Getting an ADHD Diagnosis in a Teenager?

[JumpyTheFrog]

We want to pursue getting our 9th grader diagnosed. Where do we start? Is there any point in making an appointment with his PCP? Is it always better to go through a psychiatrist? We have finally reached the point where we are willing to at least do a trial of medication. (Is a couple week trial enough to see if it will help?)

[popmom]

Look for a neurophychologist. Psychiatrists typically don't do those types of evaluations. Your PCP should be able to recommend someone. After the neuropsych makes the dx, you take the report to your PCP or a psychiatrist to get the medications.

ETA 2 weeks is enough to know if it will help. 2 days might be enough! No-- not really. You need a longer trial just to make sure you've got the right dose. Pdocs will typically start you on a lower dosage, and if that doesn't work they will bump it up. I think my dd's Pdoc wanted her to try the initial lower dose for 4 weeks. 

Do a search on the Learning Challenges board. There have been a lot of threads on this topic. 

Edited January 14, 2021 by popmom

[Lecka]

Do you know if you would need a referral from your pcp?

If you Google for other providers — you can call them and see if they take direct appointments from your insurance or if you need a referral.  
 

I got a direct appointment with a neuropsychologist by calling their office.  They filed for insurance and I didn’t need a referral.  
 

 

[vonfirmath]

1 hour ago, JumpyTheFrog said:

We want to pursue getting our 9th grader diagnosed. Where do we start? Is there any point in making an appointment with his PCP? Is it always better to go through a psychiatrist? We have finally reached the point where we are willing to at least do a trial of medication. (Is a couple week trial enough to see if it will help?)

At our Primary Care Physician's office, they had one doctor you had to see for that evaluation.  For our son, he could tell a difference with the very first dose of medicine. It took about a month for the initial side effects to subside and the medicine has had to be tweaked over time.

[Tap]

My 2 older kids PCP did thier diagnosis. He had us fill out a questionnaire and had each of thier teachers fill them out too. It was pretty interesting to see the teachers notes on dd. She could maintain focus in the early morning chemistry, but struggled just a few hours later in history, English etc. The notes were pretty classic for ADD, so it wasn't hard to see why she struggled. He was willing to handle thier medication as well. I know some PCPs are not willing to do the dx or meds, so they may want you to go to a pdoc anyways.

My youngest, was dx by her psychiatrist.

[Carrie12345]

It can vary by region and practice. The child development center attached to a giant hospital, where we had ds’s ASD evals done, worked in all neuro areas, including ADHD. My PCP did my ADHD eval (a real brief one.) A child psychologist’s practice did dd’s ADHD eval, which was pretty extensive and mostly done by a master’s level employee under the official supervision of the psychologist. (And I think I got that employee fired for how awful she was.)

[katilac]

36 minutes ago, Tap said:

My 2 older kids PCP did thier diagnosis. 

I was coming to post that it would be unusual in my area for someone to go to a specialist if 'just' ADD is suspected. Plenty of PCPs will dx and prescribe, and you'd only move on to someone else if they had trouble tweaking your meds. 

[Katy]

I think some states have locked down stimulant medications much more than other states. I’d call your pcp and ask a nurse whether they should go to pcp or get a referral. 

Edited January 14, 2021 by Katy
Typo

[JumpyTheFrog]

2 minutes ago, Katy said:

I think some states have locked down stimulant medications much more than other states. I’d call your pcp and ask a nurse whether they should go to pcp or get a referral. 

Does this mean that in some states only certain types of doctors can prescribe stimulants now? My son sees a PA, not an MD.

[Katy]

9 minutes ago, JumpyTheFrog said:

Does this mean that in some states only certain types of doctors can prescribe stimulants now? My son sees a PA, not an MD.

I don’t know the answer to that, but when we lived in Oklahoma my husband had to go to a physician to get ADHD medication, not a NP or PA.  And I know NP’s can practice independently in Oklahoma, or at least they could back then. In our smaller city only a psychiatrist would see patients for ADHD.  DH decided meds wouldn’t work for him and now sticks to high volumes of coffee. DH didn’t get diagnosed until college. 

