Neuropsych - no diagnosis

[Anonymous]

OP, have you looped back to the school psychologist to get her input? It sounds like she was helpful in first grade, so it would be helpful to involve her and see what she thinks as a first step.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:What made you think your child might have ADHD, OP? I saw what you said about sometimes impulsive and chatty but it’s not just that, correct?

OP here. DS is currently in 3rd grade in public school. 1st grade teacher suggested we “talk to our doctor” because of DS having emotional outburst and low frustration tolerance. This was also first year back after pandemic. We spoke to ped who said to have school therapist evaluate as a first step. She observed in the classroom and didn’t think further evaluation was necessary and said the teacher was overreacting. Nonetheless, we started a positive behavior plan and by the end of the year the teacher was glowing about our sons progress.

Fast forward to third grade - we still hear the same concerns from teachers at conferences but no, there are not regular phone calls home. Teachers report low frustration tolerance particularly in social settings. He is easily baited by other children. He is a “big feelings” kind of kid. We are doing a social skills group but I wonder if I’m in denial and we need to do more.

The other part of me says that just because he has social challenges, I don’t need to drop thousands to get a doctor to tell me what I want to hear and medicate him. We could totally wait and see if he matures but will I be doing some kind of permanent damage to his self esteem if it does turn out he has a legitimate issue that needs to be medicated?
Sorry for the rant here.

I dunno, OP--I don't think you're in denial. I think the social skills group is good. Third grade is a big year for development. I'd be tempted to keep an eye on it and see how things go next year. With that said, you could also try occupational therapy for emotional regulation (maybe in a summer day camp setting), but that might be hard without a diagnosis of some kind.

DP I do not think OP is in denial either. But I think our system for identifying kids' needs is horrible and the process is very confusing. I think it is important to remember:
- Schools don't necessarily provide supports for kids with more subtle/less significant needs. Either they don't have the expertise to identify those needs or are just trying to ration their limited resources for those kids with the most needs. Not blaming schools, their resources are limited, but the upshot is that you may not want to take what the school therapist says as the last word.
- IME, teachers don't share fake concerns with parents. On the contrary they are often hesitant to share concerns because that's often not a fun conversation.
- A neuropsych is expensive. So is therapy. Sometimes, therapy feels easier to pay for because it is smaller amounts at a time versus thousands of dollars that you have to drop immediately. But the therapy adds up to as much or more as a neuropsych over the course of a year. Either is absolutely too much of a financial burden for many families, which is a huge problem, but many others can afford it but are worried about wasting money. If you are in the second category, consider how much $5-6k is to you really versus the benefits it can provide. A good neuropsych will really help you focus on the services that will truly benefit your child. It may be there is a more targeted test to identify those needs, but the neuropsych will definitely give you a fuller picture.
- Nobody is going to force you to medicate your child. They will give you their professional opinion about what your child needs.

[Anonymous]

We got a neuropsych done and while everyone accepted ADHD, the doctor was unable to decide if my teen has autism or not. I get the honesty but we paid thousands and we still don’t know.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:What made you think your child might have ADHD, OP? I saw what you said about sometimes impulsive and chatty but it’s not just that, correct?

OP here. DS is currently in 3rd grade in public school. 1st grade teacher suggested we “talk to our doctor” because of DS having emotional outburst and low frustration tolerance. This was also first year back after pandemic. We spoke to ped who said to have school therapist evaluate as a first step. She observed in the classroom and didn’t think further evaluation was necessary and said the teacher was overreacting. Nonetheless, we started a positive behavior plan and by the end of the year the teacher was glowing about our sons progress.

Fast forward to third grade - we still hear the same concerns from teachers at conferences but no, there are not regular phone calls home. Teachers report low frustration tolerance particularly in social settings. He is easily baited by other children. He is a “big feelings” kind of kid. We are doing a social skills group but I wonder if I’m in denial and we need to do more.

The other part of me says that just because he has social challenges, I don’t need to drop thousands to get a doctor to tell me what I want to hear and medicate him. We could totally wait and see if he matures but will I be doing some kind of permanent damage to his self esteem if it does turn out he has a legitimate issue that needs to be medicated?
Sorry for the rant here.

I dunno, OP--I don't think you're in denial. I think the social skills group is good. Third grade is a big year for development. I'd be tempted to keep an eye on it and see how things go next year. With that said, you could also try occupational therapy for emotional regulation (maybe in a summer day camp setting), but that might be hard without a diagnosis of some kind.

