Update #9: ADD or ADHD diagnosis how did it come to your attention?

[AnnieW625]

My daycare provider* suspects that my DD2 (5) might have ADD, which honestly doesn't surprise me much and her issues have become more pronounced in the last couple of months. She doesn't want to sit when she has to do handwriting, but if she is able to play dress up, do crafts, or play outside she can do that for long periods of time. She has always been active and interested in doing a lot of different things at one time, but more recently it has gotten worse in terms of concentration at school. She starts kindergarten in the fall and I don't want her getting frustrated from the get go.

Also the peds. group my daycare provider recommended is different than our current peds. group and is well known in our area for working with kids who have ADD or ADHD, but I have scheduled her already with our regular peds. group for her yearly well check visit next Thursday so should I switch to the new group or go to the well visit exam at the current peds. practice? The current peds. practice which we have been happy with is pretty old school and I have not heard that they evaluate kids for ADD/ADHD.

FWIW I will also be scheduling her yearly eye exam at the optometry college because a big part of her issues could be that it is just her prescription changing.

*my DCP has a degree and credential in early childhood education, and has two sons who have been dx. with ADD as children so I am pretty comfortable with her assesment.

TIA!

[Indianamom2]

Honestly, I doubt she would be diagnosed at her age. Usually, doctors want to wait until the child is 7 or so before they are willing to diagnose ADHD.

For DD, part of what made us suspicious was a complete lack of ability to follow multi-step directions without multiple reminders. For example, we would ask her to go upstairs, go in her room, collect all her dirty clothes, turn off the light and bring the clothes downstairs. She would make it upstairs, start playing with something and then leave the light on and completely forget about the clothes. So we'd tell her again to gather her dirty clothes, turn off the light and bring the clothes downstairs. She might bring the clothes, but leave on the light.

She also could focus forever on a tv show or video game, but every.single.tiny.sound or movement would distract her while doing her homework. It would take her hours to do something that should easily have been completed in about 15 minutes. She is smart (usually A's) but she would make careless errors because she wasn't paying attention and was rushing to finish in the school's timeframe because she was never focused. A poster on the wall would distract her during class.

All these sorts of things were clues for us. Also, in order for a diagnosis, the behavior must be observed and documented in two or more settings (so home and school). You'll have to fill out a questionnaire (can't remember the name at the moment) and so will the teacher and then the doctor scores the answers and determines if it points to ADHD.

[wellyes]

My pediatrician sent me to a neurologist when we suspected ADHD. There are a whole lot of things that look like ADHD, and I don't necessarily think going to an 'ADHD factory' pediatric practice is the best way. I'd work to rule out other issues with your current ped first, just because there are so many conditions with similar symptoms.

[goldenpig]

DD's 2nd grade teacher first noticed some problems with lack of focus, fidgeting, difficulty with transitioning and emotional reactivity and talked with us in the fall. We saw her pediatrician b/c she was complaining of somatic symptoms like headaches and stomachaches frequently. We met with her school counselor, and began family therapy with an MFT and we also had her evaluated by another therapist (LCSW) at Kaiser. They both thought she might have ADHD and/or anxiety so we did an ADHD assessment through Kaiser (parent/teacher forms and group eval session with other kids with her pediatrician, a temperament specialist and child psychologist). After that they dx ADHD and gave us a scrip for meds but I ended up waiting until after we did comprehensive neuropsych testing because I wasn't sure about the dx. Then in May we started the medication (Adderall XR) because we wanted to do a med trial while she was still in school with her teacher. She noticed a dramatic improvement in DD's ability to focus and self-regulate. However the medication suppressed her appetite and made her more irritable when it wore off so we saw a child psychiatrist, and are trying a new one (Metadate CD). We just got the results back from the comprehensive testing and they said she is gifted and has depression and anxiety, but they don't think she has ADHD (they think her problems with emotional reactivity and intensity are from the giftedness). So I'm going to have to discuss with them and with our therapist and pediatrician to see what the best course of action is, because she does seem to benefit from the medication (although it doesn't solve all her problems). It's very complicated. BTW like PP we also have problems with both hyperfocus and underfocus, and DD also never turns out the lights, no matter how many reminders she gets! I do think it is worth getting as much information as you can, so it may be worth seeing someone who is more of an ADHD expert if you don't think your current pedi is equipped to do the eval. That said, there may be many factors at play, which is why we did the additional testing out of pocket.

[MamaMolly]

Honestly, I doubt she would be diagnosed at her age. Usually, doctors want to wait until the child is 7 or so before they are willing to diagnose ADHD.

