View Full Version : Diagnosed in under 5 minutes, normal?


Caco3girl
04-14-17, 09:54 AM
Last night my son had an appointment with his psychiatrist, it was a medicine check to see how he was doing. This isn't therapy, this is just a check in. This is the second one we have had and my 7 year old daughter was present for both.

At the end I asked about my 7 year old daughter, who was bouncing all over the place and interrupting with random things during this 10 minute meeting. I briefly explained about the Tier III meeting I had at the school where the general consensuses was that while she isn't mean about it she won't sit down and do her work, she's constantly up or asking to go to the bathroom, get a drink, has to tell the teacher about her dog...and she is getting further behind grade level even with interventions because she can't stay focused.

The Dr. asked me a set of about 15-20 questions and asked me to gauge never, sometimes, and often....at the end of that she said she's obviously ADHD and wrote her a prescription.

This seemed SUPER fast. The doctor didn't ask to talk to the teachers, or get scales, or anything. I thought it took two environments to diagnose? Was my daughter in her office one, and my explanation of home the other maybe? This seemed weird. Thoughts?

Lunacie
04-14-17, 11:31 AM
Has your son been diagnosed with adhd? Have you? Sorry, I can't remember.

If an immediate family member has adhd, the chances of a sibling or offspring
having adhd are pretty high, like 30-40%.

Johnny Slick
04-14-17, 01:05 PM
Sometimes the symptoms are super-obvious, sometimes they aren't. I was diagnosed (not as a child) in like 15 minutes too.

Caco3girl
04-14-17, 01:31 PM
Has your son been diagnosed with adhd? Have you? Sorry, I can't remember.

If an immediate family member has adhd, the chances of a sibling or offspring
having adhd are pretty high, like 30-40%.

Her half brother is ADHD. I am dyslexic but not ADHD. My seven year old was being VERY much herself last night, phsycially bouncing all over the office as well as verbally bouncing.

dvdnvwls
04-14-17, 04:09 PM
Serious obvious hyperactivity plus that kind of school problems, combined with family history - the doctor's chance of being wrong is very close to zero.

If "half brother" ends up meaning that both are your biological children, you might consider seeing that psychiatrist all by yourself some day. :)

Cyllya
04-14-17, 06:03 PM
Though it would normally be pretty nuts to diagnose that easily, it sounds reasonable in the circumstances.

It sounds like you described her school situation in addition to her home behavior? So that would be the 2+ environments.

I think the main things they're looking for as evidence the kid doesn't have ADHD are things like:
The symptoms are possibly caused by sleep or nutrition problems, mood disorders, sensory disorders, conduct disorders, autism, abuse, or the parents suck at discipline -- these are more applicable to different symptoms than your daughter has.
Parents or other authorities are driving the poor kid nuts or the kid doesn't have any problems or the parent is just paranoid or overly strict or something -- He already knows you from your other kid, so that's ruled out.

maple17
04-15-17, 09:57 PM
It also depends on the specialist too and their level of expertise. The one we saw was a developmental paediatrician who only sees kids with ADHD, ASD, SPD, and so on. Even though we did have multiple appointments with the forms filled in by the teacher and all, she said during the first appointment that she strongly suspected my daughter had ADHD.

Caco3girl
04-17-17, 08:58 AM
It also depends on the specialist too and their level of expertise. The one we saw was a developmental paediatrician who only sees kids with ADHD, ASD, SPD, and so on. Even though we did have multiple appointments with the forms filled in by the teacher and all, she said during the first appointment that she strongly suspected my daughter had ADHD.

I guess that was my glitch, the Dr didn't send forms to the school, I guess she just took my word for it that they can't get the 7 year old to sit down long enough to actually do her work.

Also, it's a very long story, but they are half siblings because they have the same father. We are divorced but both live with me, the 7 year old is biologically mine, and the 14 year old is legally mine since I did a step parent adoption when he was 9 and he chose to live with me.

maple17
04-18-17, 08:57 PM
I guess that was my glitch, the Dr didn't send forms to the school, I guess she just took my word for it that they can't get the 7 year old to sit down long enough to actually do her work.

Also, it's a very long story, but they are half siblings because they have the same father. We are divorced but both live with me, the 7 year old is biologically mine, and the 14 year old is legally mine since I did a step parent adoption when he was 9 and he chose to live with me.