DP I do not think OP is in denial either. But I think our system for identifying kids' needs is horrible and the process is very confusing. I think it is important to remember:
- Schools don't necessarily provide supports for kids with more subtle/less significant needs. Either they don't have the expertise to identify those needs or are just trying to ration their limited resources for those kids with the most needs. Not blaming schools, their resources are limited, but the upshot is that you may not want to take what the school therapist says as the last word.
- IME, teachers don't share fake concerns with parents. On the contrary they are often hesitant to share concerns because that's often not a fun conversation.
- A neuropsych is expensive. So is therapy. Sometimes, therapy feels easier to pay for because it is smaller amounts at a time versus thousands of dollars that you have to drop immediately. But the therapy adds up to as much or more as a neuropsych over the course of a year. Either is absolutely too much of a financial burden for many families, which is a huge problem, but many others can afford it but are worried about wasting money. If you are in the second category, consider how much $5-6k is to you really versus the benefits it can provide. A good neuropsych will really help you focus on the services that will truly benefit your child. It may be there is a more targeted test to identify those needs, but the neuropsych will definitely give you a fuller picture.
- Nobody is going to force you to medicate your child. They will give you their professional opinion about what your child needs.

A neuropsych provided zero practical guidance for us in terms of therapy or educational supports. The diagnosis didn’t help much either.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:What made you think your child might have ADHD, OP? I saw what you said about sometimes impulsive and chatty but it’s not just that, correct?

OP here. DS is currently in 3rd grade in public school. 1st grade teacher suggested we “talk to our doctor” because of DS having emotional outburst and low frustration tolerance. This was also first year back after pandemic. We spoke to ped who said to have school therapist evaluate as a first step. She observed in the classroom and didn’t think further evaluation was necessary and said the teacher was overreacting. Nonetheless, we started a positive behavior plan and by the end of the year the teacher was glowing about our sons progress.

Fast forward to third grade - we still hear the same concerns from teachers at conferences but no, there are not regular phone calls home. Teachers report low frustration tolerance particularly in social settings. He is easily baited by other children. He is a “big feelings” kind of kid. We are doing a social skills group but I wonder if I’m in denial and we need to do more.

The other part of me says that just because he has social challenges, I don’t need to drop thousands to get a doctor to tell me what I want to hear and medicate him. We could totally wait and see if he matures but will I be doing some kind of permanent damage to his self esteem if it does turn out he has a legitimate issue that needs to be medicated?
Sorry for the rant here.

I dunno, OP--I don't think you're in denial. I think the social skills group is good. Third grade is a big year for development. I'd be tempted to keep an eye on it and see how things go next year. With that said, you could also try occupational therapy for emotional regulation (maybe in a summer day camp setting), but that might be hard without a diagnosis of some kind.

DP I do not think OP is in denial either. But I think our system for identifying kids' needs is horrible and the process is very confusing. I think it is important to remember:
- Schools don't necessarily provide supports for kids with more subtle/less significant needs. Either they don't have the expertise to identify those needs or are just trying to ration their limited resources for those kids with the most needs. Not blaming schools, their resources are limited, but the upshot is that you may not want to take what the school therapist says as the last word.
- IME, teachers don't share fake concerns with parents. On the contrary they are often hesitant to share concerns because that's often not a fun conversation.
- A neuropsych is expensive. So is therapy. Sometimes, therapy feels easier to pay for because it is smaller amounts at a time versus thousands of dollars that you have to drop immediately. But the therapy adds up to as much or more as a neuropsych over the course of a year. Either is absolutely too much of a financial burden for many families, which is a huge problem, but many others can afford it but are worried about wasting money. If you are in the second category, consider how much $5-6k is to you really versus the benefits it can provide. A good neuropsych will really help you focus on the services that will truly benefit your child. It may be there is a more targeted test to identify those needs, but the neuropsych will definitely give you a fuller picture.
- Nobody is going to force you to medicate your child. They will give you their professional opinion about what your child needs.

A neuropsych provided zero practical guidance for us in terms of therapy or educational supports. The diagnosis didn’t help much either.

I'm sorry to hear that. Ours definitely did.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:I had the same thought--her kid sounds pretty normal without more info on the life impacts.

Apologies if you've already been down this road OP, but you may be able to get an answer without spending $$$ on neuropsych. Talk to your pediatrician; they will give you and your kid's teacher the Vanderbilt assessment as a screener. The behavior needs to be present both at home and at school at a certain level to meet criteria for ADHD.

And that is why evaluators don't typically make a diagnosis by asking the parent to write a paragraph describing their child.

Look, for those of us with kids with behavioral and academic issues, what OP describes is our desired OUTCOME of therapy! I wish I had a kid doing well academically who “can be impulsive at times.” And my kid had pretty mild issues as the spectrums go. Get back to us when your bright kid is getting Fs and getting regularly suspended for bad behavior.

Maybe there’s more OP hasn’t divulged. Maybe the frustration tolerance is really disruptive. But even so, the kid sounds fully within the range of normal and I doubt there’s any case for medication.

