Do We or Don’t We Want an ADHD “Diagnosis”? Pros/Cons

[Anonymous]

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Anonymous wrote:I don't understand this. ADHD is only supposed to be diagnosed if attention issues are causing significant impact at school. If the child simply scores below the norm, that is not ADHD. I would get a 2nd opinion.

You are incredibly incorrect. ADHD is diagnosed when symptoms are present across multiple environments, not just school and not just significantly. There are also multiple assessments used to diagnose ADHD, some are norm-referenced, some are not.

You're right that it has to be multiple environments. But it absolutely has to interfere with functioning. Otherwise why are you even seeking a psychiatric diagnosis?

They always test for a bunch of things, including things you might not have been looking for yourself. In OPs case, it sounds like her kid was struggling in school and they found dyslexia with possible ADHD as a secondary factor. Mild ADHD doesn't necessarily interfere with functioning if the kid is still able concentrate when necessary. But if she wants an IEP for ADHD symptoms, then there has to be an impact at school. That's more of a legal issue than a medical one.

No, ADHD has to actually interfere with functioning. That's the DSM definition.

What DSM V means by functioning and what a parent or school means by functioning are two different things. My DW has ADHD but she always had good grades in school, did all her work, went to college and held 9 to 5 jobs. But she is super high energy, talks a mile minute, is often late, and loses her keys a lot. So yeah, there is measurable interference with functioning, but she lived most of her life just fine.

ok so sounds like she has no psychiatric disorder if all she does is talk fast and lose her keys. What is your point?

My point is she got diagnosed with ADHD by psychiatrist, not that she only does two things. But she functioned well enough for many years before that without much problem.

So what was the problem? Presumably some area of functioning was impacted signidificantly.

Change in responsibilities due to a special needs child. But obviously she didn't suddenly develop ADHD because of the kid.

[Anonymous]

Anonymous wrote:

Anonymous wrote:Is ADHD formally considered a mental illness?

No. It is a neurological disorder.

Those are not mutually exclusive.

[Anonymous]

Anonymous wrote:If the ADHD assessment is "borderline," I would say hold off on the diagnosis and you can re-assess in a couple of months or years if you feel your child's behavior has deteriorated.

This is the OP, and this is what we have decided to do after much thought. DD's attention issues were considered borderline, and we were not comfortable with upgrading her diagnosis to official ADHD. We also know this particular testing location, while very well reputed, tends to over diagnose. So we are going to hold off on a formal ADHD diagnosis in the report, and get her retested in a few months/years. We do not want anything on her lifelong record that could be disqualifying when neither us nor her doctor were completely confident in an ADHD diagnosis.

I appreciate the PP who gave examples of how an ADHD diagnosis can impact a child in the long term. That is what my post asked for. For anyone who was insulted or offended by that, well, toughen up. it's the reality of living with a child who has a disability. Where it gets confusing is where your child may be borderline on a disability like ADHD, which is often diagnosed based on subjective data in addition to other tests. That is the case with our child. her teacher reports did not indicate ADHD, her parent questionnaire for one parent did not indicate ADHD, her parent report for one parent DID indicate ADHD, and her other independent testing was borderline.

In cases where a child is clearly diagnose-able as ADHD, then of course, you want/need the diagnosis and need to take measures to help support the child. but that was not the case here, and that is NOT what I posted asking about.

[Anonymous]

OP again, and a PP was correct. We took DD to be tested because she was struggling with writing and spelling, and we have an immediate family history of dyslexia. She was definitively diagnosed with dyslexia, as we suspected. The attention testing was done hand in hand with the full neuropsych test, especially because dyslexia and ADHD are often comorbid. We are in the process of trying to obtain an IEP for her for dyslexia, and the doctor said that because her attention testing results were borderline, we could also include an ADHD diagnosis based if we wanted. However, as noted above in the immediate post, after a lot of discussion with family, friends, trusted teachers, doctors, and therapists, we decided that we want to focus on the dyslexia diagnosis because it was certain. We will re-test for attention issues in the future, if we see her continue to struggle even with appropriate dyslexia interventions.

I do think it is extremely important and helpful for people to understand the cons of a diagnosis. We often look at these things in a vacuum, especially when we are so focused on advocating for our kids and fighting for the best services possible. I know several kids who are borderline ADHD and whose parents really pushed to get the formally diagnosed. I do think it is overdiagnosed. And maybe some of these parents are not aware of possible long term ramifications, especially if a child is borderline or the diagnosis is somewhat inconclusive. I did not know that it could be disqualifying for her to get a security clearance or other type of clearance in 20-30 years! That type of info needs to be shared more readily!

[Anonymous]

I have a child with ASD/ADHD combined type. He has had the ASD diagnosis since preK and the ADHD diagnosis since 2nd grade. Has had an IEP since preK. DS is currently in 5th grade, an excellent student, fully mainstreamed.

