ADHD, not autism -- what now?

[Anonymous]

OP, you do know that females are less-likely to be correctly diagnosed than males, right? The boys tend to act up more in class so ADHD/autism/HFA is caught earlier. Our daughter didn't get a correct diagnosis until 14 and we were using the best people in the area.

[Anonymous]

Anonymous wrote:

Anonymous wrote:We're going through the process of getting our son into the County special ed preschool program. Once he is found eligible, he can receive services ranging from speech therapy to OT while he is there. The program is 1/2 day, 2-5 days a week depending on what your child needs. Have you begun this process at all? Is your child in Early Intervention? If your child is in EI, then they transition to the County services regularly, and can definitely guide you on how the process works.

I'm curious...what made you get a second opinion? Your situation is interesting to me because my son was dxed with ASD just after he turned 2...and was said to be mild....I think mostly because he doesn't exhibit many of the classic autism behaviors. He is VERY smiley with both my husband and I, as well as others....doesn't exhibit repetitive behaviors like lining up objects etc. He is not what I'd call a social butterfly, but he tolerates a traditional daycare with many children in his class. He is extremely hyper...and we've always wondered about the ADHD component.

ASD can be accompanied by ADHD.

NP here. I don't think of it that way. That is, I don't think that most kids have two separate disorders. I think a more sensible way to look at it is that a child has one disorder, that is unique to them, that shares features with both ASD and ADHD and meets the criteria for both, or even ASD, ADHD and one or more other diagnoses such as an Anxiety Disorder, or Apraxia of Speech, or Developmental Coordination Disorder, or Expressive and/or Receptive Language Disorders. At various points in a child's development some features may be more prominent or concerning than others, and this may change over time. For example, a child's communication difficulties may seem primary when they are very young, and then improve with intensive therapy, where as their difficulties with attention and executive functioning may not be as obvious until they enter school and encounter the demands of an academic setting, at which point it may be appropriate to program for him or her as a child with ADHD.

The other thing I will point out is that the criteria used to diagnose a child as having ASD under IDEA, are quite different from the criteria used to diagnose children under the DSM. Because of this, there may be situations where a child is diagnosed by a school team as having ASD, while outside professionals describe him as ADHD, or to be diagnosed as ASD by outside professionals, but not qualify for an IEP at all at school.

[Anonymous]

Anonymous wrote:
I'm curious...what made you get a second opinion? Your situation is interesting to me because my son was dxed with ASD just after he turned 2...and was said to be mild....I think mostly because he doesn't exhibit many of the classic autism behaviors. He is VERY smiley with both my husband and I, as well as others....doesn't exhibit repetitive behaviors like lining up objects etc. He is not what I'd call a social butterfly, but he tolerates a traditional daycare with many children in his class. He is extremely hyper...and we've always wondered about the ADHD component.

OP here. Thanks to all for your very helpful feedback.

Re this question, we got a second opinion because we felt the same way the doctor at KK felt after evaluating our DD -- she did not have restrictive/repetative interests and she was actually fairly social, gave good eye contact, likes to be around people, seems to want to engage (though for the longest time, didn't see to know how), etc. Sounds a lot like your child.

Someone else asked why we got the initial diagnosis so young. We actually initially had some testing done when she was about 22 months old and not really talking. She did have some speech/language delays but said she had "no red flags for autism." We breathed easy, and eventually she did start talking, but at age 29 months, after enrolling her in preschool a month or two prior, the school came to us with their concerns, she was not engaging socially. We agree, her initial diagnosis was way off, we knew from the start it was not "moderate to severe" autism -- that said, ADHD and ASD can apparently look very similar, especially under age 3. That's another reason to re-diagnose if you're concerned (though note if he's getting the services he needs now, maybe it's not worth getting a re-evaluation -- though to us, the peace of mind has been very very much worth it).

[Anonymous]

Anonymous wrote:KKI also diagnosed my DC with ADHD, not autism.

She has autism.

I am sorry to hear that. Would you mind filling in more details, when and at what age was the ADHD diagnosis, did it feel wrong at the time or was there a later shift/regression, how/when did DC get the diagnosis changed to ASD?

[Anonymous]

Seconding request for this story. Surprised KKI would misdiagnose.

[Anonymous]

I'm intriguedby the fact that the OP's daughter was diagnosed with ADHD at such a young age. We were told with our oldest that ADHD cannot be accurately diagnosed until at least 5yo. Is that no longer the case?

