ADD / ADHD - who to diagnose ped or PhD?

[deenass]

My psychiatrist (who admittedly doesn;t treat children) has suggested to me that i look into having DS (almost 6) tested for ADD / ADHD. She thinks some of the behaviors I described to her are classic symptoms (even took out her book to read me symptoms).

At first I was hesitant to think he has either but I'm willing to look into it further. He's had issues at school since pre-school (most attibuted to immaturity) but I'm getting way too many pnone calls or feedback from kindy teachers to think that this is normal 5-6 year old stuff. Teachers haven't suggested ADD / ADHD (but likley wouldn't come out and say it).

My psychiatrist reccomended a PhD testing him, I called his ped to ask for reccomednations and she says they diagnose as well.

So - for those of you with children with the above diagnosis - what is the difference and how do you decide which is best - or does it even matter?

TIA!

[tmonroe]

I would go to the pediatrician first. Personally, I'm wary of doctors who specialize in diagnosing certain conditions because they often diagnos based on what the insurance will pay. If the pediatrician thinks a visit to a another doc is necessary he/she will recommend someone.

Good luck.

[vludmilla]

I STRONGLY recommend seeing a licensed psychologist that specializes in children for this diagnosis. Pediatricians, by and large, are not trained to diagnose AD/HD (there is no official dx of ADD). Peds generally do not have access to the standardized instruments that are also used to diagnose. A qualified psychologist will take a very thorough social and developmental history and give you some standardized tests to complete. They will observe your child and make sure to get information from multiple environments. For example, one should not diagnose AD/HD if a child only has attention problems at school, but never at home or if the attention difficulties emerged well after the age of seven. There are many different reasons that a child could have attention deficits and AD/HD is only one possibility. For example, a pediatrician will be unable to discern whether or not learning difficulties are causing the attention difficulties.
Please see a qualified child psychologist for the evaluation.

[vludmilla]

I would go to the pediatrician first. Personally, I'm weary of doctors who specialize in diagnosing certain conditions because they often diagnos based on what the insurance will pay. If the pediatrician thinks a visit to a another doc is necessary he/she will recommend someone.

Good luck.

I don't know what you are "wary" of regarding psychologists. They do not specialize in AD/HD diagnoses alone and I don't think there is any evidence that a psychologist would diagnose AD/HD to obtain payment.

[egoldber]

I STRONGLY recommend seeing a licensed psychologist that specializes in children for this diagnosis.

Yeah that. A ped will do a check list in the office. A licensed psychologist will do MANY MANY hours of diagnostic testing to look not only for ADD but also other learning and developmental issues and concerns.

FWIW, I have had similar concerns about Sarah for many years. We are in the process of setting up a series of appointments for her to get a full neuropsych evaluation. She has ADD-like behaviors, but she also has (IMO) anxiety. Anxiety can produce behaviors similar to ADD. Learning disabilities can also produce ADD like behaviors. Gifted children can also appear ADD. There can be many cross-sections of behaviors (ADD, anxiety and gifted) and these are going to be impossible for a ped to diagnose.

[brittone2]

I only have my experience as a PT to go on, but I personally would not be confident in a ped diagnosing in most instances. While pediatricians have a very wide base of knowledge, I've seen many problems missed by peds in terms of musculoskeletal issues (ones that are more difficult to diagnose) as well as things like behavior on the spectrum, etc. I've seen a lot of parent concerns dismissed, resulting in a big delay in getting kids services that they could benefit from. JMO. As a PT, I haven't worked with as many kids with ADHD as kids on the autistic spectrum, or kids with musculoskeletal issies, but I think there's something to be said for peds not always being an expert in every field, kwim?

Personally, I would take my child to a psychologist specializing in the field.

[pinkmomagain]

My dd was dx by a psychiatrist. When she was in Kindy/1st the school psychologist did a behavior inventory on dd and it did not reveal ADHD. However, by 3rd grade, when I took her to a private psychiatrist she met the criteria for ADHD-Inattentive type.

I wouldn't rely on the ped to dx. I would go to a psychologist or psychiatrist.

[heidiann]

private psych would be my opinion I would not go the Ped route for a psych disorder

[lizajane]

haven't read responses, but i can speak from my VERY OWN PERSONAL AND RECENT EXPERIENCE.

i took schuyler to the ped at age THREE to ask for help with working on ADHD behavior in the hopes to intervene early (and often!) so we could avoid meds (and chaos...)

she said, and i quote, "there is nothing you can do."

don't get me wrong, i love my ped. and 3 is too early to diagnose. but i knew he had it and wanted to start working on it right away.

fast forward...

his psychologist worked with him for 6 months before suggesting seeing a psych to choose a med for him. she did NOT send us to meds right away, nor did she go straight to ADHD. (she was working with him on OCD, our primary reason for the visit. but knew ADHD was a strong possibility. we did NOT tell her what we wanted diagnosed, only what behavior we witnessed.)

so far, we can see a HUGE difference with meds and we are only on the smallest dose. i could go on and on.

here is one way i can describe the difference between my ADHD child and an active boy...
schuyler will not be still to watch tv. he will not be still to do his favorite activites. even if he is not "up and running around" he is constantly shifting, fidgeting, moving, tapping, talking.... being still HURTS him. as if it is physically painful.

schuyler is 5, almost 6 (march 23). his psych said he does not give meds to kids his age. he gave him meds. he said he was, "the most hyperactive child he had seen in YEARS, if not ever."

a ped would have said 1) he is a normal, active boy
2) kids in K. don't get meds

i thank my lucky stars for our "dr terry."

