Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:The answer depends on how quickly you want the answer. The fastest is your pediatrician. After that, a psychiatrist and after that full neuropsych testing. For the latter two, you may not have your answer for many months due to waitlists for testing and wait time for the report - maybe six or more months. And if you get your diagnosis through testing, then you need to find a doctor to prescribe medications which is another wait time for the appointment.

If you are looking for accommodations at school you also then need to go through the 504 process.

Honestly in your shoes I’d start with the pediatrician. You want answers now not in June. You can always follow up with other evaluations.

NO. A pediatrician is NOT trained to diagnose ADHD.

Actually they are and it is within their scope of practice. It is a commonly used resource. Few have the money for things like a neuropsych and often the time lag is significant.

No, they are not. I know how pediatricians are trained, PP. You are entirely incorrect, and I want to push back hard on this, because there's already controversy about overdiagnosis of hyperactivity and underdiagnosis of other forms of ADHD. No one except a psychiatrist is trained in the pharmaceutical realm of mental health disorders, so an initial diagnosis of ADHD at the ped's office should not lead to med prescription anyway. Parents need to consult the right specialists. It's not medicine's fault that healthcare is so expensive!

You guys are talking about two very different issues. Pediatricians can diagnose any mental health disorder because they are general practitioners. They can also diagnose things like depression, anxiety and eating disorders. Does that mean they should be in change of medication management? No. But they can and do diagnose by their own professional standards. This is like saying a pediatrician can't diagnose encopresis because they're not a GI doctor. They diagnose and then refer for follow up care.
https://publications.aap.org/pediatrics/article/144/4/e20192528/81590/Clinical-Practice-Guideline-for-the-Diagnosis?autologincheck=redirected

+1 One of the most pernicious things about DCUM is the amount of nonsense people spread, particularly around issues related to healthcare.

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:The answer depends on how quickly you want the answer. The fastest is your pediatrician. After that, a psychiatrist and after that full neuropsych testing. For the latter two, you may not have your answer for many months due to waitlists for testing and wait time for the report - maybe six or more months. And if you get your diagnosis through testing, then you need to find a doctor to prescribe medications which is another wait time for the appointment.

If you are looking for accommodations at school you also then need to go through the 504 process.

Honestly in your shoes I’d start with the pediatrician. You want answers now not in June. You can always follow up with other evaluations.

NO. A pediatrician is NOT trained to diagnose ADHD.

Actually they are and it is within their scope of practice. It is a commonly used resource. Few have the money for things like a neuropsych and often the time lag is significant.

No, they are not. I know how pediatricians are trained, PP. You are entirely incorrect, and I want to push back hard on this, because there's already controversy about overdiagnosis of hyperactivity and underdiagnosis of other forms of ADHD. No one except a psychiatrist is trained in the pharmaceutical realm of mental health disorders, so an initial diagnosis of ADHD at the ped's office should not lead to med prescription anyway. Parents need to consult the right specialists. It's not medicine's fault that healthcare is so expensive!

I get that you have a policy position to push. But OP needs a pretty immediate solution to a problem and current standard of care allows pediatricians to diagnose and prescribe even though you don’t think this should be permitted.

Anonymous wrote:When you all say Stixrud is expensive, what are we talking?

5k and insurance doesn’t cover it

Anonymous wrote:

Anonymous wrote:Not prepared for a $3000 cash outlay to have, I searched my health insurance website (aetna) for neuropsychological testing and found an in-network provider. For each visit, we paid a co-pay same as for any in-network specialist office visit.

We have Aetna! Who did you use?

I got on waitlists for a handful of offices and went with the first one that called with availability. You’ll wait months, but you’ll pay less… I don’t think quality was lacking compared to if we had paid thousands, only would have been seen sooner.

We did a neuro-psych through Kennedy Krieger for a $10 copay. I believe Children's Hospital was the same price. We also had a 3 year wait. The benefit of paying is that it is a much shorter wait.

Anonymous wrote:

Anonymous wrote:I work in the field. Where you want to go depends on what you want to do with the information. IEP? Full neuropsych eval. Medication? A ped. Tools for executive function and emotional regulation? A therapist.

Also completely and entirely incorrect. Man, you're full of misinformation. Only a psychologist or psychiatrist can diagnose mental health disorders properly. Pediatricians do not receive adequate training on this. Only a psychiatrist can prescribe, and for convenience, pediatricians can refill prescriptions that have already been approved by psychiatrists. Therapists come from many origins, with many different certifications and approaches, so they're a very mixed bag. You want someone trained in CBT (or ABA if it's a young kid and autism is in the mix). Executive function coaches are a very specific breed of service provider who are specialized in it. They're not necessarily therapists.