Mine didn't see the forms until about a month later, after the teacher filled hers out. The paed suspected ADHD at the first appointment after talking to me and to my daughter. So, what I'm saying is that it's not that unusual for a specialist who sees ADHD, ASD kids all the time to have a pretty good first instinct. And if they both have the same father, then there's the genetic aspect and another good reason to suspect it as your 14 year old was diagnosed already.

Caco3girl
04-27-17, 08:58 AM
Moderator note: This post and the few below it were moved here from a more general thread on ADHD and parent-child relationships so as not to derail that thread with a discussion better served in this existing thread.

Note: a proper diagnoses generally requires much more time, much of it spent taking and reviewing one's personal history. While your son may have ADHD and your daughter may exhibit many similar characteristics, it is nevertheless possible she suffers from a different condition, or ADHD plus other conditions. To skimp in any way on a thorough medical doctor's examination, performed by one who is trained and experienced in pediatric ADHD, is, IMO, a huge and potentially dangerous mistake. Boys often display different symptoms than do girls.


If the public only knew! If they only got it! ADHD kids have gobs and gobs of unused potential. Many do. Not all, but many, many, many. To be held hostage by ignorance is a cruel and unnecessary way to be forced to live. Playing sports with 2 broken legs is a tough way to measure up. Oh! the misery kids and adults could avoid with medical help for this darn disorder. Everything that can be done to educate others is significant.

Sure, some doctors over-diagnose and over-prescribe or misdiagnose. What's new? Sure ADHD drugs have addictive potential. Running from life, because we are not receiving medical intervention, isn't exactly a healthy way to live, either.

While my daughter was diagnosed in under 5 minutes she had been in the office before during my sons visits, so the doctor had seen her erratic behavior before. Also, I had just had a long meeting with the school where they said, in a nutshell, that she is a very intelligent, compassionate, helpful child who can't sit still long enough to do her work so she is not progressing like the other children, even with small group study interventions all year.

Ritalin LA seems to be having a positive effect. If she wasn't ADHD wouldn't she be bouncing off the walls from the stimulant?

Letching Gray
04-27-17, 10:22 AM
I don't know. From what you've said, it seems she diagnosed her in zero seconds. She knows your son and knows your daughter bounces off walls. Her response to Ritalin? Ask an expert about your doctor's decision.

Letching Gray
04-27-17, 05:52 PM
While my daughter was diagnosed in under 5 minutes she had been in the office before during my sons visits, so the doctor had seen her erratic behavior before. Also, I had just had a long meeting with the school where they said, in a nutshell, that she is a very intelligent, compassionate, helpful child who can't sit still long enough to do her work so she is not progressing like the other children, even with small group study interventions all year.

Ritalin LA seems to be having a positive effect. If she wasn't ADHD wouldn't she be bouncing off the walls from the stimulant?

There are reasons Ritalin is a schedule 2 drug. It is potent. It can be dangerous. Before it is administered for ADHD, all other possible causes for her symptoms must be eliminated. It is not something to mess with, ever. I am not saying that your doctor is messing around. But, to say she took less than 5 minutes to diagnose her doesn't have the ring of the best quality medical procedures, to me. If she were my child, I'd have her examined by someone else.

Stimulants should only be used when it is absolutely necessary and the patients' must be monitored closely, very closely, especially little ones, by a very competent M.D.

It should never be used as a diagnostic tool.

Cyllya
04-27-17, 06:44 PM
Ritalin LA seems to be having a positive effect. If she wasn't ADHD wouldn't she be bouncing off the walls from the stimulant?

Nope, lots of people use methylphenidate and other stimulants illegally for performance enhancement, and they're also prescribed for other conditions.

But stimulant having a positive effect means stimulant having a positive effect, regardless of reason.

Stimulants should only be used when it is absolutely necessary and the patients' must be monitored closely, very closely, especially little ones, by a very competent M.D.

It should never be used as a diagnostic tool.

Sometimes it annoys me that doctors use treatment to diagnose stuff. But at the same time, I can't completely hate it because...
It seems wasteful and potentially harmful to do a test when it's a near-certainty what the condition is and none of the alternatives are super urgent.
Tests are often unreliable, especially for mental disorders.
The treatment for multiple conditions is often similar. (For example the same drugs used for ADHD are also occasionally used for depression, some sleep disorders, age-related cognitive decline, autism, and brain injury, even if it's not the first or only treatment typically used in those cases.)
Despite the evil reputation, methylphenidate and amphetamine actually aren't as bad as other psychoactive substances. They're scheduled mainly due to potentially being euphoriants and for causing addiction in large recreational doses. (Compare Strattera, which research shows has a much worse safety profile (https://www.ncbi.nlm.nih.gov/pubmed/26293742) than methylphenidate but is not a controlled substance because is has no street value. They don't need to restrict access to it because nobody wants it!)

