How to get ADHD diagnosis?

[Anonymous]

Our pediatrician said about two years ago that our DC meets the diagnostic criteria for ADHD. This was based on parent answers to a simple questionnaire (20 or 25 questions?) given to us at the pediatrician's office, covering topics like forgetfulness, losing things, etc. The pediatrician was willing to start DC on meds but for various reasons we decided to hold off. We also separately had WISC done and there was a discrepancy of more than 40 points between verbal (very superior) and processing speed scores. The psychologist suggested that DC may have ADHD, based on the WISC scores and also behavior during testing. From psychologist we understood that further testing would need to be fine to confirm. The testing would be costly and maybe not covered by insurance.

Does more testing (full neuropsych evaluation?) truly need to be done to have an ADHD diagnosis confirmed, though pediatrician already said that the diagnostic criteria were met? This would be mainly for purposes of exploring possible accommodations by the school. We are in Fairfax County. Also I think if we had an official diagnosis it would be helpful within our family. DH is punishing child for "not trying" with schoolwork, threatens with removal and destruction of belongings. Has very unrealistic expectations for quantity and duration of work, in my opinion.

I recall reading that the school may want to do their own evaluation. Is this correct for schools within Fairfax County? If so it would make sense to let the school evaluate, rather than paying thousands of dollars for an evaluation that would not be used? Who would we approach within the school?

[Anonymous]

^separate testing would need to be DONE

[Anonymous]

Trying again: further testing would need to be done.

[Anonymous]

The checklists are not great diagnostic tools. They just look at behaviors and 'symptoms' and there are many things that look like ADHD. Also those checklists were developed about 40 years ago when ADHD was thought to just be a behavioral disorder. Now we know there is a neurological component and knowing more details about that is very beneficial for your son. I would do a neuropsych for sure.

[Anonymous]

I agree with PP that the checklist is an inadequate tool and that further testing should be done. A lot of different things can cause adhd-like behaviors (anxiety, learning differences, and so on.) I really think it is extremely irresponsible for a pediatrician to look at a checklist and prescribe meds.

As to which kind of testing, well my impression is that you get what you pay for. A neuropsych, at least the one we got, is more thorough and covers more areas than what the school would have done. We had several different kinds of tests administered over a few days. In our case, we suspected that our son was a complicated case--for one thing, anxiety was already a major factor--and I was willing to pay money to do more and explore/rule out a variety of diagnoses. I am glad that we did because the results were not really what we expected but they have proven over the years to be entirely accurate. On the other hand, I am sure that in a great many cases, what the school system will cover is entirely accurate.

As to whether the school system will require further testing anyway, our FCPS completely accepted our private testing and only added a very small amount of its own testing on something that was age appropriate at the time I was seeking the IEP but not when I did the neuropsych testing. In other words, they did not retest anything.

[Anonymous]

Absolutely. Full neuro-psych testing is required. Cost will be about $3,000. You will have to fight FCPS for an IEP so have to have documents and be prepared.

[Anonymous]

Please do some more testing before leaping to ADHD. Maybe it is, maybe not but you need more to know for sure . Need symptoms in at least two settings (like home and school ) for starters.

[Anonymous]

We got a diagnosis for ADHD without the full neuropsych for my younger child. It was a set of scales from school and home and an intensive meeting with clinical psychologist for about 90 minutes. Total cost was about $350. But she was very clearly ADHD-Hyperactive.

My other child has a lot more complex issues and we did do the full neuropsych ($2500) for her. That was several hours of testing over several days. We were also screening for anxiety, depression, and other social emotional issues. She is also the Combined type and that can be harder to screen for and diagnose vs. other issues.

[Anonymous]

OP here. Thank you, everyone, for the feedback. I'll be making calls this morning to try to schedule neuropsych. I understand the wait will be long. Would be nice to know for sure (if there can be certainty) whether DC really has ADHD and stop saying "may have ADHD" and "probably has ADHD." Has all the symptoms of losing things, forgetting things, being inattentive, talking too much during class, wandering in the classroom, taking forever to do homework, refusing to do work in subjects that aren't favorites (some homework has water spots from tears). But other symptoms I've read about DC does not have. Has excellent handwriting and has always been a strong reader. No trouble with subjects in school that DC likes. Not sure if there would typically be trouble across the board with ADHD? Maybe it is mild to moderate ADHD, or as another poster mentioned maybe it isn't even ADHD. We will see. Please keep comments coming if any other insights.