1. "Only a psychologist or psychiatrist can diagnose mental health disorders properly." This is false. Pediatricians can and do diagnose mental health disorders. A masters level therapist is also allowed to diagnose anything in the DSM. The major difference is what is done with that information. Schools, for example, will require test scores from assessments which can only be conducted by PhDs.

2. "Only a psychiatrist can prescribe, and for convenience, pediatricians can refill prescriptions that have already been approved by psychiatrists." This is false. Pediatricians can and do prescribe medication for a variety of mental illnesses, including depression, anxiety, OCD and ADHD. They will often refer complicated cases to psychiatrists or psychiatric ARNPs but they are more than able and willing to use evidence based medications for common mental health issues.

3. "Therapists come from many origins, with many different certifications and approaches, so they're a very mixed bag. You want someone trained in CBT (or ABA if it's a young kid and autism is in the mix)." Psychotherapists are not trained in ABA and don't practice ABA. ABA therapists are not trained in CBT and do not practice CBT. You are conflating two different professions and licenses.

Anonymous wrote:

Anonymous wrote:I work in the field. Where you want to go depends on what you want to do with the information. IEP? Full neuropsych eval. Medication? A ped. Tools for executive function and emotional regulation? A therapist.

Also completely and entirely incorrect. Man, you're full of misinformation. Only a psychologist or psychiatrist can diagnose mental health disorders properly. Pediatricians do not receive adequate training on this. Only a psychiatrist can prescribe, and for convenience, pediatricians can refill prescriptions that have already been approved by psychiatrists. Therapists come from many origins, with many different certifications and approaches, so they're a very mixed bag. You want someone trained in CBT (or ABA if it's a young kid and autism is in the mix). Executive function coaches are a very specific breed of service provider who are specialized in it. They're not necessarily therapists.

Do you work in the field? Because this is nonsense.

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:The answer depends on how quickly you want the answer. The fastest is your pediatrician. After that, a psychiatrist and after that full neuropsych testing. For the latter two, you may not have your answer for many months due to waitlists for testing and wait time for the report - maybe six or more months. And if you get your diagnosis through testing, then you need to find a doctor to prescribe medications which is another wait time for the appointment.

If you are looking for accommodations at school you also then need to go through the 504 process.

Honestly in your shoes I’d start with the pediatrician. You want answers now not in June. You can always follow up with other evaluations.

NO. A pediatrician is NOT trained to diagnose ADHD.

Actually they are and it is within their scope of practice. It is a commonly used resource. Few have the money for things like a neuropsych and often the time lag is significant.

No, they are not. I know how pediatricians are trained, PP. You are entirely incorrect, and I want to push back hard on this, because there's already controversy about overdiagnosis of hyperactivity and underdiagnosis of other forms of ADHD. No one except a psychiatrist is trained in the pharmaceutical realm of mental health disorders, so an initial diagnosis of ADHD at the ped's office should not lead to med prescription anyway. Parents need to consult the right specialists. It's not medicine's fault that healthcare is so expensive!

You guys are talking about two very different issues. Pediatricians can diagnose any mental health disorder because they are general practitioners. They can also diagnose things like depression, anxiety and eating disorders. Does that mean they should be in change of medication management? No. But they can and do diagnose by their own professional standards. This is like saying a pediatrician can't diagnose encopresis because they're not a GI doctor. They diagnose and then refer for follow up care.
https://publications.aap.org/pediatrics/article/144/4/e20192528/81590/Clinical-Practice-Guideline-for-the-Diagnosis?autologincheck=redirected

Anonymous wrote:I work in the field. Where you want to go depends on what you want to do with the information. IEP? Full neuropsych eval. Medication? A ped. Tools for executive function and emotional regulation? A therapist.

Also completely and entirely incorrect. Man, you're full of misinformation. Only a psychologist or psychiatrist can diagnose mental health disorders properly. Pediatricians do not receive adequate training on this. Only a psychiatrist can prescribe, and for convenience, pediatricians can refill prescriptions that have already been approved by psychiatrists. Therapists come from many origins, with many different certifications and approaches, so they're a very mixed bag. You want someone trained in CBT (or ABA if it's a young kid and autism is in the mix). Executive function coaches are a very specific breed of service provider who are specialized in it. They're not necessarily therapists.

