I need to have my child evaluated for aspergers/ adhd sooner rather than later

[Anonymous]

Anonymous wrote:For a comprehensive evaluation from a doctor (PhD) who knows what they're doing will cost you anywhere from $3K-$4K around here.

Do not take shortcuts with something like this OP. You get what you pay for, and you want to have the correct diagnosis so please do not put this in the hands of an experienced person who will give you "a good deal".

Would you consider the Children's option to be taking a shortcut? Or are you referring to other private practices that are cheaper than 4k?

[Anonymous]

Anonymous wrote:

Anonymous wrote:For a comprehensive evaluation from a doctor (PhD) who knows what they're doing will cost you anywhere from $3K-$4K around here.

Do not take shortcuts with something like this OP. You get what you pay for, and you want to have the correct diagnosis so please do not put this in the hands of an experienced person who will give you "a good deal".

Would you consider the Children's option to be taking a shortcut? Or are you referring to other private practices that are cheaper than 4k?

Not pp you are asking but no one thinks Children's or KKI are shortcuts. It's just that the wait is usually longer than most private practices (except Dr Black and Dr Stixrud) that people are reluctant to recommend them.

I am the pp whose public school will do a psyched eval at no cost. Costs for evals can range from 0 to 4K+ depending on where you go and many people on this forum don't trust the no cost school evals bc of bad experiences.

[Anonymous]

Anonymous wrote:Op here. I have heard a lot about dr black and I'm sorry if this offends some, but I have often wondered if dr black has ever not diagnosed a child with some SN case. I worry that people like him may over diagnose.

I know of people who were not diagnosed with ASD by Dr. Black. But I agree with the pp that there is *something* going on with everyone who bothers to go there.

[Anonymous]

Where is Dr. black located?

[Anonymous]

Can anyone recommend someone in Virginia?

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Op here. I have heard a lot about dr black and I'm sorry if this offends some, but I have often wondered if dr black has ever not diagnosed a child with some SN case. I worry that people like him may over diagnose.

I don't know about others but I know that for my child, Dr Black diagnosis, report and recommendations for treatment are spot on and has made DS's life 1000% better.

I would also think that if you're at the point of paying 4000 out of pocket for an evaluation you at least know *something* is wrong, even if you're going because you don't quite know what. Is that going to be universally true? Nothing ever is. But it's a highly self selecting population.

There's a really interesting unpublished PhD thesis from a sociology student who did an ethnographical-type study of an autism center. She found that every child except 1 or 2 referred to the center in her time there was diagnosed with an ASD, with the clinicians using the PDD-NOS category as a sort of catch-all for "something wrong." It's here: http://academiccommons.columbia.edu/item/ac:143070

My feeling is that while it's correct that no parent embarks on investing a lot of money/worry/time if there is nothing actually going on, that there definitely is a bias towards over-diagnosis once you enter the "institutional funnel" and go to one of these doctors and practices. What might be a developmental phase or a poor fit with an educational environment could end up getting labeled as a SN. To a certain extent these institutions are designed to produce a diagnosis to stick to whatever is identified as problem behavior.

I also feel like the diagnosis of an ASD, especially in marginal cases or where there might be other things going on, probably really benefits from an interdisciplinary, team approach, instead of one private practice doctor. That's why a place like Children's might be a better option.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Op here. I have heard a lot about dr black and I'm sorry if this offends some, but I have often wondered if dr black has ever not diagnosed a child with some SN case. I worry that people like him may over diagnose.

I don't know about others but I know that for my child, Dr Black diagnosis, report and recommendations for treatment are spot on and has made DS's life 1000% better.

I would also think that if you're at the point of paying 4000 out of pocket for an evaluation you at least know *something* is wrong, even if you're going because you don't quite know what. Is that going to be universally true? Nothing ever is. But it's a highly self selecting population.

