Developmental Pediatrician or Neuropsych | ADHD Information

I have been putting off taking my ds to a specialist for about 6 months or more mainly because everything's either too hectic or going good, sometimes I think I'm overreacting to things and some people think my ds is playing me so I second guess my gut feelings some more.

Had parent teachers conference yesterday and it kicked my @ss into high gear - one teacher said instead of talking and being silly getting in trouble like he used to, he just sits there with his head down, had a former intern sub one day and she tracked a teacher down to ask what was wrong with ds he was so withdrawn, one teacher brought up signs of autism (have suspected aspergers for awhile now but pediatrican and behavioral therapis weren't in a hurry to dx yet), another said he constantly picks at fingers, pulls his hair out and puts it in piles on his desk, counts squares on his shirt (very compulsive behaviors I notice at home also except the hair pulling - dr. thought anxiety but one teacher wants to say it's the meds, switched to Daytrana about 3-4 months ago), answered one T or F question on a 40 minute test. He's forgot or lies about homework and ends up having double the next night (usually math) and takes HOURS to complete it (constantly standing over him).

DS turned in 19 late assignments (he's very disorganized, forgetful - working on this with his teachers currently) yet he had all A's, one B and one C. Reads at a high level and can read 2 big books at once and ace the tests.

One teacher insists the change occured after the med change, the other 2 tend to agree with me - after xmas break. Finally spoke with the pediatrician today and said I can't wait another year for a referral (her recommendation, although she had no problem with whatever we decided). She referred us to a developmental pediatrician at the Children's Hospital. From reading the boards, I've got the impression a neuropsychologist is a good start, but I don't really get an answer from his regular pediatrician - only "they're for brain disorders".

Does anyone have an opinion between the two? I know they don't do any academic testing - would it be necessary with high grades even though he seems to struggle completing work? The Dev. Ped. said it will take about 1 1/2 hours (1/2 hour paperwork - and I fax as much info as I can ahead of time) and cost 0. Also can't get in until beginning of June!

Sorry so long - any opinions or previous experience with a dev. ped. would be appreciated. Thanks!!!

If you would feel better having him tested, the school can do that. You need to put it in writing, call the district office and ask them where to send it. I think a developmental pediatrician is a good place to start. You can also go to a psychologist or psychiatrist. The psychiatrist we saw specialized in children's disorders.  

I think it depends on what you think the isssue is. A neuropsych can look at issues related to ADHD and the posible co-morbid conditions, help sort out learning disorders and whether the issues are due to wrong med or wrong diagnosis. Your post sounds to me like this is the direction you are leaning. A dev ped would be a good start if you are leaning towards aspergers or mild autism.

Developmental ped:

http://www.ummeed.org/services/dpa.asp

What a neuropsychologist is:

http://www.medfriendly.com/neuropsychologist.html

And a kind of long technical read on the overall process throught the autism spectrum disorder diagnosis journey:

http://pediatrics.aappublications.org/cgi/content/full/107/5 /e85

I hope this helps.

My son sees a developmental pediatrician with specialization in ADHD and saw the neuropsych just for evaluations.  she concurred with the diagnosis

The behavior you are seeing recently may be due to a slightly high dose of methylphenidate in the Daytrana.  Please read on.

Re: picking nails and pulling hair out- this sounds similar to my ds years ago when he was on a dose of ritalin or concerta (both methylphenidate like Daytrana)  I remember he had a pile of hair on his pillow and was picking at his nails trying to clean them. He said that it felt like there was sand in his hair and under his nails.    He was quite upset by it.  Doctor said that the dose was a bit too high and this sometimes occurrs.  As soon as we lowered the dose the symptoms went away.
 
 Another side effect of too high a dose is  tiredness, sleepiness  or lethargy.  If they lose their spark it can be too high.  This also has occurred with ds who is very sensitive to methylphenidate. 

Adjusting a dose for the individual:  I have broken or shaved off some of the pills of Ritalin to finetune and get the right dose for him.  Daytrana can be cut to get the right dose as well.  Some doctors do not believe in this approach, but ds' doctor  says that  as  everyone is an individual , likewise the dose can be individual.  Altho you can't do this with some medications like  Concerta due to how they package  the pill itself.

 Organizational skills etc:  Ritalin dosen't instantly improve organizational skills.  It helps, but this is a skill they still need to learn.


I hope this helps.  What do you think? Give your doctor a call and see what he thinks.  Let me know what happens.  Good Luck!
jfla239128.3549421296Hi and welcome to the board. We also have had experience with picking and odd behaviors. She would complain of hairs coming out of her butt and be picking at it, also her fingernails. She liked to fidget with her hair, also. We finally figured out that it was too much methylphenidate. She was also a bit withdrawn. What has worked for us so far is to reduce the methylphenidate and add in Tenex (guanfacine).

As for the professional of choice, we use a developmental pediatrician, who manages her meds. She has been seeing him since the age of 2. We also had a neuropsych do testing on her last year to see if she had anything else going on that we needed to address, such as a LD (she did). The findings from the neuropsych testing was useful in coming up with school accommodations. For some reason, if someone with a PhD. backs the parents up, the school listens a lot better.

Good luck, let us know how it goes.

Thank you all for your advice/opinions. It sure helps to kind of put things in perspective and see what you want/need for your child.

I believe we will keep the appt with the dev. ped. to start with and definitely follow up with a neuropsych if we feel or she feels necessary afterwards.

I was curious if the meds could cause some of his behavior, but I worried the problem would be that they'd need upped. I understand that is necessary as they grow and their body changes, but I want to be sure that it is the problem and necessary. He's on 20mg patch so I think I will try cutting it in 1/2 and seeing if this helps some of his behavior - the backing is already hard to peel off, can't wait to try when it's cut!

I agree and actually thought about it, but I wasn't going to talk to his pediatrician before trying this and the patches only come in 10, 20 & 30 to my knowledge. So I thought, if it worked I could just keep getting the 20 mg prescription and cutting in 1/2 or suggest the 10 to his dr. Wasn't sure if she'd prescribe enough for me to cut and use 15 since cutting the patch is supposedly not recommended.

Whew....Ok, I'll try the 15mg first! You talked me into it!

The behavior he is displaying might need just a bit of fine tuning of the dose.  Cutting the dose in half -going from 20mg to 10mg.- might be bit too much too much.  Usually changes in meds were made in 5mg increments.  Perhaps trying the equivalent of a 15mg dose might do it.  Then you could go a bit up or down from there and see what happens.  What do you think? jfla239128.6109490741Good luck!  I thought that I would mention that my son tried Daytrana but had problems with his skin reaction to it.  At the time the doctor did mention that some people have used the whole patch during the daytime when they need the most focus.  Then later peel back some of the patch to a lesser dose. 

About cutting the patch:  I do not know why it has been said not to cut the patch.  Maybe it has something to do with getting the backing off the patch.  When they manufacture the patch, they have a huge sheet of plastic that they punch out the different sizes for the doses.  It seems that ds was prescribed 10s and 15s and to use those to try doses 10,15,20, 25 etc.   We started with 10 which did nothing.  So several hours after I put the 10 on, I cut a 10 in half and added one half...hence he had 15mg in the afternoon.  since that wasn't enough, we tried 20 the next day.  from my observation 25 was enough for ds (18 years old) to use in social settings.  But for schoolwork he liked the 30.

Anyway let me know how it goes.

Appreciate all the insight - trying the 15 mg today (Sat) but the real test will be Monday at school since this is where most of the picking and hair pulling happens - think possibly because he can keep his hands busy at home playing games, etc. I'll let you all know how it goes after a few days.

Thanks!