View Full Version : Questions on getting a diagnosis and meds


ADHDWife&Mom
04-10-16, 11:40 PM
My son is 10 and Im trying to find info to help him. So far his teachers have talked to us about it. He has seen a neurologist recently who pretty much said he had it but said we should have him evaluated for it because he was very concerned about his lack of focus and figitiness. He mentioned that we could see a psychologist for an evaluation or that they have a test that they can do at the neurologist's office that we can use. The test is cheaper apparently and it will give a info on the type of ADHD that the person has. Its called Quotient and its computer based but measures head movement during a computer test. Its only like 20 minutes long so I am skeptical. Since its done at a neurologist's office I thought maybe it would be legit though.
Any experiences? Should I just stick with a psychologist? I dont even know how to go about finding one though.

We arent sure we want to try meds right away. Ive been doing lots of research and its looking more like a good option though. Im just wondering, how you figure out where to start. There seem to be so many options out there. Do you start with what type of ADHD and some work better for different types? In my reading I just keep seeing how they work and what the side effects are but not how you know which one to try first.

ginniebean
04-11-16, 01:11 AM
Sadly, there is no test that can determine adhd. If he's a fidgety fella, he likely has adhd combined type.

Save yourself the headaches. Call your local CHADD advocacy group and they will recommend doctors or psychiatrists who specialize in adhd evaluation.

This sounds like someone's making money off the unsuspecting. Good luck!

ginniebean
04-11-16, 01:20 AM
Also, when it comes to meds opinions vary. They don't vary from researchers and experts who very uniformly say meds, behaviour modification and a good support system. At school and home work best. Many parents are rightly uneasy about meds, no one should be cavalier. Be informed, do your own research, and I'm sure you'll find what us best.

sarahsweets
04-11-16, 02:54 AM
I can identify with your concerns. Ginniebean is right though, there are no tests for adhd. A lot of people her the word 'neuropsyche' and tests and it all sounds dire and official. And then they hear the cost, which is usually not covered by insurance. And they are informed it can be a simple thing done in the office. You know who makes out on that deal? The doctor/clinician. The doctor knows that this is not how its done. The evaluation should be done by a knowledgeable psychiatrist, one that knows adhd is diagnosed through interviews, observation, family input, and family history.
Sorry I sound so jaded, its infuriating that these tests prey on fears and worry that parents have for their kids. Think about it...If you have a tumor and need a biopsy, the doctor isnt going to tell you that the insurance wont pay for it-and we are talking about cancer!
Ok, off my soap box now.
Welcome.

namazu
04-11-16, 04:57 AM
The Quotient system was cleared by the FDA "for use as a device that provides clinicians with objective measurements of hyperactivity, impulsivity and inattention to aid in the clinical assessment of ADHD. ...[R]esults should be interpreted only by qualified professionals".

However, despite FDA clearance (which basically said that it was safe and measured what it purported to measure), this type of testing is neither necessary nor sufficient to confirm/rule out a diagnosis of ADHD. There are currently no widely-accepted standard thresholds for clinic-based measurements of hyperactivity, impulsivity, and inattention that would result in a firm diagnosis, and other factors besides ADHD can affect those measurements.

Furthermore, the company that markets Quotient was actually warned by the FDA in August 2015 (http://www.fda.gov/iceci/enforcementactions/warningletters/ucm463351.htm)for overselling its uses.

Current best practices for diagnosis of ADHD include:
- taking a thorough medical, social, educational, and family history;
- speaking with the child about the child's experiences;
- speaking with parents/caregivers about the child and about issues in the home that could be affecting the child's behavior;
- getting input from others in the child's life (like teachers or coaches) about the child's behavior in school or play settings; and
- considering whether the child may have other medical or environmental issue(s) instead of, or addition to, ADHD.

Psychoeducational testing by a psychologist can help to shed light on processing problems or learning disabilities that may accompany or look like ADHD, but that testing in and of itself isn't enough to rule ADHD in or out. Given your son's difficulties with handwriting, this type of testing might not be a bad idea; it could help you understand whether the handwriting issues stem from attentional problems, or whether there may be additional fine-motor or visual-processing problems (among other things) that could be contributing to his difficulties. If there are other things interfering with writing, that may give you additional avenues for intervention (and/or ideas for workarounds, like typing or dictation software) so that the handwriting problems don't interfere unnecessarily with his experiences at school. Your local public school district should be able to provide a basic psychoeducational evaluation for free, though the quality may vary.

Computerized testing like Quotient can't provide definitive answers, and is unlikely to add much useful information beyond what should be gathered during the evaluation process described above.

My advice would be to skip the Quotient testing and save your money for other things.

Even if you are not keen on medication (and especially at this stage, before the diagnosis has been made, that's understandable!), my suggestion would be to find a respected child psychiatrist in your area who has experience evaluating children for ADHD. They are usually the best-informed and best-placed to conduct a thorough evaluation, and to provide treatment if necessary.

While medication is considered a first-line treatment for ADHD, there are also other approaches that can be very helpful in complementing medical treatment, including modifications at school, parent training, technological aids, and so on. Educating yourself about ADHD is one of the best things you can do for your son (and your husband, and yourself), so kudos to you for getting the ball rolling.

Best wishes to you and your family!

dvdnvwls
04-11-16, 01:11 PM
There is only one test that counts, the only test that works, and that is your son's face-to-face interview with a psychiatrist who has a lot of experience treating ADHD. That will be combined with lists of questions for you and his teachers to answer, about how he does at home and at school. Other testing has no validity at all - zero - in diagnosing ADHD.