I am sure this perspective is probably shared by the school psychologist. But just because a child is doing better than other children doesn't mean they can't benefit from support. Many of us with kids with more subtle issues know people like you roll your eyes at us but we're still going to help our kids.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:I had the same thought--her kid sounds pretty normal without more info on the life impacts.

Apologies if you've already been down this road OP, but you may be able to get an answer without spending $$$ on neuropsych. Talk to your pediatrician; they will give you and your kid's teacher the Vanderbilt assessment as a screener. The behavior needs to be present both at home and at school at a certain level to meet criteria for ADHD.

And that is why evaluators don't typically make a diagnosis by asking the parent to write a paragraph describing their child.

Look, for those of us with kids with behavioral and academic issues, what OP describes is our desired OUTCOME of therapy! I wish I had a kid doing well academically who “can be impulsive at times.” And my kid had pretty mild issues as the spectrums go. Get back to us when your bright kid is getting Fs and getting regularly suspended for bad behavior.

Maybe there’s more OP hasn’t divulged. Maybe the frustration tolerance is really disruptive. But even so, the kid sounds fully within the range of normal and I doubt there’s any case for medication.

I am sure this perspective is probably shared by the school psychologist. But just because a child is doing better than other children doesn't mean they can't benefit from support. Many of us with kids with more subtle issues know people like you roll your eyes at us but we're still going to help our kids.

OP here. The PP is spot on. I often feel like we’re in no mans land because yes, the school psychologist has bigger fish to fry, but yes, we still hear the same complaints from teachers every year. They don’t rise to the level of go get your kid tested, but they definitely imply that he’s on the more annoying end of what they like to see in class. Short of doing what I’m doing (social skills group), what else am I supposed to do with that? I want to help him but it seems like I’m on my own to do that while school complains without offering any solutions. Another part of me wonders if teachers are quick to criticize young boys in particular. I have a daughter too and it’s always been a striking difference in the worlds used in conferences. I know I’ll get flamed for that here.

[Anonymous]

Our neuropath suspected ADHD but testing was borderline. Found dyslexia and significant dysgraphia that explained the issues. Those conditions were not on my radar at all. Doing so much better now that we understand what’s going on.

[Anonymous]

Anonymous wrote:Our neuropath suspected ADHD but testing was borderline. Found dyslexia and significant dysgraphia that explained the issues. Those conditions were not on my radar at all. Doing so much better now that we understand what’s going on.

At retest, we had the opposite findings. Once adhd was under control, the lds faded. Now, they had impeccable support and well keep an eye on this but we asked like up asked, for an honest re-Val bc we saw such improvement.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:I had the same thought--her kid sounds pretty normal without more info on the life impacts.

Apologies if you've already been down this road OP, but you may be able to get an answer without spending $$$ on neuropsych. Talk to your pediatrician; they will give you and your kid's teacher the Vanderbilt assessment as a screener. The behavior needs to be present both at home and at school at a certain level to meet criteria for ADHD.

And that is why evaluators don't typically make a diagnosis by asking the parent to write a paragraph describing their child.

Look, for those of us with kids with behavioral and academic issues, what OP describes is our desired OUTCOME of therapy! I wish I had a kid doing well academically who “can be impulsive at times.” And my kid had pretty mild issues as the spectrums go. Get back to us when your bright kid is getting Fs and getting regularly suspended for bad behavior.

Maybe there’s more OP hasn’t divulged. Maybe the frustration tolerance is really disruptive. But even so, the kid sounds fully within the range of normal and I doubt there’s any case for medication.

I am sure this perspective is probably shared by the school psychologist. But just because a child is doing better than other children doesn't mean they can't benefit from support. Many of us with kids with more subtle issues know people like you roll your eyes at us but we're still going to help our kids.

OP here. The PP is spot on. I often feel like we’re in no mans land because yes, the school psychologist has bigger fish to fry, but yes, we still hear the same complaints from teachers every year. They don’t rise to the level of go get your kid tested, but they definitely imply that he’s on the more annoying end of what they like to see in class. Short of doing what I’m doing (social skills group), what else am I supposed to do with that? I want to help him but it seems like I’m on my own to do that while school complains without offering any solutions. Another part of me wonders if teachers are quick to criticize young boys in particular. I have a daughter too and it’s always been a striking difference in the worlds used in conferences. I know I’ll get flamed for that here.

PP here - we've had to do everything privately with providers that don't take insurance. Some reimbursed by insurance, some not. It's worth it as DD has progressed so much. No IEP despite diagnosis. We are grateful DD is doing well but stunned at how much this is a "rich man's game" (we are not rich by any means but privileged for sure).