[Anonymous]

Anonymous wrote:I'm intriguedby the fact that the OP's daughter was diagnosed with ADHD at such a young age. We were told with our oldest that ADHD cannot be accurately diagnosed until at least 5yo. Is that no longer the case?

OP here, sorry I've been a little lazy with the diagnosis summary -- no, nothing has changed. She was not formally diagnosed with ADHD but actually with Encephalopathy (+ anxiety, SPD, and speech/language disorders). They stated she has with "early signs and symptoms for Attention Deficit Hyperactivity Disorder." She told us in person that she seemed ADHD and that we would have received the ADHD diagnosis if she wasn't so young. They also expressly discounted ASD due to a lack of repetitive behaviors/restrictive interest/rigidity.

Hope that clarifies.

[Anonymous]

Anonymous wrote:

Anonymous wrote:KKI also diagnosed my DC with ADHD, not autism.

She has autism.

I am sorry to hear that. Would you mind filling in more details, when and at what age was the ADHD diagnosis, did it feel wrong at the time or was there a later shift/regression, how/when did DC get the diagnosis changed to ASD?

^ I'm the OP of this response (not of the original post). First CNMC diagnosis at age 6 was wrong. I then took her to KKI for a second opinion, which first brought up ADHD. The neuropsych there (actually might have been an MD) caught the ADHD and said a lot of ADHD looks like ASD, but she didn't see ASD. ADHD absolutely fits my kid, but it didn't address our other concerns. t returned to CNMC a few months later and asked for a reevaluation with another neuropsych, and she was very clearly ASD (in addition to ADHD). The misdiagnosis was a combination of an incompetent neuropsych, who had left by the time we went back, and the fact that she was just on the cusp of the two age group tests and originally was tested for the younger age. The girl thing also didn't help either. But she is clearly, unequivocally HF ASD, as well as ADHD. It would be easier if she weren't ASD, but she is, and I was very grateful for the diagnosis after two misfires.

Until this year the ADHD played a bigger role in her day-to-day (IEP), but now some of her ASD characteristics are creeping into her schoolwork. We address both issues with therapy and meds.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:We're going through the process of getting our son into the County special ed preschool program. Once he is found eligible, he can receive services ranging from speech therapy to OT while he is there. The program is 1/2 day, 2-5 days a week depending on what your child needs. Have you begun this process at all? Is your child in Early Intervention? If your child is in EI, then they transition to the County services regularly, and can definitely guide you on how the process works.

I'm curious...what made you get a second opinion? Your situation is interesting to me because my son was dxed with ASD just after he turned 2...and was said to be mild....I think mostly because he doesn't exhibit many of the classic autism behaviors. He is VERY smiley with both my husband and I, as well as others....doesn't exhibit repetitive behaviors like lining up objects etc. He is not what I'd call a social butterfly, but he tolerates a traditional daycare with many children in his class. He is extremely hyper...and we've always wondered about the ADHD component.

ASD can be accompanied by ADHD.

NP here. I don't think of it that way. That is, I don't think that most kids have two separate disorders. I think a more sensible way to look at it is that a child has one disorder, that is unique to them, that shares features with both ASD and ADHD and meets the criteria for both, or even ASD, ADHD and one or more other diagnoses such as an Anxiety Disorder, or Apraxia of Speech, or Developmental Coordination Disorder, or Expressive and/or Receptive Language Disorders. At various points in a child's development some features may be more prominent or concerning than others, and this may change over time. For example, a child's communication difficulties may seem primary when they are very young, and then improve with intensive therapy, where as their difficulties with attention and executive functioning may not be as obvious until they enter school and encounter the demands of an academic setting, at which point it may be appropriate to program for him or her as a child with ADHD.

The other thing I will point out is that the criteria used to diagnose a child as having ASD under IDEA, are quite different from the criteria used to diagnose children under the DSM. Because of this, there may be situations where a child is diagnosed by a school team as having ASD, while outside professionals describe him as ADHD, or to be diagnosed as ASD by outside professionals, but not qualify for an IEP at all at school.

NP. They are two separate disorders and we were told so by the neuropsych when we went for testing. A competent neuropsych eval should be able to tease out whether a child has both ASD and ADHD or "just" ASD or ADHD.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:KKI also diagnosed my DC with ADHD, not autism.

She has autism.

The misdiagnosis was a combination of an incompetent neuropsych, who had left by the time we went back, and the fact that she was just on the cusp of the two age group tests and originally was tested for the younger age.