DS has never had academic issues, tests above grade level in all areas, has 5s in PARCC, and his IEP has mostly addressed social communication issues... so if only grades and testing are concerned, he would have done ok without a diagnosis that may impact his getting a security clearance when he is an adult

But DS likes school, has friends, is self confident with good esteem, no anxiety, etc and is a happy kid - I attribute a lot of it to the fact that he has had a diagnosis since he started school and gotten the (mainly social) supports he needs and I think that's worth a lot more than a potential future security clearance 20+ yrs from now.

[Anonymous]

Anonymous wrote:OP again, and a PP was correct. We took DD to be tested because she was struggling with writing and spelling, and we have an immediate family history of dyslexia. She was definitively diagnosed with dyslexia, as we suspected. The attention testing was done hand in hand with the full neuropsych test, especially because dyslexia and ADHD are often comorbid. We are in the process of trying to obtain an IEP for her for dyslexia, and the doctor said that because her attention testing results were borderline, we could also include an ADHD diagnosis based if we wanted. However, as noted above in the immediate post, after a lot of discussion with family, friends, trusted teachers, doctors, and therapists, we decided that we want to focus on the dyslexia diagnosis because it was certain. We will re-test for attention issues in the future, if we see her continue to struggle even with appropriate dyslexia interventions.

I do think it is extremely important and helpful for people to understand the cons of a diagnosis. We often look at these things in a vacuum, especially when we are so focused on advocating for our kids and fighting for the best services possible. I know several kids who are borderline ADHD and whose parents really pushed to get the formally diagnosed. I do think it is overdiagnosed. And maybe some of these parents are not aware of possible long term ramifications, especially if a child is borderline or the diagnosis is somewhat inconclusive. I did not know that it could be disqualifying for her to get a security clearance or other type of clearance in 20-30 years! That type of info needs to be shared more readily!

your approach kind of rubs me the wrong way. Your kid already has a learning disability; but it seems like you view ADHD as more stigmatizing. Focus on what your kid needs, not the incredibly distant possibility that she won't be able to be an FAA certified pilot some day. (I'd only imagine dyslexia could be a concern there too ...)

[Anonymous]

NP here. We are in a very similar, although slightly more vexing, situation.

DS is six and we have received an IEP for him based on a psycho-educational evaluation that showed he is dyslexic (and maybe dysgraphic too). It is still early for a dyslexia diagnosis but it seems highly, highly likely so we are starting to give him the necessary tutoring to learn to read as a dyslexic kid.

There were also issues with attention and executive functioning in the psycho-educational evaluation. We have not gotten a diagnosis although we were encouraged to do further testing to rule out ADHD. I have reviewed the questionnaire (Vanderbilt scales) that are often used to diagnose ADHD and I know that my rating of DS would be borderline. And now that I know how the questionnaire works, I could just fill it to tip him in one direction or another (one way to try to get ADHD diagnosis, other way to avoid it). When the pediatrician sent me the Vanderbilt scales when I asked about getting an ADHD diagnosis, I almost laughed.....(of course, DS's teachers would also have to fill it out).

I was thinking we should go ahead and get the ADHD diagnosis, primarily to see if there are more school supports with it. But here's the catch: since he was 3 years old, DS has always wanted to be a pilot. He is obsessed with everything to do with airplanes and at this point, has a pretty good understanding of aerodynamics and how airplanes function. Now that I know that he might be excluded from this passion with an ADHD diagnosis, what do I do???

DS is also a very young first grader and I know that those kids tend to get over-diagnosed (boys and young for the grade).

[Anonymous]

Anonymous wrote:NP here. We are in a very similar, although slightly more vexing, situation.

DS is six and we have received an IEP for him based on a psycho-educational evaluation that showed he is dyslexic (and maybe dysgraphic too). It is still early for a dyslexia diagnosis but it seems highly, highly likely so we are starting to give him the necessary tutoring to learn to read as a dyslexic kid.

There were also issues with attention and executive functioning in the psycho-educational evaluation. We have not gotten a diagnosis although we were encouraged to do further testing to rule out ADHD. I have reviewed the questionnaire (Vanderbilt scales) that are often used to diagnose ADHD and I know that my rating of DS would be borderline. And now that I know how the questionnaire works, I could just fill it to tip him in one direction or another (one way to try to get ADHD diagnosis, other way to avoid it). When the pediatrician sent me the Vanderbilt scales when I asked about getting an ADHD diagnosis, I almost laughed.....(of course, DS's teachers would also have to fill it out).

I was thinking we should go ahead and get the ADHD diagnosis, primarily to see if there are more school supports with it. But here's the catch: since he was 3 years old, DS has always wanted to be a pilot. He is obsessed with everything to do with airplanes and at this point, has a pretty good understanding of aerodynamics and how airplanes function. Now that I know that he might be excluded from this passion with an ADHD diagnosis, what do I do???