Letching Gray
04-27-17, 08:30 PM
Nope, lots of people use methylphenidate and other stimulants illegally for performance enhancement, and they're also prescribed for other conditions.

But stimulant having a positive effect means stimulant having a positive effect, regardless of reason.



Sometimes it annoys me that doctors use treatment to diagnose stuff. But at the same time, I can't completely hate it because...
It seems wasteful and potentially harmful to do a test when it's a near-certainty what the condition is and none of the alternatives are super urgent.
Tests are often unreliable, especially for mental disorders.
The treatment for multiple conditions is often similar. (For example the same drugs used for ADHD are also occasionally used for depression, some sleep disorders, age-related cognitive decline, autism, and brain injury, even if it's not the first or only treatment typically used in those cases.)
Despite the evil reputation, methylphenidate and amphetamine actually aren't as bad as other psychoactive substances. They're scheduled mainly due to potentially being euphoriants and for causing addiction in large recreational doses. (Compare Strattera, which research shows has a much worse safety profile (https://www.ncbi.nlm.nih.gov/pubmed/26293742) than methylphenidate but is not a controlled substance because is has no street value. They don't need to restrict access to it because nobody wants it!)



Despite the evil reputation, methylphenidate and amphetamine actually aren't as bad as other psychoactive substances.

Yes and no. Regardless what the rep of certain drugs is, for a particular individual, any drug within a certain class of drugs may be harmful, even lethal. Although, it is true aspirin kills more people each year than Adderall.


Tests are often unreliable, especially for mental disorders.

A "positive" response to Ritalin reliably demonstrates what? If she dies from complications, that is not the kind of response one would hope for.

It seems wasteful and potentially harmful to do a test when it's a near-certainty what the condition is and none of the alternatives are super urgent.

Can you expand this idea a little? What standardized test to determine if ADHD exists might be harmful?

Without a thorough workup, how can a physician evaluate the child's overall health and suitability for a specific medication? If the child has a heart murmur, and the prescribing physician takes less than 5 minutes to diagnose her, and she dies from complications arising from ingesting a stimulant, not only would that be tragic and uncalled for, it would be malpractice, maybe worse.

sarahsweets
04-30-17, 05:51 AM
There are reasons Ritalin is a schedule 2 drug. It is potent. It can be dangerous. Before it is administered for ADHD, all other possible causes for her symptoms must be eliminated. It is not something to mess with, ever. I am not saying that your doctor is messing around. But, to say she took less than 5 minutes to diagnose her doesn't have the ring of the best quality medical procedures, to me. If she were my child, I'd have her examined by someone else.

Stimulants should only be used when it is absolutely necessary and the patients' must be monitored closely, very closely, especially little ones, by a very competent M.D.

It should never be used as a diagnostic tool.

This isnt correct. Stimulants are considered a first line treatment for adhd. They are recommended as the first treatment options over behavior modifications and diet. Ideally, you would want the child to be on stimulants and also incorporate behavior modifications, the meds can help with the severe symptoms and leave room to work on other coping skills.

People are always so quick to condem stimulants because of their schedule and cloass, ignoring the benefits and evidence backing up the choice in using them.
My son was diagnosed when he was 3.5 and began meds when he was 4. They saved his life. He is 21 now and if we hadnt gotten him on meds, I know he wouldnt have been able to manage his symptoms well enough to learn in school.

Caco3girl
05-01-17, 08:46 AM
This isnt correct. Stimulants are considered a first line treatment for adhd. They are recommended as the first treatment options over behavior modifications and diet. Ideally, you would want the child to be on stimulants and also incorporate behavior modifications, the meds can help with the severe symptoms and leave room to work on other coping skills.

People are always so quick to condem stimulants because of their schedule and cloass, ignoring the benefits and evidence backing up the choice in using them.
My son was diagnosed when he was 3.5 and began meds when he was 4. They saved his life. He is 21 now and if we hadnt gotten him on meds, I know he wouldnt have been able to manage his symptoms well enough to learn in school.