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:The answer depends on how quickly you want the answer. The fastest is your pediatrician. After that, a psychiatrist and after that full neuropsych testing. For the latter two, you may not have your answer for many months due to waitlists for testing and wait time for the report - maybe six or more months. And if you get your diagnosis through testing, then you need to find a doctor to prescribe medications which is another wait time for the appointment.

If you are looking for accommodations at school you also then need to go through the 504 process.

Honestly in your shoes I’d start with the pediatrician. You want answers now not in June. You can always follow up with other evaluations.

NO. A pediatrician is NOT trained to diagnose ADHD.

Actually they are and it is within their scope of practice. It is a commonly used resource. Few have the money for things like a neuropsych and often the time lag is significant.

No, they are not. I know how pediatricians are trained, PP. You are entirely incorrect, and I want to push back hard on this, because there's already controversy about overdiagnosis of hyperactivity and underdiagnosis of other forms of ADHD. No one except a psychiatrist is trained in the pharmaceutical realm of mental health disorders, so an initial diagnosis of ADHD at the ped's office should not lead to med prescription anyway. Parents need to consult the right specialists. It's not medicine's fault that healthcare is so expensive!

Anonymous wrote:

Anonymous wrote:I work in the field. Where you want to go depends on what you want to do with the information. IEP? Full neuropsych eval. Medication? A ped. Tools for executive function and emotional regulation? A therapist.

Shouldn’t the diagnosis determine what you do to support your child?

I wrote that assuming OP was correct in thinking her child has ADHD. Obviously if the parent doesn't know what the diagnosis is and needs more guidance they should start with a psychiatrist or psychologist. But if they think this is ADHD they need to ask themselves what they're hoping to get out of the diagnosis. Meds? Or accommodations? Or tools? All come from different provider types.

Anonymous wrote:I work in the field. Where you want to go depends on what you want to do with the information. IEP? Full neuropsych eval. Medication? A ped. Tools for executive function and emotional regulation? A therapist.

Shouldn’t the diagnosis determine what you do to support your child?

I work in the field. Where you want to go depends on what you want to do with the information. IEP? Full neuropsych eval. Medication? A ped. Tools for executive function and emotional regulation? A therapist.

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:The answer depends on how quickly you want the answer. The fastest is your pediatrician. After that, a psychiatrist and after that full neuropsych testing. For the latter two, you may not have your answer for many months due to waitlists for testing and wait time for the report - maybe six or more months. And if you get your diagnosis through testing, then you need to find a doctor to prescribe medications which is another wait time for the appointment.

If you are looking for accommodations at school you also then need to go through the 504 process.

Honestly in your shoes I’d start with the pediatrician. You want answers now not in June. You can always follow up with other evaluations.

NO. A pediatrician is NOT trained to diagnose ADHD.

Actually they are and it is within their scope of practice. It is a commonly used resource. Few have the money for things like a neuropsych and often the time lag is significant.

Most pediatricians are trained to recognize classical and obvious ADHD. You know, the super hyperactive little boy jumping off the wall type.
I have a very quiet daughter who has been diagnosed with predominantly inattentive ADHD and it only showed once we did a proper neuropsych testing with a psychologist. The ADHD screening questionnaire they give you at the pediatrician which is also filled by 2 teachers came back with no signs of ADHD .

When we then went to a psychiatrist to discuss treatment options, the first thing she asked is “ how did you arrive at a diagnosis ?” Hoping that we had gone through the neurophysiological evaluation and not just a quick screening.

We used Dr. Christina Hyon-Wynn of Child and Family Associates in Falls Church. The price was $3.5K out of pocket but honestly, well worth it.

Anonymous wrote:

Anonymous wrote:The answer depends on how quickly you want the answer. The fastest is your pediatrician. After that, a psychiatrist and after that full neuropsych testing. For the latter two, you may not have your answer for many months due to waitlists for testing and wait time for the report - maybe six or more months. And if you get your diagnosis through testing, then you need to find a doctor to prescribe medications which is another wait time for the appointment.

If you are looking for accommodations at school you also then need to go through the 504 process.

Honestly in your shoes I’d start with the pediatrician. You want answers now not in June. You can always follow up with other evaluations.

NO. A pediatrician is NOT trained to diagnose ADHD.

Actually they are and it is within their scope of practice. It is a commonly used resource. Few have the money for things like a neuropsych and often the time lag is significant.