Quick--WWYD regarding Neuropsych eval ASAP

[infocrazy]

I need to decide in the next 2 hrs if we are going to go ahead with a neuropysch eval with DS1. There is a longer post, but I can't link to it. Long story short, DS1-8, 3rd grade is slow doing work in class and needs reminders. The school has done an eval and thinks it is attention--primarily because he tested very well in their eval. I am not sure it is attention. He just got his second report card. Hard to tell in the warm fuzzy world of no letter grades, but is probably in the C range. HUGE improvements in Math from the fall, but still not great in the percentiles. Teacher does not think he is anywhere needing to be retained but thinks his classwork is being affected. I think some of her examples are a little strange, but I do think he clearly is not interested in school. He is not at all a behavior problem--quite the opposite, just very daydreamy.

Basically, it comes down to the eval is $4k and is not covered by insurance. It is within our means, but it is still a heart-stopping amount of money for 1 day of testing, that may or may not even tell us anything...even if he IS diagnosed with ADD, at this point we would want to start with diet changes/etc before we would go to meds.

DH: Doesn't think we should do it yet. DS is showing good improvement. He just started a Tae Kwon Do program specialized for ADD kids and he wants to see how that goes before we invest this kind of money. Also, it is a private institute that offers the therapies for the things they diagnose so he questions their objectivity.

Me: Totally torn. I definitely see DH's points and actually agree with all of them. I honestly think that I WANT to cancel but part of me just wonders if I am taking the easy (cheap) way out. I actually lean more towards his issue being auditory processing...which this place doesn't test... I'm actually having trouble finding more info on where to get that checked...

Thoughts?

[acmom]

As a former special ed teacher, I was leaning towards advising you do it but then read the part about auditory processing concerns at the end. I would probably still pursue testing if you and the teachers have significant concerns in 3rd grade, but I would look for a psych that could look at both ADHD and auditory processing as well as any other learning disabilities/issues. That way you would only have to pay once (it may be more as it might be several days of testing, but I would think it would be less that 2 separate evals) and someone could be looking at the whole picture and not just the possible attention piece.

[wellyes]

I'd probably go ahead. This is the kind of problem that can linger on semi- or misdiagnosed for years. Just get some answers if you can. Especially if it's NOT an attention issue.
I would not assume that because they offer treatment, they will not give an honest evaluation.

[egoldber]

Also, it is a private institute that offers the therapies for the things they diagnose so he questions their objectivity.

I do think this can be problematic. Not always, but many private places do indeed have an upsell policy.

Also, I think $4K is a LOT of money for a neuropsych eval mainly for ADHD-Inattentive. We had an evaluation for younger DD that was only for ADHD and it was $350. A full neuropsych eval for older DD was only $2K (granted it was 6 years ago).

But $3K is the most I have ever heard and more typically in the $1500-$2500 range.

Also not sure why the urgency? Why does it have to be today?

[NJ_Mom2011]

How long has this been going on? Is this just 3rd grade, or has this always been a problem?

Personally, I would wait, so I could do research to find out if the school is obligated to pay for an evaluation under a school disability law, or if the insurance company has to pay under your current health insurance contract. Just because some health insurance representative is claiming that it doesn't have to pay is necessarily so. As Beth suggests, you waiting allows you time to shop around for a more reasonable medical service price quote.

[llama8]

I would do an eval but 4K seems ridiculously high (and I am in NY where everything is expensive). Perhaps shop around to find a cheaper testing site or doctor.

[Simon]

We just did cognitive neuropsy testing for Ds2. It was covered by insurance or else we couldn't do it. I found the results very interesting and we didn't even come away with a diagnosis. It did clarify that without obvious underlying conditions then we need to pursue different avenues to resolve issues that crop up. The Dr. provided some recommendations for things we could do at home and also a suggestion that we consider OT.

Be up front with the Dr. that you do not plan, regardless of results, to pursue therapy at that location. That should clear up any question of their potentially earning any additional $$. Personally, I think age 8 is a very good time for this type of evaluation. Also, I am guessing that any eval for auditory processing will also want to know if ADD/ADHD or other LD have been ruled out. This Dr. should also be able to tell you whether APD is worth pursuing. If you cancel, what is the wait time to get another appt. elsewhere? I am not sure I can see any real up side to waiting. If it turns out he really could benefit from some specific accommodations/strategies, then it would make sense to get those in place right away!