For DD, part of what made us suspicious was a complete lack of ability to follow multi-step directions without multiple reminders. For example, we would ask her to go upstairs, go in her room, collect all her dirty clothes, turn off the light and bring the clothes downstairs. She would make it upstairs, start playing with something and then leave the light on and completely forget about the clothes. So we'd tell her again to gather her dirty clothes, turn off the light and bring the clothes downstairs. She might bring the clothes, but leave on the light.

She also could focus forever on a tv show or video game, but every.single.tiny.sound or movement would distract her while doing her homework. It would take her hours to do something that should easily have been completed in about 15 minutes. She is smart (usually A's) but she would make careless errors because she wasn't paying attention and was rushing to finish in the school's timeframe because she was never focused. A poster on the wall would distract her during class.

All these sorts of things were clues for us. Also, in order for a diagnosis, the behavior must be observed and documented in two or more settings (so home and school). You'll have to fill out a questionnaire (can't remember the name at the moment) and so will the teacher and then the doctor scores the answers and determines if it points to ADHD.

Such a timely post OP. I've been wondering about one of my DDs and she sounds so much like this!!! If I may ask, what interventions, treatment, etc does your DD get?

[lalasmama]

DD is one of the early-diagnosis cases. She was dx'ed just before her 5th birthday. Yes, that's unusually young, but, in her case, there were other factors at play--namely, she was exposed to meth and other harmful substances in utero (she's not mine biologically), both birth parents had ADHD, and both older siblings had/have significant mental health issues, so I was a bit anxious/overly-pro-active making sure things were addressed sooner rather than later.

Our initial flags were things like:
--DD had no idea that Dora (or any show) was more than just the time between commercial breaks--she couldn't stay in one place long enough to see that there was a story in a TV show!
--Impulsivity was far beyond what we saw with other kids her age.
--She had no understanding of "sometimes": it was either black or white. So, if I allowed, let's say, Kool Aid at dinner one night, she was convinced Kool Aid was a dinner drink, and dinner drink only. (Talk about confusing when I tried to do something fun, like ice cream for dinner on a hot day, and she flipped out that we were having an afternoon snack-time food at dinner time!)
--Emotions were always in "black and white" as well--either she was super happy, or super sad, but there was no middle "it's an okay day, not good or bad" for her.
--Staying on-task for short, multi-step tasks was difficult. (I was having to help dress her at 5yo, because she couldn't work through how to get undies on if she had already put pants on, and couldn't remember to put undies on first.)
--She couldn't stay still long enough to fall asleep at night.
--If a task required concentration, she immediately deemed it "too hard."

We started noting these things when she was young--like 3yo. It was obvious there was just something "different" about her, especially when we compared her and her similarly-aged cousin to other kids around their ages. (Cousin is still "quirky" but doesn't have any diagnosis.) She needed her tonsils and adenoids out (she had frequent adenoid infections), so we did that first, right at her 4th birthday. We knew that often OSA (sleep apnea) can look like ADHD because kids with OSA don't get restful sleep. So, we did the T&A, and she finally started sleeping better. But, her impulsivity didn't improve. She still couldn't "be still" for *any* amount of time. Seriously, she couldn't be still long enough to go pee without getting it everywhere! At that same time, we knew that DD turned into a "demon child" when on Amoxicillin; when we did the T&A, she didn't need Amox all the time any more, so we thought that would help improve things as well. But, her impulsivity still wasn't age-appropriate. She was ran by a motor that just wouldn't stop, no matter how hard she tried to control it. And, oh so often, she would do something impulsive, not be in control of herself, then bawl when she got in trouble for it, saying that she knew it was naughty but couldn't *not* do it.

So, at her 5th birthday, it was obvious that she needed help to be successful. She was testing "high" according to the child psych we took her to by our report, but she couldn't "perform" for the psych, so it was hard to get an accurate picture. We just knew that she was obviously smart, but couldn't show it, because she spent so much energy just trying to keep herself and the impulsivity in check. I took the plunge, and started her on liquid methylphenidate. It was like the dark finally lifted, and I had this smart child who was learning at an astonishing rate, who people loved to be around, asking to have her over for play dates, listening (like old ladies stopping me to comment on how well-behaved she was!), who could be in control of her body. I hesitate to call it a "miracle" for her, but it was pretty amazing for our family!

We went through the whole PT-OT-Nutrition-DevPed-psych work-up when she was 5.5yo, and she was diagnosed with ADHD, anxiety, PTSD (due to issues before she came to me), and a few other things. The Dev. Ped recommended continuing on the medication that we had started.