That is where my daughter was. She is in second grade and last year reading was SOOO hard for her, they modified her assignments mid year. This year they took her out of her class for half the day for small group reading, more individualized instruction, more at her level, lots of rewards and such...she hasn't progressed much.

I had a meeting with her normal teacher and her reading teacher as well as the guidance counselor and the school psychologist and then general consensus was that she won't sit down long enough to learn. When they teach she interrupts with random statements, they aren't even questions about what is being taught. When they sit down to do work she won't stay seated. She loves math, but even during the math evaluation done on the computer she sped through it so she could get up and do something else, this resulted in an average score when the teacher is certain she would have achieved an accelerated score if she had slowed down and really payed attention.

How can a kid get through school when they aren't willing to sit and learn?

Lunacie
05-01-17, 11:45 AM
That is where my daughter was. She is in second grade and last year reading was SOOO hard for her, they modified her assignments mid year. This year they took her out of her class for half the day for small group reading, more individualized instruction, more at her level, lots of rewards and such...she hasn't progressed much.

I had a meeting with her normal teacher and her reading teacher as well as the guidance counselor and the school psychologist and then general consensus was that she won't sit down long enough to learn. When they teach she interrupts with random statements, they aren't even questions about what is being taught. When they sit down to do work she won't stay seated. She loves math, but even during the math evaluation done on the computer she sped through it so she could get up and do something else, this resulted in an average score when the teacher is certain she would have achieved an accelerated score if she had slowed down and really payed attention.

How can a kid get through school when they aren't willing to sit and learn?

Maybe she is willing, but her disorder interferes with her ability?

Caco3girl
05-01-17, 02:35 PM
Maybe she is willing, but her disorder interferes with her ability?

That seems to be the case. I asked her teachers for an update since she's been on medicine for going on 3 weeks now. The reading teacher summed it up the best, she said:

" I have seen a world of difference in XXXX. She is staying in her seat and paying attention so much better than she has in the past. When she finishes her work, she waits patiently and does not start playing or distracting others. I have noticed a difference in her quality of work as well."

That right there gives me hope!

Lunacie
05-01-17, 02:45 PM
That seems to be the case. I asked her teachers for an update since she's been on medicine for going on 3 weeks now. The reading teacher summed it up the best, she said:

" I have seen a world of difference in XXXX. She is staying in her seat and paying attention so much better than she has in the past. When she finishes her work, she waits patiently and does not start playing or distracting others. I have noticed a difference in her quality of work as well."

That right there gives me hope!


Yep. :D

It's not that these kids aren't willing to listen or sit still. Their brains just don't
make the connection between what they know they should be doing and what
they actually do.

Even as an adult, I knew that I shouldn't interrupt, but the thought simply
jumped from my brain to my mouth, totally bypassing the circuit for self-
control. I'm finally doing better at this since I've been taking Omega 3 and
did some CBT.

Letching Gray
05-01-17, 07:04 PM
Originally Posted by Letching Gray View Post
There are reasons Ritalin is a schedule 2 drug. It is potent. It can be dangerous. Before it is administered for ADHD, all other possible causes for her symptoms must be eliminated. It is not something to mess with, ever. I am not saying that your doctor is messing around. But, to say she took less than 5 minutes to diagnose her doesn't have the ring of the best quality medical procedures, to me. If she were my child, I'd have her examined by someone else.

Stimulants should only be used when it is absolutely necessary and the patients' must be monitored closely, very closely, especially little ones, by a very competent M.D.

It should never be used as a diagnostic tool.


"This isnt correct. Stimulants are considered a first line treatment for adhd. They are recommended as the first treatment options over behavior modifications and diet. Ideally, you would want the child to be on stimulants and also incorporate behavior modifications, the meds can help with the severe symptoms and leave room to work on other coping skills." sarahsweets

I didn't say that stimulants aren't a first line of treatment for ADHD. I didn't mention behavior mod.

"People are always so quick to condem stimulants because of their schedule and cloass, ignoring the benefits and evidence backing up the choice in using them." sarahsweets

I never said stimulants aren't beneficial. I said without a proper diagnosis they shouldn't be used to treat ADHD. I said they are potent and can be dangerous and used the example of someone with an undiagnosed heart murmur. Stimulants could kill a person in that case.