[willow33]

Here is our experience: DS2 is also 8 and in third grade and we just had a neuropsych eval done a few weeks ago. He had previously been diagnosed ADD Inattentive type, but I just didn't feel like that was an accurate diagnosis. He does okay on math and spelling, but doesn't even start when it comes to any type of writing assignment. His teacher expressed concern so we decided to have him evaluated again since the last time he was evaluated was about 2 years ago.

Our testing cost 3K, but half was paid by our insurance. We had to pay the academic testing portion. We just had the parent feedback meeting with the psychologist and he didn't agree with the ADD diagnosis. He feels that DS has an Executive Functioning disorder and that with specific tutoring he can learn to approach projects in a more logical manner. He also has an anxiety disorder which we were not surprised by.

I feel like if the testing is done right it can give you important information about your child and how he learns. I'm very glad we did it. Good luck!

[minnie-zb]

Also, I think $4K is a LOT of money for a neuropsych eval mainly for ADHD-Inattentive. We had an evaluation for younger DD that was only for ADHD and it was $350. A full neuropsych eval for older DD was only $2K (granted it was 6 years ago).

But $3K is the most I have ever heard and more typically in the $1500-$2500 range.



I agree. This is a HCOL area and typically it would cost about $2K in this region.

[Kindra178]

Chicagoland has some fantastic auditory processing specialists, including one of the most pre-eminent specialists in the field. Could you guys schedule an appointment on a Friday afternoon and do something fun in Chicago the next day? I think $4000 is crazy high. Have you asked them to work with you since you are a self pay? Any nearby universities with clinics? All that said, if you ruled out all other financially feasible options, I think you need to do it.

[infocrazy]

I do think this can be problematic. Not always, but many private places do indeed have an upsell policy.
Also, I think $4K is a LOT of money for a neuropsych eval mainly for ADHD-Inattentive. We had an evaluation for younger DD that was only for ADHD and it was $350. A full neuropsych eval for older DD was only $2K (granted it was 6 years ago).
But $3K is the most I have ever heard and more typically in the $1500-$2500 range.
Also not sure why the urgency? Why does it have to be today?

It would be a "full evaluation" but they check:
Intellectual or general cognitive abilities
Learning disabilities or academic achievement (concerns with reading, writing or math)
Sensory perceptual (how information is input: vision, hearing, touch)
Motor function (how information is output: fine or gross motor, graphomotor, coordination)
Attention and behavioral concerns (including ADD /ADHD)
Memory and learning
Language abilities
Visual-spatial skills
Executive functions, problem solving, reasoning and analysis
Emotional status and how it relates to learning (anxiety, depression)
Personality and behavioral assessment
Social issues (autism, Asperger’s, peer problems)

There is not an audiologist on their staff. It is only a hurry because they have a spot available in 3 weeks but I need to tell them today if I want it.


How long has this been going on? Is this just 3rd grade, or has this always been a problem?
Personally, I would wait, so I could do research to find out if the school is obligated to pay for an evaluation under a school disability law, or if the insurance company has to pay under your current health insurance contract. Just because some health insurance representative is claiming that it doesn't have to pay is necessarily so. As Beth suggests, you waiting allows you time to shop around for a more reasonable medical service price quote.

I had no idea the school might have to pay for it! This has been something we have been watching for awhile but this is the first time that the teacher is saying that it is affecting his schoolwork. Last year, the school evaluation was initiated by me--primarily because he just could NOT get the math facts down. His teacher did support it though, but she described him as a puzzle because his symptoms are very inconsistent.


I would do an eval but 4K seems ridiculously high (and I am in NY where everything is expensive). Perhaps shop around to find a cheaper testing site or doctor.