She's now 11yo, and we're taking our first break from medication for the summer, at DD's request. She's doing "okay" without it, but we're only on day 3 or 4. We talked about it before we did it, both with her and her doctor. The doctor wanted the break so that DD could continue into puberty without it as much as possible to allow her body to grow naturally without "fighting" the medication. DD wanted a break from it because "other kids don't have to take medicine every day." We talked about how she would be getting lots of reminders about her behavior, and that she would need to keep a good attitude about it, as we only point it out to help her be aware of it so that she can work on being in control of __whatever__.

Personally, I wouldn't change pediatricians just because one office diagnoses ADD/ADHD more than another one. In this case, I don't think "old school" is a bad thing. Quite honestly, I think ADHD is WAY over-diagnosed, and often used as a catch-all when nothing else seems to fit. Kind of like an office where I used to work--the doctors had their 10 favorite diagnoses, and everyone got put into one of those until proven different. DD was initially diagnosed by her (old school) pediatrician, and then the Dev Ped concurred. If *I* switched because I heard that Group B was more likely to give an ADHD diagnosis because they "see it more", I'd forever be wondering if it's "really" what was going on with DD, or if it was the "easy answer" for the doctor to give to satisfy the need to name behaviors.

[smilequeen]

We suspected towards the end of preschool and he was diagnosed towards the end of K. The early things we noticed were a lack of focus on things he was not overly interested in (but not uninterested in) and a hyper focus on things he was very interested in. We noticed that he couldn't follow through with 2-3 instructions, he'd get stuck and distracted after the first...so say...go upstairs, get your pjs on, brush your teeth...even now he'll go upstairs and get distracted and forget the rest...and he's 8. He'd get distracted through basically all simple tasks...eating, putting on clothes, going to grab something...And then he started school and he'd get distracted watching other kids or tapping his pencil and he needed constant reminders to keep working on something. Things got progressively worse through the first half of K and we made the appointments. I had a doctor before K tell me he was too young, but a second doctor tell me that if you know earlier, you can start helping them earlier. I'm a fan of helping earlier. We went to a neurologist, a child psychologist, and a LD specialist (to rule that out as the cause as he does also have an expressive language delay).

[elephantmeg]

DS, I knew he was ADHD or something from when he was 3. Although honestly his sensory stuff was the hardest but once the ADHD was medicated he was better able to cope with the sensory stuff. It took us a long time to find someone to test him-we didn't get him tested until 1/2 way though 2nd grade. DD, her K teacher came to me 2/3 of the way through K and she was diagnosed right before 1st grade and has been on meds since. They are very different. I wouldn't do testing until the end of K personally but I would ask for a structured classroom/organized teacher and share your concerns with the K teacher and see what they say.. DS missed a LOT not being diagnosed/medicated until the end of 2nd grade-both accademically and socially. DD has done so much better having been diagnosed early.

[AnnieW625]

My kids had their yearly well check visits yesterday. I talked to the ped. about our concerns about DD2 and she saw some of the same things that I saw as well. DD2 has oodles of energy and needs to be asked to do things repeatedly, yesterday's example was sit in the chair and put her shoes back on after her exam while I was talking to the doctor. The ped. suggested that we wait a few months and see how kindergarten goes and then I can call her back and discuss if the kindergarten teacher thinks there are issues because the settings will be different than her current preschool/daycare which has two small tables shared by kids aged 2-5 (there are about 8-10 kids full time, and there is only one other 5 yr. old there right now full time, and one other 5 yr. old part timer, and all of the 4 yr. olds are boys) where as her classroom will have 6 or 8 tables of four. (Right now her class has an enrollment of 24 and I am hoping it stays that way, but will most likely end up at 30, but there is a full time aide).

Last week I did make an appointment with the pediatrician at the other medical group just in case the ped. said to go ahead and get her tested. I will keep the appointment for now because if my DCP doesn't see an improvement then I would like to have her tested before kindergarten starts just as precaution, but if things go smoothly the next couple of weeks I won't have an issue cancelling the appointment.

DD2 also had her annual eye exam on Monday and her RX is getting worse for her -6.50 eye, is now at -7.50, but her +3 eye is now at +2, so slightly better. She has a follow up in two weeks and they are going to have her try the new prescription at the office before giving her an RX for the new glasses. I honestly hope that the bulk of her issues are due to her eyes, but I do want to keep an open mind about all of this.