There's a really interesting unpublished PhD thesis from a sociology student who did an ethnographical-type study of an autism center. She found that every child except 1 or 2 referred to the center in her time there was diagnosed with an ASD, with the clinicians using the PDD-NOS category as a sort of catch-all for "something wrong." It's here: http://academiccommons.columbia.edu/item/ac:143070

My feeling is that while it's correct that no parent embarks on investing a lot of money/worry/time if there is nothing actually going on, that there definitely is a bias towards over-diagnosis once you enter the "institutional funnel" and go to one of these doctors and practices. What might be a developmental phase or a poor fit with an educational environment could end up getting labeled as a SN. To a certain extent these institutions are designed to produce a diagnosis to stick to whatever is identified as problem behavior.

I also feel like the diagnosis of an ASD, especially in marginal cases or where there might be other things going on, probably really benefits from an interdisciplinary, team approach, instead of one private practice doctor. That's why a place like Children's might be a better option.

Interesting study... Would love to see a similar study as it pertains to Asperger's. The study was obviously made before 2013 when Asperger's and PDD-NOS still exists as a separate diagnosis from Autism. Why was the phD thesis not published?

Kids with Asperger's are usually different from most others with ASD in that Asperger's is not found (if at all) until a child starts school and the family usually has no experience with early intervention services. So for kids with Asperger's, going to school is the "institutional funnel" that results in these kids ending up with an ASD dx or just maybe they get the diagnosis bc they actually have a diagnosis and getting an IEP and supports/services improves how they function at school.

Dr. Black and Children's Center for Autism Spectrum Disorders are the two main sources in the area that regularly conduct ADOS/ADI-R testing which is considered by many to be the gold standard for diagnosing ASDs.

[Anonymous]

OP could just go for ADOS/ADI-R at Children's but this only looks for ASD not ADHD and the wait time will be the same as for a neuropsych eval. You can ask for both ADOS/ADI-R and a neuropsych eval from Children's and Dr Black once you decide who to see.

[Anonymous]

I like Dr. Belsito. I know others on this board do not, but we have had a good experience with her so far. I am a little concerned that she is sometimes dismissive because we are not as "severe" but she is careful and approachable.

[Anonymous]

Anonymous wrote:I like Dr. Belsito. I know others on this board do not, but we have had a good experience with her so far. I am a little concerned that she is sometimes dismissive because we are not as "severe" but she is careful and approachable.

If the child is 6 or older a developmental pediatrician will refer for a neuropsych eval bc at school age, that is the standard of care for diagnosing ADHD, ASD, etc.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Op here. I have heard a lot about dr black and I'm sorry if this offends some, but I have often wondered if dr black has ever not diagnosed a child with some SN case. I worry that people like him may over diagnose.

I don't know about others but I know that for my child, Dr Black diagnosis, report and recommendations for treatment are spot on and has made DS's life 1000% better.

I would also think that if you're at the point of paying 4000 out of pocket for an evaluation you at least know *something* is wrong, even if you're going because you don't quite know what. Is that going to be universally true? Nothing ever is. But it's a highly self selecting population.

There's a really interesting unpublished PhD thesis from a sociology student who did an ethnographical-type study of an autism center. She found that every child except 1 or 2 referred to the center in her time there was diagnosed with an ASD, with the clinicians using the PDD-NOS category as a sort of catch-all for "something wrong." It's here: http://academiccommons.columbia.edu/item/ac:143070

My feeling is that while it's correct that no parent embarks on investing a lot of money/worry/time if there is nothing actually going on, that there definitely is a bias towards over-diagnosis once you enter the "institutional funnel" and go to one of these doctors and practices. What might be a developmental phase or a poor fit with an educational environment could end up getting labeled as a SN. To a certain extent these institutions are designed to produce a diagnosis to stick to whatever is identified as problem behavior.

I also feel like the diagnosis of an ASD, especially in marginal cases or where there might be other things going on, probably really benefits from an interdisciplinary, team approach, instead of one private practice doctor. That's why a place like Children's might be a better option.