[PeterPan]

6 hours ago, JumpyTheFrog said:

We want to pursue getting our 9th grader diagnosed. Where do we start? Is there any point in making an appointment with his PCP? Is it always better to go through a psychiatrist? We have finally reached the point where we are willing to at least do a trial of medication. (Is a couple week trial enough to see if it will help?)

So you have a few different issues to tease apart. You can't get medications without going to an MD, and it would be unusual to *skip* your PCP for this step. They each have how they roll, but they have how they diagnose and they determine what meds they want to use. 

The next issue is how this is affecting him educationally and personally and how it affects him long term. Getting some kind of psych (psychological, not psychiatric) evals is likely to give you *good long term advice* that you'll be very glad you got. They may spot additional things you didn't realize were going on and they can give paper trail for later accommodations.

Psych evals are a funny thing. Partly the evals are distinguished by the amount of hours the person will spend evaling. So you can find a "clinical psych" who specializes in gifted (which OFTEN comes with ADHD, EF issues, anxiety, ASD, etc.) and have them end up spending 6-8 hours doing your evals and being really in the trenches and doing a great job! Or you can have a clinical psych who spends one hour (yes, for real) and writes a report. Now typically a neuropsych eval will be 6-8 hours, but I've had some real donkey's body part neuropsychs in my day. They just come in all breeds. There are some people who are middle of the road who call themselves educational psychs who sometimes do a good job.

In our area we have psychs who specialize in ADHD. You'll sometimes see them advertising as EF coaches or ADHD coaches. They're fine if no SLDs are present.

I would be looking for:

-hours they'll spend testing (more is ALWAYS better)

-variety/quality of tests (ask them! write the jibberish down and google it and ask on LC!)

-how you feel talking with them. Do they talk over you? Are they helpful? Do they listen? Do they sound ready to interact well with your dc and bring good things out of them? Psychs are not equal, demeanor MATTERS. I've been through at least 6 psychs with my kids. I'm about to hire another and deal with another from the ps. It's so fun, lol. Oops, 7, I forgot. And to a person, every time, demeanor matters. If they're donkey's butts, they're donkey's butts.

So the reason you want a psych eval is to find out what you don't already know. The MD is just for the meds. If you want to change how you teach, how he functions, how you interact together, how he understands himself, how he SELF ADVOCATES ABOUT WHAT HE NEEDS, you want a psychological eval. If you end up with a more complex situation (spectrum, anxiety, etc.) then consider moving up to a psychiatrist for the meds. If there's any history of mental health issues (bipolar, schizoprenia, etc. in the family or any aggression), move up to a psychiatrist. 

In other words, the answer can be all three, but at least two.

So then just to share what you might not know, we got my dd diagnosed around 11/12 but didn't start meds till 16. That's a lot of water under the bridge, so earlier is fine. But there are a lot of longterm issues that these kids sort through, making it VERY WISE to get a psychological (psych) eval. Dd used her accommodations (from the psych report, many pages) but for high school and college. They allowed her to show what she knew. Kids with ADHD can have a gap between who they are and what is showing. There can be things like low processing speed, and they benefit from extended time and limited distraction testing environments. She chose a college that could give her these accommodations discretely and that had systems in place for it. Meds *help* but they don't solve everything. If he's going to go to college, if he is having this affect his ability to access his education, then you want a psych eval.

Fwiw, you can get that psych eval through the ps for free! You can take your MD diagnosis to the school as evidence and say you are requesting evals for suspected ADHD that is affecting his ability to access his education. It can take some work to advocate, but you CAN GET thorough evals through the ps. I had my dd's 2nd round of evals right before college done by the ps because the pricepoint was right at the time. They created paper trail that the college could accept for accommodations. I already knew what she needed because we had done private neuropsych evals, but if your pricepoint is free don't let it hold you back, kwim? My ds has also had psych evals (and much more) through the ps because of his list of disabilities. The main thing is get it done. 

And then a couple bonus things you didn't ask for.

1) have you checked for retained reflexes? They can cause all kinds of issues and integrating retained reflexes can decrease *some* of the behaviors.

2) how is he in background noise, how is his auditory processing? Again, not a complete explanation, but another thing to be looking for.

Come hang on LC and ask lots of questions! 

Edited January 15, 2021 by PeterPan

[PeterPan]

6 hours ago, JumpyTheFrog said:

(Is a couple week trial enough to see if it will help?)

