenmom5]

36 minutes ago, kand said:

Mine was diagnosed by a neuropsychologist who ran two days of tests. While her parent and self questionnaires were very suggestive of the diagnosis, the tests that made it most clear were very specific ones that a pediatrician wouldn’t have access to (tests of visual attention, tests of auditory attention, the difference in timed versus untimed performance on some academic measures). 

 

I long remember attending a homeschool conference class on adhd.  the guy teaching it was a MD who ran an adhd clinic.  he only see's patients by referral.  of those diagnosed adhd by their ped - he said fully 50% weren't adhd.

[Tap]

7 minutes ago, gardenmom5 said:

 

I long remember attending a homeschool conference class on adhd.  the guy teaching it was a MD who ran an adhd clinic.  he only see's patients by referral.  of those diagnosed adhd by their ped - he said fully 50% weren't adhd.

Did he say why he received the referrals in the first place?

DD11 was refereed for neropsych because she has complicated co-morbid issues that a pediatrician wouldn't be qualified to diagnose.  Even her very, very experienced psychiatrist didn't want to put more that generic labels on her without doctors who specialize in the diagnostic part of childhood psychiatry having a chance to meet/test her. Off topic but just a side note..... The head of neurophyciatry at the teaching hospital told me that she feels that more than 3-4 diagnoses for one child is not usually accurate and is actually harmful. That being said....She said that dd is so complicated she gave dd11 5 diagnosis. LOL 

I can also see a pediatrician referring out, if they don't have clear testing to go by for the diagnosis.  A home school child would be harder to diagnose than a child in a classroom with peers since the parent would have more limited view of the child. 

In pharmacy, I have had had some parents who told me that their pediatrician won't write for ADD/ADHD meds and refer out all of the patients to psychiatrist for diagnosis and medication management. 

If the pediatrician is referring the children to a specialist, it makes me wonder if the pediatrician suspected there was more to it than just ADD/ADHD in the first place. 

I think that there area many, many children who are misdiagnosed.  But a blanket statement by a doctor saying that 50 percent were misdiagnosed may or may not be as startling if the results are broke down and looked at for the reason behind the referral in the first place. 

[Lady Florida.]

Since there's no blood test or other type of definitive medical test for ADHD, it's important to get a good evaluation. 

Ds was diagnosed by his pediatrician but the doctor had been very involved at the state and national level in ADHD studies of both diagnosis and treatment. I felt comfortable that he knew what he was doing. We had to fill out the Vanderbilt test. It was a bit difficult with ds being homeshooled because we didn't have teachers who could also do it. Dh and I each filled one out but we didn't discuss it with each other before doing so. We didn't even talk about the type of questions. At the time we were still attending church so we asked ds' Sunday School teacher to fill one out as well. 

Ds was easy to diagnose because his ADHD is moderate and is combined type. You could easily see the ADHD behaviors in him. It's probably harder to diagnose a milder version or for kids who only have inattentive type. 

[gardenmom5]

18 minutes ago, Tap said:

Did he say why he received the referrals in the first place?

DD11 was refereed for neropsych because she has complicated co-morbid issues that a pediatrician wouldn't be qualified to diagnose.  Even her very, very experienced psychiatrist didn't want to put more that generic labels on her without doctors who specialize in the diagnostic part of childhood psychiatry having a chance to meet/test her. Off topic but just a side note..... The head of neurophyciatry at the teaching hospital told me that she feels that more than 3-4 diagnoses for one child is not usually accurate and is actually harmful. That being said....She said that dd is so complicated she gave dd11 5 diagnosis. LOL 

I can also see a pediatrician referring out, if they don't have clear testing to go by for the diagnosis.  A home school child would be harder to diagnose than a child in a classroom with peers since the parent would have more limited view of the child. 

In pharmacy, I have had had some parents who told me that their pediatrician won't write for ADD/ADHD meds and refer out all of the patients to psychiatrist for diagnosis and medication management. 

If the pediatrician is referring the children to a specialist, it makes me wonder if the pediatrician suspected there was more to it than just ADD/ADHD in the first place. 

I think that there area many, many children who are misdiagnosed.  But a blanket statement by a doctor saying that 50 percent were misdiagnosed may or may not be as startling if the results are broke down and looked at for the reason behind the referral in the first place. 

other than they were referred to him for treatment - I don't recall.  and he had re-evaluated them when they came into his clinic - so yes, he has a right to say he found them to be misdiagnosed.

I know many things are comorbid - and many things overlap.   e.g. CAPD (there are three kinds) has MANY of the same symptoms/deficits as adhd.  but it's treated differently.

My long-time ped, would only refer out to a OT (which was a fight, and only after he (the dr) had a snit about how he couldn't do a well check when the terrified of scales child wouldn't stand on one. . . . and still wouldn't even refer to a specialist for actual testing.  I was able to bypass him to get into the university for a thorough eval.

[Lady Florida.]

2 hours ago, Tap said:

 

In pharmacy, I have had had some parents who told me that their pediatrician won't write for ADD/ADHD meds and refer out all of the patients to psychiatrist for diagnosis and medication management. 