DS is also a very young first grader and I know that those kids tend to get over-diagnosed (boys and young for the grade).

That's exactly why ADHD shouldn't be diagnosed through checklists.

If you have concerns about attention and focus, get it diagnosed through a comprehensive evaluation.

[Anonymous]

We had a diagnosis of a borderline/mild/inattentive sort of ADHD, and after a couple of years of watching and waiting, we realized that we were almost handcuffing our child by not embracing the diagnosis. She had to work so much harder than peers just to get through the day.

So, OP, please keep an eye on your child's ability to direct her attention, regardless of diagnosis. Inattentive ADHD is very often overlooked in girls, especially by teachers who don't know the kids as well as the parents. It takes huge amounts of effort for these kids to sustain attention in the boring environment of school. If she truly has attention problems, going through the extra tutoring and extra work to ameliorate the dyslexia could be tortuous.

[Anonymous]

Anonymous wrote:NP here. We are in a very similar, although slightly more vexing, situation.

DS is six and we have received an IEP for him based on a psycho-educational evaluation that showed he is dyslexic (and maybe dysgraphic too). It is still early for a dyslexia diagnosis but it seems highly, highly likely so we are starting to give him the necessary tutoring to learn to read as a dyslexic kid.

There were also issues with attention and executive functioning in the psycho-educational evaluation. We have not gotten a diagnosis although we were encouraged to do further testing to rule out ADHD. I have reviewed the questionnaire (Vanderbilt scales) that are often used to diagnose ADHD and I know that my rating of DS would be borderline. And now that I know how the questionnaire works, I could just fill it to tip him in one direction or another (one way to try to get ADHD diagnosis, other way to avoid it). When the pediatrician sent me the Vanderbilt scales when I asked about getting an ADHD diagnosis, I almost laughed.....(of course, DS's teachers would also have to fill it out).

I was thinking we should go ahead and get the ADHD diagnosis, primarily to see if there are more school supports with it. But here's the catch: since he was 3 years old, DS has always wanted to be a pilot. He is obsessed with everything to do with airplanes and at this point, has a pretty good understanding of aerodynamics and how airplanes function. Now that I know that he might be excluded from this passion with an ADHD diagnosis, what do I do???

DS is also a very young first grader and I know that those kids tend to get over-diagnosed (boys and young for the grade).

get your kid the support he needs now.

btw, a borderline adhd disgnosis at 6 would not disqualify a pilot. Adult ADHD that has to be treated with drugss might.

http://www.aopa.org/go-fly/medical-resources/health-conditions/mental-health/add-and-adhd

[Anonymous]

Anonymous wrote:OP,
One thing to consider is the longer-term impact of having that diagnosis on your child's record. I'm not anti-diagnosis when it's warranted, but in this case I would weigh the potential benefits (which sound minimal) with the effects that'll follow the child all the way to adulthood.

For one thing, some security clearances may be harder to get if there is a childhood diagnosis of ADD/ADHD - it depends on the agency and level of clearance, but it can come up and cause problems during a security investigation.

It will make it nearly impossible for the child to ever get an FAA medical certificate, if they desire someday to become a pilot (even a private pilot flying for recreation), air traffic controller, etc. The FAA considers any lifetime ADD/ADHD diagnosis - even early childhood - to be disqualifying. You may not even consider this a path your child will take, but do you want to make decisions now that'll limit their options 20 years or 40 years in the future?

I know this sounds really far off and theoretical, but I work in a world where it's a big issue. People come in with a diagnosis of ADHD from 2nd grade, they haven't received treatment or medication since middle school, but it's on their record and disqualifies them from a number of things. Again - if ADHD is truly an issue, I'm not opposed to the diagnosis and these rules are in place to prevent people with severe issues from ending up in a place where it can become a safety or security risk, so I'm not trying to circumvent the rules - but you should understand the long-term consequences of pushing for a diagnosis in borderline cases.

I have NEVER heard this.

[Anonymous]

Anonymous wrote:

Anonymous wrote:OP again, and a PP was correct. We took DD to be tested because she was struggling with writing and spelling, and we have an immediate family history of dyslexia. She was definitively diagnosed with dyslexia, as we suspected. The attention testing was done hand in hand with the full neuropsych test, especially because dyslexia and ADHD are often comorbid. We are in the process of trying to obtain an IEP for her for dyslexia, and the doctor said that because her attention testing results were borderline, we could also include an ADHD diagnosis based if we wanted. However, as noted above in the immediate post, after a lot of discussion with family, friends, trusted teachers, doctors, and therapists, we decided that we want to focus on the dyslexia diagnosis because it was certain. We will re-test for attention issues in the future, if we see her continue to struggle even with appropriate dyslexia interventions.