"My son was diagnosed when he was 3.5 and began meds when he was 4. They saved his life. He is 21 now and if we hadnt gotten him on meds, I know he wouldnt have been able to manage his symptoms well enough to learn in school." sarahsweets

That's great. What did I say that is incorrect about that?

Caco3girl
05-02-17, 10:33 AM
"This isnt correct. Stimulants are considered a first line treatment for adhd. They are recommended as the first treatment options over behavior modifications and diet. Ideally, you would want the child to be on stimulants and also incorporate behavior modifications, the meds can help with the severe symptoms and leave room to work on other coping skills." sarahsweets

I didn't say that stimulants aren't a first line of treatment for ADHD. I didn't mention behavior mod.

"People are always so quick to condem stimulants because of their schedule and cloass, ignoring the benefits and evidence backing up the choice in using them." sarahsweets

I never said stimulants aren't beneficial. I said without a proper diagnosis they shouldn't be used to treat ADHD. I said they are potent and can be dangerous and used the example of someone with an undiagnosed heart murmur. Stimulants could kill a person in that case.


"My son was diagnosed when he was 3.5 and began meds when he was 4. They saved his life. He is 21 now and if we hadnt gotten him on meds, I know he wouldnt have been able to manage his symptoms well enough to learn in school." sarahsweets

That's great. What did I say that is incorrect about that?

What you said was "Before it is administered for ADHD, all other possible causes for her symptoms must be eliminated. It is not something to mess with, ever."

So, you said all other possible causes needed to be eliminated, Sarah is saying NOPE, meds are the first line.

I mean really ADHD isn't like the flu, there is no blood test or eye test that you can say with 100% certainty "this child has adhd"....every doctor who has ever diagnosed ADHD was performing a guess based on observed opinions about the child. Personally I am SO freaking thrilled this was identified early and hopefully she won't have to struggle like my son, who was not diagnosed until 8th grade, did.

Johnny Slick
05-02-17, 11:04 AM
What you said was "Before it is administered for ADHD, all other possible causes for her symptoms must be eliminated. It is not something to mess with, ever."

So, you said all other possible causes needed to be eliminated, Sarah is saying NOPE, meds are the first line.

I mean really ADHD isn't like the flu, there is no blood test or eye test that you can say with 100% certainty "this child has adhd"....every doctor who has ever diagnosed ADHD was performing a guess based on observed opinions about the child. Personally I am SO freaking thrilled this was identified early and hopefully she won't have to struggle like my son, who was not diagnosed until 8th grade, did.I... guess I come in somewhere in the middle here? I kind of agree with LG that in most cases you do want to check and double-check and be careful, especially when the person in question exhibits some but not all of the symptoms of ADHD. Stimulants can be addictive and should be handled with care. On the other hand, I think you have to take a Bayesian approach to this as well. When a patient drops in unannounced and you're diagnosing them, you don't really have any way of knowing that they have ADHD except for the fact that something like 5% of the population suffers from it. You can observe them, run tests, etc. from there but you're still starting from a prior plausibility of like a 1 in 20 chance, so yeah, you absolutely have to be careful. Your daughter on the other hand... well, I'm not sure what the exact numbers on ADHD and heritability are (I'm not even sure this has been studied heavily, actually) but if a child with a sibling who has ADHD has even a 30% chance of having it themselves, that's a *massively* larger prior plausibility, and that in turn means that there are just plain going to be fewer hoops that that child has to jump through until you as a doctor are sure enough that they've got the condition to prescribe them drugs.

Also, I don't know your doctor but I'm of the personal opinion that since girls/women are seriously underdiagnosed and since an awful lot of that is because of cultural issues, if a girl exhibits the cluster of symptoms that ought to be taken more seriously at face value than if a boy does the same. I'm not saying that boys and men can't suppress undiagnosed symptoms but *so* many of them are just kind of anathema to what women are "supposed to be" - interrupting, not paying attention to others when other people are getting boring, saying thoughtless things without first thinking of the consequences - that I feel like with a lot of girls/women with ADHD what you see is like the tip of an iceberg.

sarahsweets
05-02-17, 01:03 PM
This part:
Stimulants should only be used when it is absolutely necessary and the patients' must be monitored closely, very closely, especially little ones, by a very competent M.D