Interesting study... Would love to see a similar study as it pertains to Asperger's. The study was obviously made before 2013 when Asperger's and PDD-NOS still exists as a separate diagnosis from Autism. Why was the phD thesis not published?

Kids with Asperger's are usually different from most others with ASD in that Asperger's is not found (if at all) until a child starts school and the family usually has no experience with early intervention services. So for kids with Asperger's, going to school is the "institutional funnel" that results in these kids ending up with an ASD dx or just maybe they get the diagnosis bc they actually have a diagnosis and getting an IEP and supports/services improves how they function at school.

Dr. Black and Children's Center for Autism Spectrum Disorders are the two main sources in the area that regularly conduct ADOS/ADI-R testing which is considered by many to be the gold standard for diagnosing ASDs.

I think that you don't normally publish your thesis as a book until you're a few years into your tenure-track job. The change in diagnostic categories probably presents a challenge too!

According to the paper, the children in the clinic were almost all younger than 3 at diagnosis, and were, with the exception of one older child who was diagnosed with Aspergers, all diagnosed with Autism or PDD-NOS. The children who were verbal and seemed to be "making progress" were given PDD labels.

Now that there is no more Aspergers or PDD in the DSM, it remains to be seen if those children who seem to be less severely affected who would have been PDD (or Aspergers later on) will be diagnosed with Autism, or nothing at all. It will probably depend on the clinician's beliefs about the services that might benefit the child if they get a diagnosis.

[Anonymous]

Anonymous wrote:

Anonymous wrote:Op here. I have heard a lot about dr black and I'm sorry if this offends some, but I have often wondered if dr black has ever not diagnosed a child with some SN case. I worry that people like him may over diagnose.

I know of people who were not diagnosed with ASD by Dr. Black. But I agree with the pp that there is *something* going on with everyone who bothers to go there.

It makes no sense to pursue an evaluation and especially one that costs 4K and involves a long wait unless you think that your child needs help.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:For a comprehensive evaluation from a doctor (PhD) who knows what they're doing will cost you anywhere from $3K-$4K around here.

Do not take shortcuts with something like this OP. You get what you pay for, and you want to have the correct diagnosis so please do not put this in the hands of an experienced person who will give you "a good deal".

Would you consider the Children's option to be taking a shortcut? Or are you referring to other private practices that are cheaper than 4k?

Not pp you are asking but no one thinks Children's or KKI are shortcuts. It's just that the wait is usually longer than most private practices (except Dr Black and Dr Stixrud) that people are reluctant to recommend them.

I am the pp whose public school will do a psyched eval at no cost. Costs for evals can range from 0 to 4K+ depending on where you go and many people on this forum don't trust the no cost school evals bc of bad experiences.

Heads up. All public schools should do a psyched eval at no cost. They is part of IDEA, identifying children with suspected disabilities. It is simply that some people have had bad experiences and/ or don't trust the school to do a good job because of potential conflict of interest.

However, our school psycho ed eval was 27 pages so I don't think it could have been more comprehensive. It was also through a charter and done through a contracted private practice so they had no skin in the game...I think the report would have been the same for one of their private clients.

[Anonymous]

Laurie Smith in Vienna

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Op here. I have heard a lot about dr black and I'm sorry if this offends some, but I have often wondered if dr black has ever not diagnosed a child with some SN case. I worry that people like him may over diagnose.

I know of people who were not diagnosed with ASD by Dr. Black. But I agree with the pp that there is *something* going on with everyone who bothers to go there.

It makes no sense to pursue an evaluation and especially one that costs 4K and involves a long wait unless you think that your child needs help.

Well, on my part, I can say that there's a strong possibility that we are only dealing with environmental factors and not a "SN" ... but they freak you out so much about the value of Early Intervention that it starts to seem like irresponsible parenting not to follow up on the most minimal possibility of missing something. And "needs help" is not necessarily the same thing as "has a diagnosable developmental disorder."