[jse107]

As a school psych and counselor, I would agree about seeing a child or developmental psychologist. Your pediatrician may be a good place to get a referral though! Plus, I always think it's important for all providers to be in the loop--everyone sees things from a different perspective.

Another reason to see a psychologist is that they are more likely to give you a variety of recommendations beyond the medical "medicate" model. Studies upon studies show that the most efffective treatment of ADD (primarily inattentive, primarily hyperactive, or combined-type) is the combination of both medication and behavior modification. Medication is a tool to help children be able to use strategies--not as a magic wand that fixes everything. Plus, a psychologist will most likely be able to a child psychiatrist or psycho-phamacologist who will specialize in medication, should you choose to go that route.

CHADD.org is an excellent web-resource!

The most widely used scale to evaluate for ADD is the Connors scale. There are scales for parents and teachers. The BASC (Behavior Assesment Scale for Children) or the Achenbach can be used to look for ADD and other concerns such as anxiety.

Driven to Distraction is an excellent book for you to read, as well as DTD: Questions and Answers. Written by Dr. Hallowell (sp?), who is ADD himself, the books are easy to read and insightful.

Just my 2 cents.

[DrSally]

I'm prob biased, but I would go with a PhD psychologist who specializes in testing children.

[KarenLud]

I STRONGLY recommend seeing a licensed psychologist that specializes in children for this diagnosis. Pediatricians, by and large, are not trained to diagnose AD/HD (there is no official dx of ADD). Peds generally do not have access to the standardized instruments that are also used to diagnose. A qualified psychologist will take a very thorough social and developmental history and give you some standardized tests to complete. They will observe your child and make sure to get information from multiple environments. For example, one should not diagnose AD/HD if a child only has attention problems at school, but never at home or if the attention difficulties emerged well after the age of seven. There are many different reasons that a child could have attention deficits and AD/HD is only one possibility. For example, a pediatrician will be unable to discern whether or not learning difficulties are causing the attention difficulties.
Please see a qualified child psychologist for the evaluation.

:yeahthat: Generally speaking, Peds don't have the training to do as thorough of a dx as PhD's do. Good luck!

[DagnyT]

I have a DS who, over two years ago was found to be in the moderately gifted range The first time we had him evaluated (by PsyD whose emphasis is on giftedness) there were no signs of ADHD. Two years later there were major signs- both during testing and reflected on checklists completed by teachers. However with testing done by the psychologist (who was accustomed to gifted children) rather her assistant (whose experience had been with the prison population!) his IQ shot up into the profoundly gifted range. The only reason we had him retested was because of the huge difference in his IQ when compared with that of his brother. It is a statistical anomaly for Bio fam members to be more than seven points apart.

Fast forward to this past fall- we set him up with an accelerated curriculum, he spends three AMs a week at home working on that curriculum with a tutor. He is now doing primarily fifth and sixth grade work- except math which is at a fourth grade level. In addition we took him off Zyrtec (his dosage was as much as mine!) and commenced the Feingold diet- no artificial flavors, colors, or preservatives (he has always been very sensitive to environmental allergens).

As of today his teachers at school indicate he is a changed child, still an active seven year old second grader, but a lot of the "twitchier" behaviors have vanished. At home we notice he is calmer. Please note that he was always able to be still for things that interested him- television, he attended an evening performance of "Wicked" and was entranced, being read to, etc.... He goes early next month for achievement testing with the same psychologist. It will be interesting to see what she thinks!

My opinion, as mom, is that he was reacting to things in his environment, he was over medicated with allergy drugs, and his intellectual needs were not being met. I don't know which component had greatest impact- I think it was a combo of all. What I do know is that about 85% of the "ADHD" behaviors are gone.

So my point (and I do have one ;-) is that when you are dealing with children (especially boys) who are so young there can be many things at play. I have recently heard friends advised not to even look for ADHD diagnosis until their sons are eight years of age. Gifted children are OFTEN misdiagnosed as ADHD- and it can go the other way too- if a child is gifted sometimes their ADHD issues are not addressed!

I would strongly suggest a psychologist who has experience with children do an assessment- including IQ and achievement. Don't listen to anyone who makes an ADHD Dx based on seeing the child in one environment! Last bit of my advice is listen to your gut- you know your child like no one else.

Good luck!

[lizajane]

I have a DS who, over two years ago was found to be in the moderately gifted range The first time we had him evaluated (by PsyD whose emphasis is on giftedness) there were no signs of ADHD. Two years later there were major signs- both during testing and reflected on checklists completed by teachers. However with testing done by the psychologist (who was accustomed to gifted children) rather her assistant (whose experience had been with the prison population!) his IQ shot up into the profoundly gifted range. The only reason we had him retested was because of the huge difference in his IQ when compared with that of his brother. It is a statistical anomaly for Bio fam members to be more than seven points apart.