If a child or an adult for that matter has ADHD, stimulants are almost always necessary. Why? Because they are a proven(with scientific evidence), first line treatment for adhd. Saying something is a first line treatment means its the most studied intervention, is supported by medical evidence, and supported by experts in their field. You cant just call anything a first line treatment. So saying a first line treatment should only be used when its absolutely necessary makes no sense. The statistics behind treated adhd shed a lot of light on proper treatment. To say that "especially little ones" need to be monitored also is insulting, and seems to play into the misinformation about stimulants that make the rounds. ANY parent is going to monitor their child if they are on medication, no matter what kind it is. ANY parent should keep a log of symptoms, side effects and whatever else, so they can watch out for anything amiss, and communicate them to their doctor.
People tend to think meds are fine, meds that hurt your liver like Tylenol is no problem; but because we are dealing with big bad stimulants suddenly people have to be told to monitor their kids and closely look out for any changes.

Stimulants are drugs, just like insulin and cold medicine. Just because they are abused and classfied as controlled substances, doesnt mean a child requires even more oversight. The oversight should be the same regardless.
People also seem to believe myths about kids being doped up zombies, not growing or darling little meth heads. This is all false. Its crap you can dig up on the internet. Meds are approved for use in kids as young as 4. I would like to guess that a 4 year old needing medication might be more rare than common but the fact is, evidence and science have proven that this is safe and effective.
I have often found that the loudest opponents to kids and meds are people who do not have an adhd child and havent had to make decisions on ways to treat it.
No parent takes medicating their child lightly.


"This isnt correct. Stimulants are considered a first line treatment for adhd. They are recommended as the first treatment options over behavior modifications and diet. Ideally, you would want the child to be on stimulants and also incorporate behavior modifications, the meds can help with the severe symptoms and leave room to work on other coping skills." sarahsweets

I didn't say that stimulants aren't a first line of treatment for ADHD. I didn't mention behavior mod.

"People are always so quick to condem stimulants because of their schedule and cloass, ignoring the benefits and evidence backing up the choice in using them." sarahsweets

I never said stimulants aren't beneficial. I said without a proper diagnosis they shouldn't be used to treat ADHD. I said they are potent and can be dangerous and used the example of someone with an undiagnosed heart murmur. Stimulants could kill a person in that case.


"My son was diagnosed when he was 3.5 and began meds when he was 4. They saved his life. He is 21 now and if we hadnt gotten him on meds, I know he wouldnt have been able to manage his symptoms well enough to learn in school." sarahsweets

That's great. What did I say that is incorrect about that?

Little Missy
05-02-17, 03:16 PM
I would take a 5 minute diagnosis any day.

Johnny Slick
05-02-17, 04:47 PM
Yeah, just to add to what sarahsweets said, not only are they a vital first-line defense but, contrary to what you might think (that they'll make your kid dependent on them for their daily functions, etc.), studies are beginning to look at the composition of ADHD brains, and those studies are finding a couple of really interesting things:

1. Our brains are in fact shaped differently than those of "normal" people. Obviously there's a whole spectrum of symptoms and behavior and brain chemistry/composition is still a very, very young discipline, so I don't think we're anywhere close to being able to diagnose ADHD by CAT scan or anything like that, but still... there are observed differences.

http://mcgovern.mit.edu/news/news/inside-the-adult-adhd-brain/

2. This effect has been observed with adults who get treated, but that first factoid looked at adults who had ADHD as kids but "kicked it" vs. adults who had it but did not so I think you can extrapolate this to kids as well: taking medication for ADHD causes your brain to grow into those places that are smaller. In other words, whatever it is the stimulants do - and I think the science on that is still pretty unclear - they also allow the ADHD brain to become more "normal" over time.

So... as sarahsweets was saying, while I totally understand the desire to make sure you're right before your kid gets medication, and while I also understand the desire to not get them addicted to speed (it's small doses of speed or a speed-like substance, but hey, it is speed), if they've got this condition, the medication *is* a good first-line treatment with both positive short-term *and* long-term effects.

Letching Gray
05-02-17, 08:31 PM
Is it ADHD? What Neuropsychological Assessment Shows Us

As a clinical neuropsychologist, I often wonder how primary care clinicians (PCPs) or pediatricians assess and treat ADHD.

The diagnosis of ADHD is complex each individual is unique and symptoms vary! The reality is most physicians are quick to opt for pharmacological solutions (medication) when perhaps non-pharmacological/alternative therapies (lifestyle changes, coaching, neurofeedback, etc.) are more appropriate. Parents often tell me that they are hesitant to give medication to their children without really knowing if it is truly ADHD.