PP, I'm sorry for the wringer you've been through. I've wondered about this with our testing, which my child took as a young 5 - thorough testing including for ADHD. But the scale was for 5 to 12 year olds and I found some of it hard to answer like "is homework a struggle?" and "does he forget his homework?" - and other stuff I can't remember but basically there was no answer for Not Applicable because I got his backpack ready (wonder I fell into that?) or because he didn't have homework at the time.

I think my child has ADHD and mentioned at the time that I thought some of the q's on the scales were hard to answer. We continue on our journey and seeing a new-to-us developmental ped soon. We shall see.

Thank you for sharing your story.

[Anonymous]

Go to five different specialists and you get five different diagnoses...unless your child is very clearly disabled don't force a label on them when they are infants. Jesus, reading this forum drives me nuts - how readily parents seem to want their kids to have some kind of SN, how everything that's 'out of the norm' must immediately be some kind of SN...

Yes, sure, some children DO actually have autism, ADHD and whatnot else. SOME. But people need to stop looking for diseases where there are just different kinds of children with different kinds of needs. The market for therapy and drugs for children is increasing in a scary way every year and parents seem to be oblivious to the fact that maybe their child is fine and some people just want to make money off of them because after all - what will a bit of speech therapy here and a bit of Ritalin there hurt anyone, right?

Does the fact that your child got diagnosed with autism first, then with ADHD without showing signs of autism anymore not make you the least bit suspicious?!?! How about you let them grow a bit and nurture their strengths instead of always looking for a diagnosis for every behavior of your child. This isn't just for the OP, but for everybody else as well. Sorry for the rant, but I see so many children who are developed perfectly normal and then their parents tell me "Oh, yeah she has ADHD." Does not...?! It makes me so sad and mad and sometimes I have to let it out. -.-

[Anonymous]

Our child was evaluated by four different doctors so far and they all gave the same diagnosis... Oh, and none of them recommended medication but did recommend an IEP which he has.

[Anonymous]

Anonymous wrote:Go to five different specialists and you get five different diagnoses...unless your child is very clearly disabled don't force a label on them when they are infants. Jesus, reading this forum drives me nuts - how readily parents seem to want their kids to have some kind of SN, how everything that's 'out of the norm' must immediately be some kind of SN...

Yes, sure, some children DO actually have autism, ADHD and whatnot else. SOME. But people need to stop looking for diseases where there are just different kinds of children with different kinds of needs. The market for therapy and drugs for children is increasing in a scary way every year and parents seem to be oblivious to the fact that maybe their child is fine and some people just want to make money off of them because after all - what will a bit of speech therapy here and a bit of Ritalin there hurt anyone, right?

Does the fact that your child got diagnosed with autism first, then with ADHD without showing signs of autism anymore not make you the least bit suspicious?!?! How about you let them grow a bit and nurture their strengths instead of always looking for a diagnosis for every behavior of your child. This isn't just for the OP, but for everybody else as well. Sorry for the rant, but I see so many children who are developed perfectly normal and then their parents tell me "Oh, yeah she has ADHD." Does not...?! It makes me so sad and mad and sometimes I have to let it out. -.-

PP you are a nut job. Perhaps you should stop reading the "Special Needs" forum if it gets you hot and bothered enough to make a total ass of yourself. There is indeed probably an overmedicating of children going on today in the US, but you are so clearly an example of under-medicating. Please keep your ignorant, misguided rants to yourself.

[Anonymous]

Anonymous wrote:

Anonymous wrote:Go to five different specialists and you get five different diagnoses...unless your child is very clearly disabled don't force a label on them when they are infants. Jesus, reading this forum drives me nuts - how readily parents seem to want their kids to have some kind of SN, how everything that's 'out of the norm' must immediately be some kind of SN...

Yes, sure, some children DO actually have autism, ADHD and whatnot else. SOME. But people need to stop looking for diseases where there are just different kinds of children with different kinds of needs. The market for therapy and drugs for children is increasing in a scary way every year and parents seem to be oblivious to the fact that maybe their child is fine and some people just want to make money off of them because after all - what will a bit of speech therapy here and a bit of Ritalin there hurt anyone, right?