Fast forward to this past fall- we set him up with an accelerated curriculum, he spends three AMs a week at home working on that curriculum with a tutor. He is now doing primarily fifth and sixth grade work- except math which is at a fourth grade level. In addition we took him off Zyrtec (his dosage was as much as mine!) and commenced the Feingold diet- no artificial flavors, colors, or preservatives (he has always been very sensitive to environmental allergens).

As of today his teachers at school indicate he is a changed child, still an active seven year old second grader, but a lot of the "twitchier" behaviors have vanished. At home we notice he is calmer. Please note that he was always able to be still for things that interested him- television, he attended an evening performance of "Wicked" and was entranced, being read to, etc.... He goes early next month for achievement testing with the same psychologist. It will be interesting to see what she thinks!

My opinion, as mom, is that he was reacting to things in his environment, he was over medicated with allergy drugs, and his intellectual needs were not being met. I don't know which component had greatest impact- I think it was a combo of all. What I do know is that about 85% of the "ADHD" behaviors are gone.

So my point (and I do have one ;-) is that when you are dealing with children (especially boys) who are so young there can be many things at play. I have recently heard friends advised not to even look for ADHD diagnosis until their sons are eight years of age. Gifted children are OFTEN misdiagnosed as ADHD- and it can go the other way too- if a child is gifted sometimes their ADHD issues are not addressed!

I would strongly suggest a psychologist who has experience with children do an assessment- including IQ and achievement. Don't listen to anyone who makes an ADHD Dx based on seeing the child in one environment! Last bit of my advice is listen to your gut- you know your child like no one else.

Good luck!

a good point. and my child is also highly gifted. but mine can NOT be still for things he enjoys and can NOT be academically stimulated appropriately because of his inability to be still. instead, he gets extremely frustrated and depressed because his head is going one way and his body is going another. so as you said, a good reason to get a complete evaluation

[cchavez]

DagnyT, What a great success story. My son has also done well on Feingold and the elimination of zyrtec....I wanted to share the name a natural antihistimine that has been great for my son. It is Orhomollecular Dhist Jr. It is not on the FG list but is all nature and my son does not react to it at all.

http://www.shop-orthomolecular.com/store/DhistJr.html

[egoldber]

That's interesting about the Zyrtec. Sarah is not currently taking any meds, but she does take Nasonex and Advair in her allergy season (which starts next month). We also use albuterol as needed. Nebulized albuterol over a long period of time (more than 2-3 days) makes her wired, but she has reacted negatively to at least 2 other steroids.

Pulmicort literally turned her into a demon. Tantrums of unbelievable length and ferocity. Agitation like I have never seen. She literally could not calm down to sleep and this is a child who has always been an easy and terrific sleeper. She also reacted negatively, although not as strongly, to Singulair. Finding meds for her asthma and allergies is a very hard balance.

[pinkmomagain]

Interesting, my ADHDer is also my seasonal alergy kid (spring). I've always wondered what role allergy meds played in her behavior and have always felt that they helped her (she is inattentive type though). We have been doing allergy injections for about a year now with the hope that eventually she won't need all the allergy meds (singulair, alegra, sometimes zyrtec too, eye drops, nose spray, and occassionally a puffer for asthmatic symptoms).

BTW, I think steroids are pretty well-known to make practically anyone irritable and aggitated.

[vludmilla]

It is a statistical anomaly for Bio fam members to be more than seven points apart.

I'm curious, do you have a citation for this?




I would strongly suggest a psychologist who has experience with children do an assessment- including IQ and achievement. Don't listen to anyone who makes an ADHD Dx based on seeing the child in one environment! Last bit of my advice is listen to your gut- you know your child like no one else.


ITA. This is excellent advice. No one should ever dx AD/HD on the basis of a child's behavior in one setting. There is much work to be done to do an AD/HD eval effectively and this is why a qualified PhD or PsyD psychologist is the way to go.

Great news about your son too. What a great mother he has to help figure all that out!

[cchavez]

Yeah, I am praying that DS can survive the Spring Allergy season w/o Zyrtec....but I will give it him if he needs it. We just do .5 (maybe I will try .25) of a white tablet to avoid the dyes, flavors....I haven't needed zyrtec in awhile b/c I do the injections.... well, my allergies were really bad last wk and I took one before bed...the next day I could hardly function....I was so sleepy!!! Now I know why it makes my son irritable...he is sleepy!

Anyway, you all have seen the warning about singulair and the link to suicidal thoughts?

http://singulair.legalview.info/articles/653077/

[egoldber]

Ugh, yes that warning about Singulair came out about a week after Sarah tried it. I was kind of glad it didn't agree with her!

ETA: Have you tired an inhaled allergy med like Nasonex?

[cchavez]

not yet, he is so sensitive that anything in his nose drives him nuts....he is also prone to nose bleeds....I do have a sample of nasonex and rhinocort though from his allergist