Neuropsychological measures are the only way to objectively assess the nature, extent, and severity of difficulties to assist with diagnosis and treatment.

Why? The list of reasons why someone can have attention problems is very extensive. Psychological and psychosocial factors (e.g., depression, anxiety, parental divorce, trauma), neurodevelopmental disorders (e.g., dyslexia, autism spectrum), medical reasons (e.g., sleep apnea, head injuries/concussions), and as well as other conditions can masquerade as ADHD.

A neuropsychological evaluation can also inform treatment planning, in terms of both pharmacologic and non-pharmacologic considerations. For students, testing can be extremely useful to help them understand their unique learning style and develop study strategies, and, if needed, obtain accommodations for school and standardized examinations (SAT, ACT, etc.).

Hallowell says this about diagnosis:

diagnosis includes:

Detailed history from parents
Observations from parents and educators
Interviews
Physical examination (to rule out other medical conditions that could be causing symptoms and behaviors)
Behavioral testing and evaluation

Letching Gray
05-02-17, 08:52 PM
every doctor who has ever diagnosed ADHD was performing a guess based on observed opinions about the child. That's not true and that's not sufficient according to best medical procedures. A doctor may "diagnose" ADHD in 5 seconds. That doesn't make it an accurate assessment.

If a child or an adult for that matter has ADHD, stimulants are almost always necessary. Why? Because they are a proven(with scientific evidence), first line treatment for adhd. Saying something is a first line treatment means its the most studied intervention, is supported by medical evidence, and supported by experts in their field. You cant just call anything a first line treatment. So saying a first line treatment should only be used when its absolutely necessary makes no sense.I said, "Before it is administered for ADHD, all other possible causes for her symptoms must be eliminated." The diagnosis must be accurate. If the child doesn't have ADHD, don't prescribe the first line of treatment or do anything else to treat ADHD. Get the diagnosis correct first. And don't give stimulants to anyone who might die from complications like someone with a heart murmur. Other conditions mimic ADHD. Rule them out first before using or doing anything to treat ADHD.

I have said more than once or twice that medication would have saved me from hell growing up as a child. I have praised the benefits of drugs for ADHD. I have shouted that drugs work for ADHD and we shouldn't be ashamed to tell the world.

Lunacie
05-02-17, 09:03 PM
Hallowell says this about diagnosis


diagnosis includes:

Detailed history from parents
Observations from parents and educators
Interviews
Physical examination (to rule out other medical conditions that could be causing symptoms and behaviors)
Behavioral testing and evaluation



More to come

That's not true and that's not sufficient according to best medical procedures. A doctor may "diagnose" ADHD in 5 seconds. That doesn't make it an accurate assessment.

I said, "Before it is administered for ADHD, all other possible causes for her symptoms must be eliminated." The diagnosis must be accurate. If the child doesn't have ADHD, don't prescribe the first line of treatment or do anything else to treat ADHD. Get the diagnosis correct first. And don't give stimulants to anyone who might die from complications like someone with a heart murmur. Other conditions mimic ADHD. Rule them out first before using or doing anything to treat ADHD.

I have said more than once or twice that medication would have saved me from hell growing up as a child. I have praised the benefits of drugs for ADHD. I have shouted that drugs work for ADHD and we shouldn't be ashamed to tell the world.

The psychiatrist has seen and observed both children and treated the oldest
one for adhd. Caco3girl asked about the obvious behaviors/symptoms and
explained what educators had reported on the child's behaviors. He had her
fill out an evaluation form.

I don't think psychiatrists do complete physical evaluations to rule out other
conditions, but if there is any concern they do recommend the pediatrician
do some testing. I think what this psychiatrist did in diagnosing a sibling of
a boy who has already been diagnosed with adhd was plenty sufficient.

Letching Gray
05-02-17, 09:15 PM
What you said was "Before it is administered for ADHD, all other possible causes for her symptoms must be eliminated. It is not something to mess with, ever."

So, you said all other possible causes needed to be eliminated, Sarah is saying NOPE, meds are the first line.

I mean really ADHD isn't like the flu, there is no blood test or eye test that you can say with 100% certainty "this child has adhd"....every doctor who has ever diagnosed ADHD was performing a guess based on observed opinions about the child. Personally I am SO freaking thrilled this was identified early and hopefully she won't have to struggle like my son, who was not diagnosed until 8th grade, did.