Most (many? some?) people know very very quickly. 

Edited January 15, 2021 by PeterPan

[hippymamato3]

Has he already been diagnosed? If so and you are already ready for meds, just call whoever diagnosed him.

[hopeallgoeswell]

2 hours ago, PeterPan said:

So you have a few different issues to tease apart. You can't get medications without going to an MD, and it would be unusual to *skip* your PCP for this step. They each have how they roll, but they have how they diagnose and they determine what meds they want to use. 

The next issue is how this is affecting him educationally and personally and how it affects him long term. Getting some kind of psych (psychological, not psychiatric) evals is likely to give you *good long term advice* that you'll be very glad you got. They may spot additional things you didn't realize were going on and they can give paper trail for later accommodations.

Psych evals are a funny thing. Partly the evals are distinguished by the amount of hours the person will spend evaling. So you can find a "clinical psych" who specializes in gifted (which OFTEN comes with ADHD, EF issues, anxiety, ASD, etc.) and have them end up spending 6-8 hours doing your evals and being really in the trenches and doing a great job! Or you can have a clinical psych who spends one hour (yes, for real) and writes a report. Now typically a neuropsych eval will be 6-8 hours, but I've had some real donkey's body part neuropsychs in my day. They just come in all breeds. There are some people who are middle of the road who call themselves educational psychs who sometimes do a good job.

In our area we have psychs who specialize in ADHD. You'll sometimes see them advertising as EF coaches or ADHD coaches. They're fine if no SLDs are present.

I would be looking for:

-hours they'll spend testing (more is ALWAYS better)

-variety/quality of tests (ask them! write the jibberish down and google it and ask on LC!)

-how you feel talking with them. Do they talk over you? Are they helpful? Do they listen? Do they sound ready to interact well with your dc and bring good things out of them? Psychs are not equal, demeanor MATTERS. I've been through at least 6 psychs with my kids. I'm about to hire another and deal with another from the ps. It's so fun, lol. Oops, 7, I forgot. And to a person, every time, demeanor matters. If they're donkey's butts, they're donkey's butts.

So the reason you want a psych eval is to find out what you don't already know. The MD is just for the meds. If you want to change how you teach, how he functions, how you interact together, how he understands himself, how he SELF ADVOCATES ABOUT WHAT HE NEEDS, you want a psychological eval. If you end up with a more complex situation (spectrum, anxiety, etc.) then consider moving up to a psychiatrist for the meds. If there's any history of mental health issues (bipolar, schizoprenia, etc. in the family or any aggression), move up to a psychiatrist. 

In other words, the answer can be all three, but at least two.

So then just to share what you might not know, we got my dd diagnosed around 11/12 but didn't start meds till 16. That's a lot of water under the bridge, so earlier is fine. But there are a lot of longterm issues that these kids sort through, making it VERY WISE to get a psychological (psych) eval. Dd used her accommodations (from the psych report, many pages) but for high school and college. They allowed her to show what she knew. Kids with ADHD can have a gap between who they are and what is showing. There can be things like low processing speed, and they benefit from extended time and limited distraction testing environments. She chose a college that could give her these accommodations discretely and that had systems in place for it. Meds *help* but they don't solve everything. If he's going to go to college, if he is having this affect his ability to access his education, then you want a psych eval.

Fwiw, you can get that psych eval through the ps for free! You can take your MD diagnosis to the school as evidence and say you are requesting evals for suspected ADHD that is affecting his ability to access his education. It can take some work to advocate, but you CAN GET thorough evals through the ps. I had my dd's 2nd round of evals right before college done by the ps because the pricepoint was right at the time. They created paper trail that the college could accept for accommodations. I already knew what she needed because we had done private neuropsych evals, but if your pricepoint is free don't let it hold you back, kwim? My ds has also had psych evals (and much more) through the ps because of his list of disabilities. The main thing is get it done. 

And then a couple bonus things you didn't ask for.

1) have you checked for retained reflexes? They can cause all kinds of issues and integrating retained reflexes can decrease *some* of the behaviors.

2) how is he in background noise, how is his auditory processing? Again, not a complete explanation, but another thing to be looking for.

Come hang on LC and ask lots of questions! 