DD2's behavior (other than sitting still and having to repeat directions) has no signs depression or anxiety issues at all. She is very happy go lucky, and last spring at the school fair she made friends while washing her hands in the bathroom, kids she had never met before. She doesn't have tantrums that would be considered unusual for a 5 year old. At this point I think we are just the most concerned about keeping her engaged in kindergarten and wanting her to be able to handle the setting in a manner that doesn't get her singled out or frusterated with the whole school experience. She has no language issues or other cognitive issues and is more than ready to go to kindergarten.

FWIW, my dad probably if diagnosed as a kid would have been considered ADHD (even at almost 65 and working 30+ hours a work...semi retired for him he has more energy than I do....if it wasn't for his knees he'd be running 6-8 miles a day, he had to give that up in his late 40s), and I have a few cousins with the diagnosis on both sides of my family so it could very well be a genetic thing.

My pediatrician sent me to a neurologist when we suspected ADHD. There are a whole lot of things that look like ADHD, and I don't necessarily think going to an 'ADHD factory' pediatric practice is the best way. I'd work to rule out other issues with your current ped first, just because there are so many conditions with similar symptoms.

I don't think that the pediatric practice in question is an ADHD/ADD factory at all, it just happens that the few families I know of who have children with this diagnosis go there, and have been happy with the diagnosis and care they have received there. I have friends who went there as children themselves, actually a lot of people in my area who are 50 and younger went there or to the pediatric practice my kids go to now. We initially were planning on switching to the peds. group in question when we switched from Kaiser a few years ago, but DD2 had a medical emergency (recurrant staph infection) where we needed to have her seen ASAP and the ped. group in question wouldn't see her without an initial evaluation first and there was a month long waiting list for that so we went to the current ped. group where we are now (and have been happy).

.....The early things we noticed were a lack of focus on things he was not overly interested in (but not uninterested in) and a hyper focus on things he was very interested in. We noticed that he couldn't follow through with 2-3 instructionshe'd get stuck and distracted ........ He'd get distracted through basically all simple tasks...eating, putting on clothes, going to grab something...And then he started school and he'd get distracted watching other kids or tapping his pencil and he needed constant reminders to keep working on something.

This is very much my DD2, especially when it comes to handwriting, which is really what brought a lot of these issues to our attention. Her worst traits since she was about 2 yrs. old is to not sit still while eating a meal, she drinks her milk, eats a bite of food, and gets up and walks around. I think it is just her quirk at home as she is good at restaurants, and at school, but it makes me feel like an awful parent because she can't sit still during a meal. She has days where she goes and gets dressed on her own, and then pulls up her bed, but then other days where she needs constant reminders to do those things. She needs constant reminders though to put shoes and socks on (and hates wearing socks.....I am not looking forward to kindergarten for this reason alone).

DS, I knew he was ADHD or something from when he was 3. Although honestly his sensory stuff was the hardest but once the ADHD was medicated he was better able to cope with the sensory stuff. It took us a long time to find someone to test him-we didn't get him tested until 1/2 way though 2nd grade. DD, her K teacher came to me 2/3 of the way through K and she was diagnosed right before 1st grade and has been on meds since. They are very different. I wouldn't do testing until the end of K personally but I would ask for a structured classroom/organized teacher and share your concerns with the K teacher and see what they say.. DS missed a LOT not being diagnosed/medicated until the end of 2nd grade-both accademically and socially. DD has done so much better having been diagnosed early.

Thanks for this. DD2 doesn't have any sensory issues other than her preference to walk around without socks or shoes on.

[georgiegirl]

My kids had their yearly well check visits yesterday. I talked to the ped. about our concerns about DD2 and she saw some of the same things that I saw as well. DD2 has oodles of energy and needs to be asked to do things repeatedly, yesterday's example was sit in the chair and put her shoes back on after her exam while I was talking to the doctor.












This is very much my DD2, especially when it comes to handwriting, which is really what brought a lot of these issues to our attention. Her worst traits since she was about 2 yrs. old is to not sit still while eating a meal. She has days where she goes and gets dressed on her own, and then pulls up her bed, but then other days where she needs constant reminders to do those things. She needs constant reminders though to put shoes and socks on (and hates wearing socks.....I am not looking forward to kindergarten for this reason alone).


.

I don't know. This all sounds totally normal for a new 5 year old to me. DS1 turns 6 next month, and that's exactly him. Constant reminders. Lots of energy. Can't sit still at dinner, etc. I agree that waiting until K starts is a good idea. My DS did great in K, although it was hard for him "to behave" for so long every day. I think we expect too much of 4-6 year olds. My DD had no problem conforming to expectations, but it's been a struggle for Ds1.