A thorough evaluation of ADHD symptoms is complicated — as it should be to ensure accuracy and rule out similar diagnoses. Follow this step-by-step guide to find an ADHD clinician, prepare for the testing, and learn to manage symptoms.

As a rule, most general practitioners are not trained in the idiosyncrasies of ADHD and its overlapping conditions, or not equipped to perform the in-depth evaluation needed. One reason is time. It can take several hours of talking, test taking, and analysis to diagnose someone with ADHD. Most general practitioners can’t give you or your child that much attention in a busy practice.

Hallowell says. In addition to reviewing these criteria, doctors will conduct a thorough clinical interview using one standardized ADHD rating scale. A screening test is also often administered to rule out common coexisting conditions like learning disorders, anxiety, autism, and mood disorders.

If you are being evaluated, your doctor will interview you and someone who knows you well —your spouse, a sibling, or your parents. She may or may not use similar checklists designed to identify symptoms of adult ADHD. The doctor will use the patient interview to determine which, if any, tests might rule out other conditions that may be causing symptoms.

Most clinical interviews include completing one or more of the ADHD rating scales, as well as other tests. A proper ADHD test should do two things: determine whether a person has ADHD and rule out or identify other problems — learning disabilities, autism, auditory processing disorders, anxiety, or mood disorders. Depending on your doctor’s concerns, tests may take from an hour to more than eight hours and may require several appointments.I never said stimulants are not a first line treatment modality for ADHD.


while I totally understand the desire to make sure you're right before your kid gets medication, and while I also understand the desire to not get them addicted to speed (it's small doses of speed or a speed-like substance, but hey, it is speed), if they've got this condition, the medication *is* a good first-line treatment with both positive short-term *and* long-term effects.
"If they have the condition" of course I believe in using stimulants. I have said that repeatedly on this website. I've never said anything other than that.

The psychiatrist has seen and observed both children and treated the oldest
one for adhd. Caco3girl asked about the obvious behaviors/symptoms and
explained what educators had reported on the child's behaviors. He had her
fill out an evaluation form.

I don't think psychiatrists do complete physical evaluations to rule out other
conditions, but if there is any concern they do recommend the pediatrician
do some testing. I think what this psychiatrist did in diagnosing a sibling of
a boy who has already been diagnosed with adhd was plenty sufficient.

And without a thorough work up, they may not have concerns.

It also depends on the specialist too and their level of expertise. The one we saw was a developmental paediatrician who only sees kids with ADHD, ASD, SPD, and so on. Even though we did have multiple appointments with the forms filled in by the teacher and all, she said during the first appointment that she strongly suspected my daughter had ADHD.

"strong suspicians" though, do not make a formal diagnosis.

Letching Gray
05-02-17, 09:45 PM
So, you said all other possible causes needed to be eliminated, Sarah is saying NOPE, meds are the first line.These are two issues.

For a proper diagnosis of ADHD to be made, all other issues pertaining to the symptoms that appear to be related to ADHD, must be ruled out before making the diagnosis. I didn't say anything about not using stimulants if a proper dx is made.

So saying a first line treatment should only be used when its absolutely necessary makes no sense.And treatment with stimulants is a first line treatment for ADHD, but not if stimulants could kill him, not so much. Without a proper diagnosis, including the physical health of the individual, and ruling out all other possible factors, no one should receive stimulants.

If your child had a heart murmur, would you want him to be taking stimulants?

I mean really ADHD isn't like the flu, there is no blood test or eye test that you can say with 100% certainty "this child has adhd"..No, ADHD isn't like the flu, that's true. Usually, it is a lifelong health issue that requires more than a flu shot. It is complex, destructive, persistent throughout the life cycle but with proper treatment it can be a stepping stone to really cool things.

Pilgrim
05-02-17, 10:25 PM
ADD is not well known in Australia. I had heard the term but didn't really know what it was about.
I walked in to the Psyciatrists office, not really knowing what was going on and I had a script in my hand in less than ten minutes.
I thought they were basically leaning toward depression because know one has the time to explain really what ADD is.
Where I'm a bit different from the average bear is that I spent a few weeks in hospital getting exhaustive blood work, having a number of interviews and having excellent doctors.
I am so grateful for all of this.