ADD evaluation: was this typical?

[Narnian]

A few days ago we took our son to a child psychiatrist for an initial ADD evaluation, and we came away with a prescription for Focalin XR. I’m wondering if this is common practice, or if the doc is just script happy.

 

This is basically how our visit went:

The doctor spoke with my husband and me for about 30-40 minutes while the kids played in the next room. He asked lots of questions about our son's behavior, making notes of what we said, and gave us some paperwork to fill out. Then he went into the next room and spoke with our son for 10-15 minutes.

 

When he came back, he told us that our son meets the criteria for a clinical diagnosis of ADHD, gave us an info sheet on the different types of ADD medications and went over it with us, and wrote a prescription for Focalin XR. Then he went to get more questionnaires for us to fill out (which we are to discuss at our follow-up appointment next month). When he came back it was only to shake hands with us again and end the interview.

 

He didn't discuss any non-medicated ways of managing ADHD, and that surprised me. I'm not against the idea using of meds if they are necessary, but I was under the impression that meds aren't the only way to make life easier for a kid with ADHD. He didn't recommend further tests to confirm ADHD or rule out other things that may be causing ADD-like behavior (although I'm not sure if it's common to do so, or what those tests might be).

 

Anyway, my question for those of you who have been through the whole process of having your child diagnosed and treated for ADHD: was this typical? Do you think this was a thorough evaluation? Would you get a second opinion, and if so, with what kind of doctor?

 

This psychiatrist was recommended by a family we know, who made a point of mentioning that he doesn’t just stick kids on meds willy-nilly, so it could be that he felt that our son’s ADHD really warranted meds and just didn't communicate that. But I can’t shake the feeling that an hour is not long enough to fully evaluate whether a child needs to be put on a stimulant.

 

If you've read this far, thank you, and bless you for your patience. :) I'd love to hear your thoughts on ADD evals, and your own experiences with ADHD/doctors/meds/etc. if you're willing to share them. At this point any bit of advice would very helpful, because this is all new territory for me (except for living with an insanely wired/talkative/hyper/fun/crazy/distractable kid--that part isn't new, just exhausting. Heh.)

[elise1mds]

Personally, I do not think that was a thorough evaluation, especially with a psychiatrist. I can see that from a some pediatricians, perhaps, but not from a psychiatrist. When we had our initial consultation with our psychologist (not psychiatrist, but still...), we had to fill out paperwork - tons of it - before we even walked in the door. Even that visit went into much more detail than yours did, from what I can tell.

 

I would be irritated for several reasons.

 

1. No physical exam was done. Hearing, vision, etc. at least should have been checked out to make sure that these are not causes of the ADHD symptoms. A full past medical history, I hope, was filled out for your son at some point and gone over.

2. You don't mention filling out any forms/questionnaires beforehand. Of course you homeschool, but I'm betting there is another adult in your son's life who sees him on a regular basis and would be able to fill out a form proving that someone else sees the symptoms. They should have at least asked that question.

3. He didn't ask for any tests. Has your son ever had any thyroid issues/tests? Been exposed to or tested for lead? That should have been at least mentioned, IMHO. More things to rule out.

4. Were you in the room with your son while the doctor was talking to him?? I can't believe he didn't want to observe your son during the entire visit. That amount of time, 10-15 minutes, is hardly enough time to evaluate for a well-child visit, let alone determine the extent of symptoms in a potential ADHD patient.

5. He didn't ask your opinion as to what you wanted to do as far as treatment. Not cool.

 

When my son was evaluated, we started with our pediatrician. It was a 90-minute visit that went over everything and included forms filled out by us and his teachers, and my son was in the room the entire time so the doctor could observe him. We did walk out with a prescription, but it was for Strattera, the non-stimulant, and that was after we had discussed other options and my husband and I had decided that was where we wanted to start. Behavioral strategies had already somewhat failed for him. We also walked out with the name of a pediatric psychiatrist that we wanted to call. Our insurance wouldn't take that psychiatrist, so we selected a psychologist in his office that we now use, and we had to go through the entire process again so that the two doctors could see if their assessments independently reached the same conclusions (yes, for the most crucial parts). The psychologist evaluation lasted an hour as well, with my son in her office the entire time, but since she is just a psychologist, the physical exam/lab/prescription portions were out of the question, and she didn't give us a full diagnosis. Instead, she said she would take the forms and her thoughts and talk them over - with our permission, of course - with the psychiatrist we had wanted to see in the first place, which she did, and she called us with their combined thoughts within a couple of days. They matched almost completely to what my pediatrician had said, so we felt confident to begin medication and continue therapy sessions at that point.

 

I hope that helps a little. If you do want to get a second opinion, I would see if your pediatrician does behavioral evaluations or find another pediatric psychiatrist. I wouldn't blame you for doing either one. If you don't feel comfortable with the first opinion, it is your right to get a second one, and if doctor #1 gets a bee in his bonnet about it, you don't want to be dealing with him on a long-term basis anyway because his ego and/or need to push patients through in a hurry sound potentially troublesome.