I do think it is extremely important and helpful for people to understand the cons of a diagnosis. We often look at these things in a vacuum, especially when we are so focused on advocating for our kids and fighting for the best services possible. I know several kids who are borderline ADHD and whose parents really pushed to get the formally diagnosed. I do think it is overdiagnosed. And maybe some of these parents are not aware of possible long term ramifications, especially if a child is borderline or the diagnosis is somewhat inconclusive. I did not know that it could be disqualifying for her to get a security clearance or other type of clearance in 20-30 years! That type of info needs to be shared more readily!

your approach kind of rubs me the wrong way. Your kid already has a learning disability; but it seems like you view ADHD as more stigmatizing. Focus on what your kid needs, not the incredibly distant possibility that she won't be able to be an FAA certified pilot some day. (I'd only imagine dyslexia could be a concern there too ...)

Op here. You don’t know my child and you don’t know what she may or may not need. Not every kid who is “borderline” for attention issues may be ADHD based on the largely subjective analysis. Why “round up” so to speak, if it could potential disqualify a kid from certifications down the road when she may not even have ADHD. If the doctor was that remiss to diagnose and ask us, then it could go either way. You do what’s best for your child, and I will do what’s best for mine. And that is to be conservative with a diagnosis that *may* create lifelong disqualifications for her! There’s no harm in getting a second opinion or retesting her in a few months elsewhere, once we start working on supporting the dyslexia. Maybe her attention issues will resolve or improve once her ways of learning shift and she grows more confident. Why jump to a diagnosis that is clinically borderline or subclinical. If my cautious approach “rubs yourself I the wrong way...” oh well.

[Anonymous]

Op - I think you’re wise for being conservative, if your child Truly is borderline. I agree that ADHD tends to be overdiagnosed and, in some cases, over medicated. And I am saying this as a mom to a child who is medicated for
severe ADHD. You’re fortunate that you have option of being borderline and being able to decide. We didn’t.

The judgements on this board would go either way. Some parents will be offended or “rubbed the wrong way” if your DC was borderline and you went with the official diagnosis bc then you would be siphoning resources from kids who truly have ADHD and really need the services. Now posters are rubbed the wrong way bc you might be denying your kid help she needs. How do they know? We all just do the best we can.

I would also suggest watching closely and having her retested. No need to rush to diagnose especially if your doctor agrees!

[Anonymous]

Anonymous wrote:OP,
One thing to consider is the longer-term impact of having that diagnosis on your child's record. I'm not anti-diagnosis when it's warranted, but in this case I would weigh the potential benefits (which sound minimal) with the effects that'll follow the child all the way to adulthood.

For one thing, some security clearances may be harder to get if there is a childhood diagnosis of ADD/ADHD - it depends on the agency and level of clearance, but it can come up and cause problems during a security investigation.

It will make it nearly impossible for the child to ever get an FAA medical certificate, if they desire someday to become a pilot (even a private pilot flying for recreation), air traffic controller, etc. The FAA considers any lifetime ADD/ADHD diagnosis - even early childhood - to be disqualifying. You may not even consider this a path your child will take, but do you want to make decisions now that'll limit their options 20 years or 40 years in the future?

I know this sounds really far off and theoretical, but I work in a world where it's a big issue. People come in with a diagnosis of ADHD from 2nd grade, they haven't received treatment or medication since middle school, but it's on their record and disqualifies them from a number of things. Again - if ADHD is truly an issue, I'm not opposed to the diagnosis and these rules are in place to prevent people with severe issues from ending up in a place where it can become a safety or security risk, so I'm not trying to circumvent the rules - but you should understand the long-term consequences of pushing for a diagnosis in borderline cases.

This is really dangerous mis-information to spread and could keep parents from getting their kids the help they need and needlessly increases the stigma.

A historical diagnosis of ADHD that doesn't currently need to be treated with medication will not disqualify someone from flying: https://adhdrollercoaster.org/adhd-news-and-research/no-rx-for-commercial-airline-pilots-with-adhd/

[Anonymous]

iN OP'S Defense, our 7 yr old boy was Dx dyslexia, dysgraphia, and provisional ADHD. The psychologist wrote that in her option, the ADHD symptoms would abate with proper accommodations for LDs. Those accommodations were put in place via 504 and the ADHD symptoms have drastically subsided. in about 5 school months. It's not perfect, but working.

We were not given the option of it being in the report, but I understand this concept of "borderline". Furthermore, if the dyslexia is addressed and ADHD is still suspected, the school will test for ADHD probably.

Finally, thank you to the PP who pointed out the incorrect stigma assertions upthread.

OP: get your child the best education she can get through servicing her unique brain. That's it and take care.