Your post reminded me of this doctor from a podcast I listened to a few years ago: https://www.artofmanliness.com/articles/podcast-320-adhd-explosion/.

[hippymamato3]

3 minutes ago, hippymamato3 said:

Has he already been diagnosed? If so and you are already ready for meds, just call whoever diagnosed him.

Wait - he hasn't been diagnosed? I think you're a ways off from a med trial

[PeterPan]

9 minutes ago, hopeallgoeswell said:

Your post reminded me of this doctor from a podcast I listened to a few years ago: https://www.artofmanliness.com/articles/podcast-320-adhd-explosion/.

So I REALLY like stuff like this in general, because I think there's so much benefit and need for that line of thought. That positive approach is SO important and empowering and it's balances the more analytical, tear them apart, diagnose and label everything steps. Also there's sort of a narrow view ADHD when sometimes when people are using ADHD as code for an iceberg situation. (anxiety, sensory, social, EF issues, late bloomer type developmental delays, etc.) Psych evals help the parent sort that out, because they can tease out things and put words to stuff that is going on. Sometimes stuff gets missed because it's normal in the family or because the parents had coping strategies that worked for them that they hope will work for the kids and aren't. 

I've had friends who were like evals destroy the child's psyche, I would never do that, blah blah. As if the kid doesn't know he's different and got issues, lol. Kids approaching their teens really like words for what's going on, want answers, want to understand themselves. The more information the better in that sense. But if you dissect them, I agree you have to put all that information back into a whole, positive, EMPOWERING approach. Totally agree.

[PeterPan]

13 minutes ago, hippymamato3 said:

Wait - he hasn't been diagnosed? I think you're a ways off from a med trial

Oh surely she can find one of those mythical MDs the preachers talk about, the ones where you walk in and they hand out ritalin scrips like candy. It won't involve multiple appointments spread over a couple months or involve referrals, questionaires, etc. etc., hahaha. 

[PeterPan]

18 minutes ago, hippymamato3 said:

Has he already been diagnosed?

So just slightly in her defense, on many of these things, when the parent suspects something is going on, it is. The challenge is it's not necessarily the *only* thing going on. 

[East Coast Sue]

Two of mine were diagnosed by a psychiatrist after they already had been diagnosed with another issue, so for them ADHD was a secondary diagnosis. For one of mine a psychologist diagnosed as a result of psycho educational testing which I scheduled specifically b/c I thought she had ADHD. Our pediatrician has a policy that she will NOT prescribe, diagnose or treat anxiety, depression or ADHD. However, she has helped in a pinch since my oldest received her medical care at college (in a different state than the one we live in) snd they can’t prescribe ADHD meds across state lines. Our pediatrician has maintained the prescription since last March, thankfully. 

[hippymamato3]

13 hours ago, PeterPan said:

So just slightly in her defense, on many of these things, when the parent suspects something is going on, it is. The challenge is it's not necessarily the *only* thing going on. 

And sometimes other things can look like ADHD but aren't.

[PeterPan]

34 minutes ago, hippymamato3 said:

And sometimes other things can look like ADHD but aren't.

For op, I think we had a thread on this book several years ago. https://www.amazon.com/ADHD-Does-Not-Exist-Hyperactivity/dp/006226673X  The title is meant to be provocative but the contents are more that hit list of other things you should be looking at.

I'll save my rant on the barbarism of the DSM.

[JumpyTheFrog]

On 1/14/2021 at 2:29 PM, Lecka said:

Do you know if you would need a referral from your pcp?

No, I don't need a referral.

On 1/14/2021 at 6:09 PM, Katy said:

I think some states have locked down stimulant medications much more than other states. I’d call your pcp and ask a nurse whether they should go to pcp or get a referral. 

Good idea. Thanks.

 

On 1/14/2021 at 7:58 PM, PeterPan said:

I would be looking for:

-hours they'll spend testing (more is ALWAYS better)

-variety/quality of tests (ask them! write the jibberish down and google it and ask on LC!)

 

1) have you checked for retained reflexes? They can cause all kinds of issues and integrating retained reflexes can decrease *some* of the behaviors.

2) how is he in background noise, how is his auditory processing? Again, not a complete explanation, but another thing to be looking for.

I will start a thread on the Learning Challenges board with more details and addressing PeterPan's post.