Does the fact that your child got diagnosed with autism first, then with ADHD without showing signs of autism anymore not make you the least bit suspicious?!?! How about you let them grow a bit and nurture their strengths instead of always looking for a diagnosis for every behavior of your child. This isn't just for the OP, but for everybody else as well. Sorry for the rant, but I see so many children who are developed perfectly normal and then their parents tell me "Oh, yeah she has ADHD." Does not...?! It makes me so sad and mad and sometimes I have to let it out. -.-

PP you are a nut job. Perhaps you should stop reading the "Special Needs" forum if it gets you hot and bothered enough to make a total ass of yourself. There is indeed probably an overmedicating of children going on today in the US, but you are so clearly an example of under-medicating. Please keep your ignorant, misguided rants to yourself.

NP here. You say something like that, but at the same time try to call the poster an ass? You just agreed with his/her point...just saying. Also calling someone with a different opinion a "nut job", an "ass" and "under-medicated" doesn't make YOU look very good. Sure, you may disagree with someone's opinion - but everyone is entitled to their own opinion and there is no need for name calling. Unless YOU want to appear ignorant.

On topic: OP, breathe. Relax. Love your child and don't let labels stop you! Especially for young children, focus on their strengths and don't be so intimidated by diagnoses, prognoses, specialists, opinions etc. Trust your instincts. There is plenty of help out there, so take what you need, but don't let it get in the way of just loving your child!

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:We're going through the process of getting our son into the County special ed preschool program. Once he is found eligible, he can receive services ranging from speech therapy to OT while he is there. The program is 1/2 day, 2-5 days a week depending on what your child needs. Have you begun this process at all? Is your child in Early Intervention? If your child is in EI, then they transition to the County services regularly, and can definitely guide you on how the process works.

I'm curious...what made you get a second opinion? Your situation is interesting to me because my son was dxed with ASD just after he turned 2...and was said to be mild....I think mostly because he doesn't exhibit many of the classic autism behaviors. He is VERY smiley with both my husband and I, as well as others....doesn't exhibit repetitive behaviors like lining up objects etc. He is not what I'd call a social butterfly, but he tolerates a traditional daycare with many children in his class. He is extremely hyper...and we've always wondered about the ADHD component.

ASD can be accompanied by ADHD.

NP here. I don't think of it that way. That is, I don't think that most kids have two separate disorders. I think a more sensible way to look at it is that a child has one disorder, that is unique to them, that shares features with both ASD and ADHD and meets the criteria for both, or even ASD, ADHD and one or more other diagnoses such as an Anxiety Disorder, or Apraxia of Speech, or Developmental Coordination Disorder, or Expressive and/or Receptive Language Disorders. At various points in a child's development some features may be more prominent or concerning than others, and this may change over time. For example, a child's communication difficulties may seem primary when they are very young, and then improve with intensive therapy, where as their difficulties with attention and executive functioning may not be as obvious until they enter school and encounter the demands of an academic setting, at which point it may be appropriate to program for him or her as a child with ADHD.

The other thing I will point out is that the criteria used to diagnose a child as having ASD under IDEA, are quite different from the criteria used to diagnose children under the DSM. Because of this, there may be situations where a child is diagnosed by a school team as having ASD, while outside professionals describe him as ADHD, or to be diagnosed as ASD by outside professionals, but not qualify for an IEP at all at school.

NP. They are two separate disorders and we were told so by the neuropsych when we went for testing. A competent neuropsych eval should be able to tease out whether a child has both ASD and ADHD or "just" ASD or ADHD.

Just a very experienced parent here, not a psychiatrist or tester, but I agree with this. DD (yes they get it wrong for girls a lot) was misdiagnosed many times as having "just" ADHD/exec. functioning. DS also has ADHD as does DH, so I'm pretty well versed in all the literature. It took several attempts at different testers to finally get the then-used HFA label on DD and the moment the psychiatrist said it my brain went "bingo". I had worked with the severely autistic and knew about Aspergers but was too close to the situation to see it myself. My first argument to the psychiatrist was that DD had perfect eye contact. He said "you are too close to it to see it". He was right. DD is definitely on the spectrum and it is becoming very obvious as we move into late adolescence/early adulthood. All the private schools, therapists, psychiatrists, pediatricians and testers missed it for 15 years. Testing is much better now than it was even a decade ago - but there are still too many in the field who don't know what they are doing and are too eager to put an ADHD label on anyone, especially boys, who act up. My advice is to be willing to go with the flow and see what develops. Get all the therapy and intervention you can but be open to new diagnoses. I think I could have helped DD better if I had known that she was HFA two decades ago.