Reply to Might this be ADHD? How do we explore a diagnosis if so?

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[quote=Anonymous]So my 10 year old does not meet the standard DSM criteria for ADHD... there's only like 4-6 of them that I'd say she does "often" (split across the two subcategories, although mostly hyperactive/impulsive: interrupts, blurts out, fidgets, makes careless mistakes, and maybe also "difficulty awaiting turn" and "avoids mental effort" but I'm less clear on how far outside the normal range she is on those), although a few others she does "sometimes." I found this helpful link with percentiles and it shows her as somewhere between the 85th-93rd percentile of girls age 8-10 for the hyperactive/impulsive symptoms (depending on how conservative I am with the sometimes vs often vs very often.)  But I don't see any way she could get to 6 or even 5 of the hyperactive/impulsive symptoms because she's not constantly in motion (she definitely fidgets a lot, but isn't inappropriately leaving her seat or climbing things, or "on the go" all the time), she's fine playing or reading quietly for long stretches when she's in the mood or is just grumpy with the rest of us, and she's extroverted/chatty but I don't think it's to the extent they mean when they say "talks excessively." And she's even further from 6 inattentive symptoms.

However, she does also have a number of other characteristics I associate with ADHD (I have it myself and have read a lot about it as well) despite not being on the official list-- things like emotional dysregulation, low frustration tolerance, strong emotional reactions/difficulty adjusting when things don't go the way she had imagined they would (being found in hide and seek, us not appreciating a joke, etc), hyperfocus, impatience and difficulty tolerating curiosity/the unknown (i.e. not opening a package immediately, a conversation she's not part of), agitation and/or "tuning out" when bored by something, jumping to conclusions, justice sensitivity/strong focus on fairness, sensory sensitivities (clothes must feel a certain way, sensitivity to smells), etc.

She does not have nearly as much trouble with disorganization, distraction, forgetfulness, or procrastination as I do-- she is generally fairly organized and doesn't have too much trouble with task initiation as long as it's not something she's expecting to be difficult/unpleasant, in which case she's more likely to avoid it.  However, her teacher has mentioned that she can be inattentive in class and has marked it on her report card a few times (although at parent-teacher conference she said it was not to the level that she would actively flag it for us as a reason to screen her for ADHD), and I see her careless mistakes on tests and quizzes as well as her struggles to pay attention to and retain information on topics that bore her.

My questions: 
1) Does this sound like actual ADHD to you, or is it probably just a cluster of subclinical ADHD-like symptoms? I don't want to push for a diagnosis (or spend a lot of money evaluating her for one) if it doesn't really seem like she has it, but I also don't want her to fall through the cracks if it's a situation where her presentation just happens to be heavy on symptoms that aren't listed in the DSM currently but maybe should be.  
2) If it might be actual ADHD, what are our options for exploring a diagnosis, given the lack of full alignment with the DSM criteria? How strictly do most evaluators stick to the "6 out of 9" requirement? I see there is an option in the DSM for "unspecified ADHD" for people who don't meet the full criteria, but is that actually used, and if so, are there particular places more willing to explore it? Would it require a full neuropsych and if so, where? (Ideally Children's or KKI or somewhere else that takes insurance, but open to any suggestions.)

Thanks so much![/quote]

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