Ok, I am really glad I posted! I thought that the 4k was normal and I just didn't know! I'll have to look around more and see what I can find. My ped had given us names for 2 places. The other was through UofMichigan but it was much harder to nail down details and they had NO info really on their website. They also gave expected costs of "thousands". I much preferred the tone of the private place but obviously, that is their business.

Thanks everyone!

[JustMe]

I agree it makes sense to look into other options first.

You can tell the person offering you the slot in 3 weeks that you want to remain on the waiting list, but pass up that slot since it does not work for you.

As far as the school eval, it may be a good idea and yes they do have to pay for it, but otoh, in my experience at least, they get to choose what testing they want to do and it is not at all the same as a private eval. My dd looked like she had no issues on their testing, but a private eval was very different (and we went to a very reputable place that has no therapy to sell--I have no doubt about their results).

[egoldber]

As far as the school eval, it may be a good idea and yes they do have to pay for it, but otoh, in my experience at least, they get to choose what testing they want to do and it is not at all the same as a private eval.

Exactly. I think that can be an extremely long and painful process to get schools to pay for this. They are hugely strapped for money and resources (people) to do these types of tests. It could easily be months before the school system got to the point of testing and it would likely not be as thorough.

I think going through UMichigan is a great idea. I found our evaluator through a local university. They actually had a very long wait time, but they had a list of people they referred to who would also do similar testing.

[maestramommy]

I had no idea these evals were so expensive! Granted yours seems to be for many areas, but still....

We are looking into DD2's issues, and so far have filled out 2 different assessment forms, the Vanderbilt and the ASEBA. Both screen for, among other things, ADHD. The Vanderbilt was given to us by our ped, and the ASEBA by a psychologist referred to us by the school counselor. So far we haven't paid anything except the regular office fee for the ped and the initial fee for the psychologist, which is in the neighborhood of $130. DD2's teachers also have to fill out assessments.

I would go back to the school and (if your DS is not already on an IEP) to ask for a meeting with a special ed caseworker at the school. In our school it's the resource teacher, though her title is special educator. If the teacher is the one who brought up the concerns she will need to be at the meeting. You can talk over specific concerns and ask THEM: What do you suggest? I was advised before our first meeting with DD's IEP team that typically the team is careful not to advise testing because then THEY have to pay for it. What they usually do is recommend you talk to your ped, and that is indeed what happened to us. I talked with a cousin whose DS was recently assessed for ADHD and she did the same thing, the ped gave her all the forms for parents and teachers to fill out. I would try that line of action first because 1) it does cost the least, and 2) you might get the answers you need. I would go on to the other options only if/after this one doesn't give you the answers you need.

[cuca_]

I think you should explore your options before deciding on a place. We've done three neuropsychologist evals and while your price seems high, it doesn't seem outrageous to me (but we were in a HCOL area at the time). I agree with you that the fact that it is a center that offers therapies could be problematic. Also, I think an in-depth evaluation of a kid that possibly has ADHD done in one day is pretty ambitious. Our neuropsychologist always did several appointments for testing and an appointment with the parents to discuss the results, and all was included in the fees.

I would not go through your pediatrician. You need a specialist. I have found that pediatrician are not all that knowledgeable about ADHD. In addition, there are often coexisting conditions such as anxiety, processing issues, LDs and executive functioning issues, and your ped would probably not test for that.

For us, the evaluations for our 2 DDs were well worth it. They were sort of a blueprint for two very different situations. I really, really recommend that you do it, and I think it will be money well spent n. However, I do think you need to look at the alternatives available before you decide to commit to this center.

ETA: Also, the value of an independent evaluation, vs the school district eval, is that they will recommend accommodations at school and treatments for your son, without taking cost or resources into consideration (which IME the school does).

[hillview]

I've done it for both boys and been very happy we did. That said Boston area HCOL and it was 2600. I'd maybe look around a little more?

[infocrazy]

What they usually do is recommend you talk to your ped, and that is indeed what happened to us. I talked with a cousin whose DS was recently assessed for ADHD and she did the same thing, the ped gave her all the forms for parents and teachers to fill out. I would try that line of action first because 1) it does cost the least, and 2) you might get the answers you need. I would go on to the other options only if/after this one doesn't give you the answers you need.