 

Good luck!

[Laurie4b]

Personally, I do not think that was a thorough evaluation, especially with a psychiatrist. I can see that from a some pediatricians, perhaps, but not from a psychiatrist. When we had our initial consultation with our psychologist (not psychiatrist, but still...), we had to fill out paperwork - tons of it - before we even walked in the door. Even that visit went into much more detail than yours did, from what I can tell.

 

I would be irritated for several reasons.

 

1. No physical exam was done. Hearing, vision, etc. at least should have been checked out to make sure that these are not causes of the ADHD symptoms. A full past medical history, I hope, was filled out for your son at some point and gone over.

2. You don't mention filling out any forms/questionnaires beforehand. Of course you homeschool, but I'm betting there is another adult in your son's life who sees him on a regular basis and would be able to fill out a form proving that someone else sees the symptoms. They should have at least asked that question.

3. He didn't ask for any tests. Has your son ever had any thyroid issues/tests? Been exposed to or tested for lead? That should have been at least mentioned, IMHO. More things to rule out.

4. Were you in the room with your son while the doctor was talking to him?? I can't believe he didn't want to observe your son during the entire visit. That amount of time, 10-15 minutes, is hardly enough time to evaluate for a well-child visit, let alone determine the extent of symptoms in a potential ADHD patient.

5. He didn't ask your opinion as to what you wanted to do as far as treatment. Not cool.

 

When my son was evaluated, we started with our pediatrician. It was a 90-minute visit that went over everything and included forms filled out by us and his teachers, and my son was in the room the entire time so the doctor could observe him. We did walk out with a prescription, but it was for Strattera, the non-stimulant, and that was after we had discussed other options and my husband and I had decided that was where we wanted to start. Behavioral strategies had already somewhat failed for him. We also walked out with the name of a pediatric psychiatrist that we wanted to call. Our insurance wouldn't take that psychiatrist, so we selected a psychologist in his office that we now use, and we had to go through the entire process again so that the two doctors could see if their assessments independently reached the same conclusions (yes, for the most crucial parts). The psychologist evaluation lasted an hour as well, with my son in her office the entire time, but since she is just a psychologist, the physical exam/lab/prescription portions were out of the question, and she didn't give us a full diagnosis. Instead, she said she would take the forms and her thoughts and talk them over - with our permission, of course - with the psychiatrist we had wanted to see in the first place, which she did, and she called us with their combined thoughts within a couple of days. They matched almost completely to what my pediatrician had said, so we felt confident to begin medication and continue therapy sessions at that point.

 

I hope that helps a little. If you do want to get a second opinion, I would see if your pediatrician does behavioral evaluations or find another pediatric psychiatrist. I wouldn't blame you for doing either one. If you don't feel comfortable with the first opinion, it is your right to get a second one, and if doctor #1 gets a bee in his bonnet about it, you don't want to be dealing with him on a long-term basis anyway because his ego and/or need to push patients through in a hurry sound potentially troublesome.

 

Good luck!

 

I agree and most work-ups for ADD or ADHD include a WISC-IV, which is an IQ test, but the patterns on a WISC-IV can be indicative of ADHD. There are other tests which can be given as well to test a child's impulsivity, attention, etc. So, honestly, your report was the basis of the diagnosis. That could be positive in the sense that he listened to you or negative in the sense that I would not want a dx like that riding primarily on my observations. What if there was something I missed? What if I am biased?

 

I'm not surprised at a psychiatrist giving meds quickly. That is one thing that makes psychiatrists different from psychologists--they can prescribe meds. They also have more expertise in stuff that is very serious and that might involve physical functioning. A psychologist will have more expertise in testing, so is more likely to do that, if that makes sense.

[momtotkbb]

From my experience both in terms of my own dc's evaluations and in my having worked in the field - I'm not surprised esp since it was from a psychiatrist. I prefer a Dev Ped, Psychologist, and Psychiatrist to eval my own dc - more of a team approach. This allows for more than 1 Dr. and myself/dh giving our impression, they each perform various testing measurements and then we are able to sit down together and confer. Our Dr's did not rec'd meds right off the bat for our dc ---they gave rec'd for things for us to try both in terms of foods, behavior, teaching strategies, etc. After 4-6 weeks we then re-eval. We now go in every 3 months and only one is on meds ---they were greatly needed at this point and make a tremendous difference in our dc's learning ability, temper, and family dynamics.

[Misty]

Our experience was a tad more thorough...The psychologist spent a whole lot of time with my daughter.. About four hours split over two days. She was being tested for other things though (autism spectrum disorder, IQ, etc.) so I don't know if our experience was typical for an ADHD assessment. The psychologist noted her ADHD symptoms during testing AND took info from forms that dh and I had filled out (I had to fill out a teacher form too since we homeschool).