 

 

 

Ds' pediatrician wrote his prescriptions and did his re-evals but once you reach adulthood most doctors won't deal with ADHD. He left the pedi practice when he turned 18 and couldn't find a primary care doc who would write his ADHD meds. He sees a psychiatrist now for it. This is something to keep in mind if you have an older child or teen who currently sees their pedi for ADHD and will be aging out soon. Make sure you (or your dc) have a doctor, probably a psychiatrist, in place before leaving the pedi practice and moving to an adult practice.

[PeterPan]

9 hours ago, Jen500 said:

I've made an appt with an MD in psychiatry at a Children's Hospital

That's a really expensive way to go. You'd be much better off getting a proper psych eval, getting your insurance to cover that if possible, and then getting your ped to write the scrip. Usually the ped will have his own hoops to jump through. 

Meds for ADHD require visits with the doc every 3 months, so that's going to get horribly expensive using a pdoc. Unless there are extenuating circumstances, it's unnecessary. Also, the pdoc appointment won't give you the depth of feedback a psych will, and the psych eval WILL be necessary for accommodations, college testing, etc. You're at a nice time to do it, with age 13, because you can eval now and then repeat right before college. My dd is in college using her accommodations from her psych evals, so it's a pretty important step, HIGHLY in favor of it.

The other reason to pursue the evals now and get that feedback from the psychologist (not pdoc but psychologist) is because you want feedback on how this carries over to academics, the right words for everything going on (possible learning disabilities, referrals needed, things you weren't anticipating) so that he can start USING those terms and accommodations now. The more comfortable he becomes in his own skin, knowing what he needs and how to advocate for it, the better. You'll also be able to connect with good strategies like 360 Thinking or SKLAR.

What I finally had to realize was that the decision about this was not 50/50 like marriage. My vote had to count twice as much, because I was teaching the dc, living with the consequences, and more informed on what was going on. So I had the teacher vote AND the mom vote, while he only had the one vote. Also, your dc is probably at a point where he is beginning to notice things and ask questions, and he may have an opinion on wanting help.

[Katy]

I recommend seeing if the major universities in your area (with medical and other grad schools) have something like a Center for Disabilities and Development or something like that.  That's frequently where children who need a diagnosis are best evaluated IME. It would likely be at least half a day, if not a full day.

[Lecka]

Heartlikealion -- You need to request an eval in writing.  It is no big deal, just leave it in the front office.

Saying things verbally does not do anything.

It is really not a big deal to do this!  It is just the process.  

It's one of those things, it is best to follow the process the way "it is supposed to be done." 

That means -- write a letter saying you have concerns about x and y and would like an evaluation.  It does not have to be anything fancy at all.  

[Jen500]

Lots of good advice and things for me to consider, thank you so much to those who responded!

I called the local University center that does testing and they were very friendly but their waiting list is full so they aren't adding any new evaluation appts at this time.

I have been trying to make some lists of psychologists in my area that do this testing and may take our insurance. Our insurance is lousy for some things and good for others. Also trying to sift through  the Private Centers that do add/gifted/ld testing ...I wonder how reliable they are. I've known families that will test and retest their kids trying to get into gifted so I'm wary of some of these places that might be trying to 'help' them.

 

[Storygirl]

I think a good place to start is to talk to your pediatrician or family doctor. They should be able to give you advice about the best way to get the evaluation in your area, which is easier than doing it on your own.

In your OP, you asked what is the standard process, and you can see from the responses that it can really vary. Some practitioners will diagnose from a checklist, such as Connors or Vanderbilt, which requires a parent and teacher to each fill out a form (and perhaps the student, as well, after a certain age). Some will do a computer test, such as the Quotient or TOVA. Some will do both of those. There are some people now who have blood tests done to screen to see what medicine will work best and what the individual should avoid.

My own kids have been tested by pediatricians (two), a psychologist, a psychiatrist, a neuropsychologist, and a school psych. All are able to screen; not all are able to prescribe meds. It's also possible to get counseling that can be beneficial before trying meds, while using meds, or instead of using meds.

You can make an appointment with the pediatrician to talk this over, instead of trying to figure it out on your own.

 

[Storygirl]

In your last post, it sounds like you may be looking for testing beyond figuring out ADHD. There are choices for that, as well, but they may be different than figuring out the ADHD.

Some psychs will screen for attention issues as well as learning issues. However, it can be beneficial for the ADHD to already be treated when those other educational tests are run.

As far as going several places to get tests -- it's really not uncommon, I think, and doesn't necessarily mean that parents are shopping around for someone to tell them what they want to hear. Some people offer different tests than others, and parents may find they need more information after getting initial screenings, because there are still unanswered questions. It's also possible for students to be gifted plus have learning challenges, and not all psychs are best at figuring that out. It's also good practice to have some testing repeated at intervals (schools do it every three years) after the initial evaluation, to see how things have changed over time and with intervention.