If a competent ADHD-treating psychiatrist suspects that this might not be ADHD, only then are other tests warranted.

ADHDWife&Mom
04-11-16, 08:31 PM
Thank you for your responses. I was thinking it was probably not the best route. I have lots of books and websites and none of them have even mentioned this test. I wasnt sure if it was just new or if it wasnt helpful.

Id love more info if anyone knows more about how they determine which meds to try though. Im not talking about if they should try meds or combining with other treatments, Im just wondering which type of drugs like the brand names or the stimulants vs non stimulants. Are there just some that work better for most and they start with that?

dvdnvwls
04-12-16, 12:33 AM
Thank you for your responses. I was thinking it was probably not the best route. I have lots of books and websites and none of them have even mentioned this test. I wasnt sure if it was just new or if it wasnt helpful.

Id love more info if anyone knows more about how they determine which meds to try though. Im not talking about if they should try meds or combining with other treatments, Im just wondering which type of drugs like the brand names or the stimulants vs non stimulants. Are there just some that work better for most and they start with that?

The stimulants work better for most, and the good doctors do start with the stimulants. The other medications tend to be "also-rans" because they are usually less effective. (The only major exceptions, where stimulants are not tried first, are people with a history of stimulant addiction or who have certain types of serious heart defects.)

There are several brand names among the stimulants, but in reality there are only two - they're just prepared in many different formats. Those two are amphetamine and methylphenidate.

Amphetamine meds used with ADHD include (among other brands) Adderall, Dexedrine, and Vyvanse.

Methylphenidate meds include (again among others) Ritalin, Concerta, and Focalin.

It's nearly impossible to predict which medication works best for an individual; therefore, most doctors will simply prescribe one, and adjust from there. It's normally best to start these medications at a low dosage to try to minimize any unwanted reactions, and then to gradually increase them to the best dosage over a space of weeks or months.

ADHDWife&Mom
04-12-16, 10:23 AM
The stimulants work better for most, and the good doctors do start with the stimulants. The other medications tend to be "also-rans" because they are usually less effective. (The only major exceptions, where stimulants are not tried first, are people with a history of stimulant addiction or who have certain types of serious heart defects.)

There are several brand names among the stimulants, but in reality there are only two - they're just prepared in many different formats. Those two are amphetamine and methylphenidate.

Amphetamine meds used with ADHD include (among other brands) Adderall, Dexedrine, and Vyvanse.

Methylphenidate meds include (again among others) Ritalin, Concerta, and Focalin.

It's nearly impossible to predict which medication works best for an individual; therefore, most doctors will simply prescribe one, and adjust from there. It's normally best to start these medications at a low dosage to try to minimize any unwanted reactions, and then to gradually increase them to the best dosage over a space of weeks or months.

Thank you, this is helpful

Caco3girl
04-12-16, 02:11 PM
Where do you start with the meds...well in most places you start with whatever the doctor prescribes. Then you try to fill the prescription and the pharmacy informs you that your insurance company has rejected the prescription because your kid has to take X, Y, and Z before they are allowed to take the one the doctor wants him or her to try first.

I was appalled when this happened to my son but when I spoke with the doctor they said it happens all the time and it was no big deal. If X doesn't work for your son we were going to try Y next anyway, so it's really not a big deal. There are about 5 types they like to try.

When you get your first medicine it will be a very low dose, it is likely not going to work. You call the doctor and he/she says let's try a higher dose of that one. If that doesn't work they try another type of medicine and start with a low dose, then a higher dose then another medicine.

I won't lie, it can be a royal pain! 5 co-pays in one month and now I have 5 bottles of useless ADHD medicine because they didn't work. One gave my son a horrible demon child personality (we stopped that on day 2), one made him dizzy, and now he tells me he has no idea if this one is working or not. My child has mostly inattentive ADHD so even when he misses things he doesn't realize he missed them, LOL! The medicine ride has been oh so much fun but I NEED for my son to do better in school and in classes and to be able to function. Getting sent to the office 3 times a week and not even knowing why was REALLY not working for our family.

ADHDWife&Mom
04-12-16, 09:01 PM
Where do you start with the meds...well in most places you start with whatever the doctor prescribes. Then you try to fill the prescription and the pharmacy informs you that your insurance company has rejected the prescription because your kid has to take X, Y, and Z before they are allowed to take the one the doctor wants him or her to try first.

I was appalled when this happened to my son but when I spoke with the doctor they said it happens all the time and it was no big deal. If X doesn't work for your son we were going to try Y next anyway, so it's really not a big deal. There are about 5 types they like to try.

When you get your first medicine it will be a very low dose, it is likely not going to work. You call the doctor and he/she says let's try a higher dose of that one. If that doesn't work they try another type of medicine and start with a low dose, then a higher dose then another medicine.

I won't lie, it can be a royal pain! 5 co-pays in one month and now I have 5 bottles of useless ADHD medicine because they didn't work. One gave my son a horrible demon child personality (we stopped that on day 2), one made him dizzy, and now he tells me he has no idea if this one is working or not. My child has mostly inattentive ADHD so even when he misses things he doesn't realize he missed them, LOL! The medicine ride has been oh so much fun but I NEED for my son to do better in school and in classes and to be able to function. Getting sent to the office 3 times a week and not even knowing why was REALLY not working for our family.

Thank you for sharing your experiences. I should have thought about the fact that probably start with the cheapest first so that the insurance companies will cover it. That seems to be how it always works.