 

Now my older girls, besides spending a lot of time with the evaluator, also had to take a computerized test that assessed impulse control and attention. But I'm not sure if she gave that to my 5-year-old daughter or not.

 

I would say that your doctor wasn't as thorough as some other doctors, but if you agree that your son is ADHD, then I wouldn't worry much about it. I knew my daughter was ADHD. It's up to you on whether or not you want to give him the medication. You are the mother and you know what your son needs. We were referred to psychiatry for medication, but we didn't go because we're not ready to medicate just yet... someday, but not yet.

[Tree House Academy]

Our ADHD test took DAYS. We had to go 4 different times and have an eval by at least 4 different people in different areas of expertise. In the end, they did diagnose and recommend meds...which I declined. Now....meds are looking better and better.

 

A psychiatrist is always going to give you meds. They actually figure that is why you are there. If you aren't interested in meds, you will want to get in with a therapist or counselor who can help him deal with life (and help you deal with him, if he is anything like my ADHD son).

[Hillary in KS]

I would be concerned because the Dr. didn't seem to rule other things out.

 

What jumped immediatley to mind is a friend with a ds who was diagnosed with ADHD. They had medicated him for years, and the medicine helped a bit, but not as much as hoped. As he got older, he seemed to worsen.

 

When their son was a teen, it was eventually discovered that he didn't have ADHD. He had Tourette's. The original misdiagnosis of ADHD and the subsequent medicating had masked symptoms of Tourette's for all those years.

 

He's doing much better now. :001_smile:

[elizam]

I think it is fairly difficult to get a "thorough" evaluation. I do think it is more typical that a bunch of forms have to be filled out before the appointment. Parent rating scales, teacher rating scales, etc. Often the child even fills out one, depending on his or her age.

 

The main reason I freak out now at the thought of a brief eval from any dr is because my ds actually has bipolar disorder, which is usually made worse by stimulants. In fact, the stimulants can bring it out; if there is a family history of BP, they shouldn't be given stimulants.

 

I am one who disagrees that it is desirable to avoid stimulants in all cases. ADHD is managed better by meds than by any other means. Diet, all that...might help, but not as much as the right med. And the meds really aren't all that dangerous if prescribed and taken correctly. There is a bunch of anti med hype that bothers me, especially amongst homeschoolers. I wasted years of my ds' life homeschooling him and thinking I had this awful child who couldn't focus, flew into rages, etc. If I had looked into it all more seriously when he was younger, he could have maybe gotten the help he needed before he got to be a balky teen who turns to weed and alcohol to self medicate and have "friends." Better to accept medical help. Drs aren't just pill pushers.

[Evergreen State Sue]

I agree with the others that this was not a thorough evaluation. I think the most important thing you should do is educate yourself. Medication can help in 75-80% of cases with the core issues of impulsivity, hyperactivity, and stimulating the frontal lobes, but that isn't all that can help. Getting enough sleep, exercise, diet, working memory training, therapy and coaching all have their place. I'm still learning and our family has dealt with it for about 6 years.

[Narnian]

Thank you all for your replies. It really helps to read about the different processes you have gone through with your own kids.

 

From what many of you have said, it sounds as though it's not uncommon to have several doctors in different specialties working together to diagnose and determine the best course of action, so I'll definitely look into that.

 

 

Personally, I do not think that was a thorough evaluation, especially with a psychiatrist. I can see that from a some pediatricians, perhaps, but not from a psychiatrist. When we had our initial consultation with our psychologist (not psychiatrist, but still...), we had to fill out paperwork - tons of it - before we even walked in the door. Even that visit went into much more detail than yours did, from what I can tell.

 

I would be irritated for several reasons.

 

1. No physical exam was done. Hearing, vision, etc. at least should have been checked out to make sure that these are not causes of the ADHD symptoms. A full past medical history, I hope, was filled out for your son at some point and gone over.

2. You don't mention filling out any forms/questionnaires beforehand. Of course you homeschool, but I'm betting there is another adult in your son's life who sees him on a regular basis and would be able to fill out a form proving that someone else sees the symptoms. They should have at least asked that question.

3. He didn't ask for any tests. Has your son ever had any thyroid issues/tests? Been exposed to or tested for lead? That should have been at least mentioned, IMHO. More things to rule out.

4. Were you in the room with your son while the doctor was talking to him?? I can't believe he didn't want to observe your son during the entire visit. That amount of time, 10-15 minutes, is hardly enough time to evaluate for a well-child visit, let alone determine the extent of symptoms in a potential ADHD patient.

5. He didn't ask your opinion as to what you wanted to do as far as treatment. Not cool.

 

 

 

No, no physical exams or tests were done. We did fill out a LOT of paperwork/questionnaires, but that was it.

 

You mentioned testing for thyroid problems and lead exposure. Do you know of any other tests that are used to rule out other causes of ADHD-like behavior?