And speaking of schools, it's pretty common for parents who have had evaluations though the school to find that they still have questions or that the school did not do enough to get to the root of the issues or explain the test results. Educational psychs see a lot of families that have been tested at the school first but want more answers.

With that said, in case you are not aware, if you suspect there could be a learning disability, the schools are required to evaluate homeschoolers, so that is an option. It's not the best course if you mainly suspect ADHD, because they will not want to diagnose that and will not treat it, so you would have to go elsewhere anyway. But you mentioned LDs in your last post, so I wanted to mention that it is there as an option.

[Jen500]

11 minutes ago, Storygirl said:

I think a good place to start is to talk to your pediatrician or family doctor. They should be able to give you advice about the best way to get the evaluation in your area, which is easier than doing it on your own.

In your OP, you asked what is the standard process, and you can see from the responses that it can really vary. Some practitioners will diagnose from a checklist, such as Connors or Vanderbilt, which requires a parent and teacher to each fill out a form (and perhaps the student, as well, after a certain age). Some will do a computer test, such as the Quotient or TOVA. Some will do both of those. There are some people now who have blood tests done to screen to see what medicine will work best and what the individual should avoid.

My own kids have been tested by pediatricians (two), a psychologist, a psychiatrist, a neuropsychologist, and a school psych. All are able to screen; not all are able to prescribe meds. It's also possible to get counseling that can be beneficial before trying meds, while using meds, or instead of using meds.

You can make an appointment with the pediatrician to talk this over, instead of trying to figure it out on your own.

 

I did take ds to the ped. when he was in 5th grade for an evaluation. We filled out some checklists, as did his teacher. I really like this pediatrician, but he spent about 5 minutes with us and I felt like he was looking for an extreme case--he said my son didn't have ADHD, but that his classroom situation was the problem. (That year he had a very lively, spunky class and the teacher had little classroom control) and he always had good grades. My son has a very high IQ so I think that makes it 'easier' for him to get good grades even when he's feeling distracted in class a lot.

I really don't know if he has ADHD, or if he just doesn't like to put effort or pay attention to things he's not interested in. He says his mind wanders even in the classes he likes and he doesn't know why. It takes him 90 minutes to do any task at home that should take 20 minutes (homework or get ready for bed). I don't know what is normal kid /teen stuff (because my other kids were never like this) .

[Storygirl]

Just to give a personal note about getting multiple evaluations -- years ago one of my children had very thorough testing through a neuropsychologist, and we received several diagnoses and a twenty page report with so much information that it made my head spin.

Despite that, we still have some unanswered questions, and we are considering doing some more private evaluations to sort some things out.

It is really so, so common for that to happen, because the situations can be complex. And the families that you know of may not be sharing all of their issues and questions with you, so you may not know.

[Storygirl]

Our pediatrician was the same way. We loved him in general, but he was hesitant on the ADHD issue. In our case, the diagnosis came first from a counseling psych that the pediatrician had referred us to. After that, the doctor paid attention to our concerns. The truth is that pediatricians only see the child for a short period in the office and do not get to see the behaviors that are causing the issues if the child can sit through the appointment without a problem.

I wish I had given our pediatrician another chance to listen by making an appointment just to talk about this, instead of adding it to a well-visit appointment. I wonder if you went back to the doctor again and acknowledge that he didn't agree there was a problem before, but that the issues persist and are present now that your son is in a different classroom situation. Instead of asking him to screen again, since he has done that, ask for a referral to an educational psychologist.

I don't know. It might be worth a try. I know how frustrating it is when the doctor can't see what we see. I did end up going around the pediatrician and getting the screening elsewhere first and then taking the results back to him, so your approach can work, if you can figure out who to go to. If you have a school in your nearby area that enrolls students with LDs, it can be worth a call there to see if they have evaluators they recommend.

[Storygirl]

12 minutes ago, Jen500 said:

 

I really don't know if he has ADHD, or if he just doesn't like to put effort or pay attention to things he's not interested in. He says his mind wanders even in the classes he likes and he doesn't know why. It takes him 90 minutes to do any task at home that should take 20 minutes (homework or get ready for bed). I don't know what is normal kid /teen stuff (because my other kids were never like this) .

I agree that these are red flags and worth checking out. We want our kids to have all the tools they need to thrive. I think what you are describing is not typical. It's possible to have executive function issues without actual ADHD, and at the very least, you are describing that. You might want to read the book Smart but Scattered.

[Jen500]

6 minutes ago, Storygirl said:

I agree that these are red flags and worth checking out. We want our kids to have all the tools they need to thrive. I think what you are describing is not typical. It's possible to have executive function issues without actual ADHD, and at the very least, you are describing that. You might want to read the book Smart but Scattered.

Thank you, I'll check that book out. 

[Storygirl]

My son with ADHD also has extremely low processing speed. It can be hard to sort out the differences and figure out the root issue. Educational testing should include tests for processing speed. https://www.understood.org/en/learning-attention-issues/child-learning-disabilities/information-processing-issues/processing-speed-what-you-need-to-know