This is exactly what happened. After we had the evaluation last year and he scored so well on everything the room was silent. I said well...what next? Pretty much the tone was that they couldn't do anything YET because he was still doing too well. He does get a pull-out for Math tutoring (this year). At the beginning year conference, his teacher said that the school has pretty much done everything they can and we needed to pursue a medical diagnosis with our ped...which is how we ended up here... Interesting.

[123LuckyMom]

I think $4k is very expensive! That testing should cost about half that. I'd pass up the slot, stay on the list, and shop around.

[annex]

Are you in Ann Arbor? EMU in Ypsi has a Neuropsych clinic which offers $250 Evals. I was just referred there by someone who thought they did a great eval.

[MSWR0319]

I would consider U of M. At least call and get information. We dr. at U of M for DS and I LOVE every single dr. we've met. I honestly haven't heard one bad thing about any department there. I'm sure there are bad ones, my point was just that it's a wonderful place. We drive 2 hrs to get there and I know others who do as well.

[egoldber]

Also, I think an in-depth evaluation of a kid that possibly has ADHD done in one day is pretty ambitious.

:yeahthat:

Older DD's testing was broken up into 2 hour segments over 3 weekends. For many kids, the testing feels intense and for an ADHD kid, they can't go that long without a break.

[maestramommy]

This is exactly what happened. After we had the evaluation last year and he scored so well on everything the room was silent. I said well...what next? Pretty much the tone was that they couldn't do anything YET because he was still doing too well. He does get a pull-out for Math tutoring (this year). At the beginning year conference, his teacher said that the school has pretty much done everything they can and we needed to pursue a medical diagnosis with our ped...which is how we ended up here... Interesting.

Well, if the SCHOOL says you need to pursue a medical diagnosis, is that in writing? Because if it is, you shouldn't be on the hook for the cost all by yourself. Esp. $4k!

Also, to clarify, do you mean you did assessments through your ped, and came up empty?

[vludmilla]

I would imagine that the school was not recommending a neuropsych eval when they recommended or mentioned a medical diagnosis. I imagine that they mean, bring them a medical diagnosis of ADHD which any physician can provide, without doing a neuropsych eval.

[NJ_Mom2011]

OP, whatever you decide, I hope that you update us on what is your son's diagnosis. I have absolutely no background for my hunches, so I am very curious what the professionals come up with. My hunch is that your son doesn't have ADHD but a learning disability, as you said your concern was first triggered by his performance in math class last year and this year's teacher said he acted inconsistently. You also don't mention any home-based behavior, which also makes me think it perhaps is a classroom disability. But I am the first to admit my opinion is a peanut gallery opinion and overly shaped by my own experiences with learning disabilities. :bag:bag

[infocrazy]

Are you in Ann Arbor? EMU in Ypsi has a Neuropsych clinic which offers $250 Evals. I was just referred there by someone who thought they did a great eval.

We are Western Detroit suburbs...and AWESOME about EMU! I will for sure be looking for that tonight!


I would imagine that the school was not recommending a neuropsych eval when they recommended or mentioned a medical diagnosis. I imagine that they mean, bring them a medical diagnosis of ADHD which any physician can provide, without doing a neuropsych eval.

This was my take.


Well, if the SCHOOL says you need to pursue a medical diagnosis, is that in writing? Because if it is, you shouldn't be on the hook for the cost all by yourself. Esp. $4k!

Also, to clarify, do you mean you did assessments through your ped, and came up empty?

No, not in writing. The "evaluation" we have already done was by the school and that came up empty. The ped did a fill out the questionairre eval for ADHD and he came up as borderline ADD-inattentive. She suggested trying meds and seeing what happened. I am not ready to go there yet so she suggested the neuropsych eval.