[Anonymous]

OP, how old is DC? The "complex" child I mentioned diagnosed with combined was able to compensate pretty well at school until 7th grade. That's when things got dicey. For many kids the diagnosis happens when the school responsibilities step up: third grade and middle school tend to be big years, depending on the kid and the school. My kid had no issues learning to read and was a huge reader. But she loved reading, so that was easy for her to focus on, KWIM? Every kid is different.

[Anonymous]

Anonymous wrote:OP, how old is DC? The "complex" child I mentioned diagnosed with combined was able to compensate pretty well at school until 7th grade. That's when things got dicey. For many kids the diagnosis happens when the school responsibilities step up: third grade and middle school tend to be big years, depending on the kid and the school. My kid had no issues learning to read and was a huge reader. But she loved reading, so that was easy for her to focus on, KWIM? Every kid is different.

My child is 8 years old, third grade, so it's funny that you mention third grade. Responsibilities have stepped up as you say. For my part I've read about ADHD and what parents can do to help, thinking that the same strategies could apply to either ADHD or something that seems very similar to ADHD. As an example, to practice math skills I give DC a smaller number of problems and not an entire worksheet that tends to overwhelm. I might present only one problem at a time. But DH will insist that whole worksheets be completed, with the threat of punishments if the work isn't done. One main reason for wanting diagnosis is to be able to show DH that DC has a medical condition and that I'm not "making excuses" for DC. Ironically, I believe that DH himself has ADHD, and a couple of members of DH's family have been diagnosed with ADHD.

[Anonymous]

Anonymous wrote:OP here. Thank you, everyone, for the feedback. I'll be making calls this morning to try to schedule neuropsych. I understand the wait will be long. Would be nice to know for sure (if there can be certainty) whether DC really has ADHD and stop saying "may have ADHD" and "probably has ADHD." Has all the symptoms of losing things, forgetting things, being inattentive, talking too much during class, wandering in the classroom, taking forever to do homework, refusing to do work in subjects that aren't favorites (some homework has water spots from tears). But other symptoms I've read about DC does not have. Has excellent handwriting and has always been a strong reader. No trouble with subjects in school that DC likes. Not sure if there would typically be trouble across the board with ADHD? Maybe it is mild to moderate ADHD, or as another poster mentioned maybe it isn't even ADHD. We will see. Please keep comments coming if any other insights.

Every kid has different strengths and weakness, and individualized interests and personality traits, that make every child with ADHD different. I know several kids with ADHD and while there is overlap with mine, they are all very different. One thing to remember is that ADHD does not indicate the inability to pay attention, but rather a challenge regulating attention, which of course is only an issue when a child is not interested/motivated. So, for example, my son loves learning about science and history so he has no problem whatsoever reading for hours and hours in his room, but ask him to wait in line or fill out a math work sheet or anything that isn't particularly to his liking and it is like torture to him. My son does advanced academics, reads several years above his grade level, etc, but cannot sit at a chair and do homework for more than five minutes without getting up. Everyone with attention issues can focus on certain things better than others. He does have "severe ADHD" and it is very obvious in certain contexts but much less so in others because of his natural strengths and preferences.

[Anonymous]

We got insurance to pay about 1/3 for a thorough, 8 hrs of 4 separate tests.

[Anonymous]

I doubt your DH will suddenly "see the light" if you get a diagnosis. Especially if he sees that you specifically sought one out. Good luck, but I wouldn't hold out hope that the diagnosis will be a panacea.

[Anonymous]

OP back again. Thanks to all for the additional thoughts. It's helpful to know that some kids with ADHD are strong readers since for some reason I had happened to see accounts of reading difficulties. It sounds like areas of difficulty can vary depending on the child and his or her interests. Will consider the thoughts posted by 17:04.