OP, whatever you decide, I hope that you update us on what is your son's diagnosis. I have absolutely no background for my hunches, so I am very curious what the professionals come up with. My hunch is that your son doesn't have ADHD but a learning disability, as you said your concern was first triggered by his performance in math class last year and this year's teacher said he acted inconsistently. But I am the first to admit my opinion is a peanut gallery opinion and overly shaped by my own experiences with learning disabilities. :bag:bag

Yes, this is my gut too...but I do think I am still kind of holding out hope that he is just still immature--which is true regardless of the diagnosis. He is the end of July with a 12/1 cutoff...but I didn't realize how incredibly prevalent red-shirting is in our district. This certainly does not help the situation. He is tall too, which gives an older kid perception. I will most likely red shirt DS4 (early July with a by then 9/1 cutoff) as a result but WAY too early to tell with him.

I will FOR SURE update...since I will likely have a whole bunch more questions! ;-)

Thanks everyone! Off to google. They did give me until Monday at 7:30 am to decide but I think I will definitely postpone if for no other reason than to talk to other offices. I usually over research everything...this time I just compared the offices my ped recommended. Not sure why! I do really like her though.

[infocrazy]

One more question...I am sure if we want it, the ped would give us a diagnosis of ADD based her borderline results. Is there any advantage to getting this from a school basis? DH doesn't want it in his record until we are sure. They already do some accommodations for him, preferred seating, pull out for math...I think that is it...

Is there anything else that I should request? He is not AT ALL a behavior problem (at school). Sweet, helpful, quiet...just daydreamy and slow worker.

[pastrygirl]

I'm in the midst of applying for supplemental insurance for my son, which would fully cover a neuropsych eval. We didn't do it last year but now wish we did. Things have gone downhill.

[maestramommy]

One more question...I am sure if we want it, the ped would give us a diagnosis of ADD based her borderline results. Is there any advantage to getting this from a school basis? DH doesn't want it in his record until we are sure. They already do some accommodations for him, preferred seating, pull out for math...I think that is it...

Is there anything else that I should request? He is not AT ALL a behavior problem (at school). Sweet, helpful, quiet...just daydreamy and slow worker.

Well, it's possible that with the ADD diagnosis in his file, he could at least get a 504 which means extra supports. This can mean anything from sitting near the front of the class or teacher's desk, to extra time on tests. The school is supposed to provide the supports. If he gets an IEP it will mean more supports. It doesn't have to mean meds.

I just finished reading Super Parenting for ADD by Mark Hallowell and Peter Jensen. AWESOME BOOK. Really helped me reframe the way I look at ADD/ADHD. Dh already looked at it in a certain way, but this is a much more positive way of looking at it and at solutions, both for in the home AND working with the school. I highly recommend it. Not a lot of academic info on ADD itself, mostly parenting stuff, and it's a pretty short read, relatively speaking.

[vludmilla]

One more question...I am sure if we want it, the ped would give us a diagnosis of ADD based her borderline results. Is there any advantage to getting this from a school basis? DH doesn't want it in his record until we are sure. They already do some accommodations for him, preferred seating, pull out for math...I think that is it...

Is there anything else that I should request? He is not AT ALL a behavior problem (at school). Sweet, helpful, quiet...just daydreamy and slow worker.

Due to recent changes in federal law, the school would be required to give you a 504 accommodation plan if you had a medical dx of ADHD. I don't know if they would agree to put any useful accommodations on that plan though, as that is dependent upon what is available at the school and the culture of that school.

[annex]

The EMU clinic info is at
http://www.emich.edu/psychology/psychologyclinic/

We're on a long UM waitlist, so were researching alternatives. Update if you decide to try EMU's clinic- I am curious. Dr Lauer I assume is the private one you were referred to? He is supposed to be quite good, but like you I can't imagine spending that much out of pocket. I thought his evals were closer to 3K than 4K though. Ouch.

[Indianamom2]

I do think this can be problematic. Not always, but many private places do indeed have an upsell policy.

Also, I think $4K is a LOT of money for a neuropsych eval mainly for ADHD-Inattentive. We had an evaluation for younger DD that was only for ADHD and it was $350. A full neuropsych eval for older DD was only $2K (granted it was 6 years ago).

But $3K is the most I have ever heard and more typically in the $1500-$2500 range.

Also not sure why the urgency? Why does it have to be today?

I know this is late, but I absolutely agree with all of the above and it tracks with my experience as well. I would be highly skeptical if they are also offering the therapies.