Underwhelmed by DS first appt | ADHD Information

Hi all,

I'm new to the board (only one previous post) & my DS (10) had his initial appt with a developmental pediatrician yesterday. DH & I had no idea what to expect, but we left feeling a bit disappointed. I liked the dr. & my DS felt comfortable with the dr., so no real complaints there. He was a bit quirky & didn't completely finish most of his thoughts, but seemed to be an intelligent and caring professional.

I was fully expecting an immediate diagnosis of ADHD - the dr. never used that term. He simply said that my DS was impulsive & had a bit of trouble with focusing. He really didn't give us any new suggestions, just to keep up what we were doing (we implemented the marble system found on this board about a month ago) & to tweak it from time to time so that DS didn't lose interest in it.

To one of our biggest concerns, DS's social issues and not behaving like the other kids at school, the dr. simply said "Yep, 4th grade boys are tough on each other." Other key points - he said it takes some children much longer than others to grasp consequences to their actions, it takes some much longer to pick up on social cues from others, he doesn't have a high opinion of the overall school system, and names teachers as the primary reason for children being evaluated.

No talks of counseling, no one-on-one meeting, no real talk of medication until I directly asked if he would suggest that. He just said he was right in the middle, on the fence so to speak. He did write a prescription for Concerta 18mg and said it may help him pay attention, and it may not. No recommendation of a follow-up appt. The visit just kind of ended.

Now I'm here, scratching my head. Has anyone experienced this feeling? I am now questioning did I not express the seriousness of our issues? (We really though we did a good job of clearly stating our concerns) Was this dr. just extremely tolerant & patient? Is it that he's just seen so many more severe cases?

Don't get me wrong, I agreed with the dr. in many ways. And was thankful that he wasn't just prescription-pad-in-hand ready, but I just expected more guidance and suggestions. Anyone care to weigh in on this?

Thanks!

If your walking away with more questions than answers I highly recommend that you get a second opinion. I think you have very valid concerns and if you are dealing with ADHD, behavior medication standing alone will not work. With a confirmed diagnosis of ADHD, a specialist may suggest medication and not for the reasons many think. Medication is a first line of treatment and the only treatment proven to effectively manage the symptoms of ADHD. While all children develop at different rates, those that do not have any type of disorders develop within the norm so I personally totally disagree with what this doctor stated and if the behaviors interfere with the child's ability to function on a daily basis, that's not within the norm and there is more than "boy stuff" going on.

Whether your child has ADHD or something else going on, the jury seems to still be out but I would definitely look into getting another opinion by either a child psychiatrist or a neuro/psych. Both specialize in diagnosing and treating childhood disorders. I'm not saying your son has one but as the mom if you think there is a cause for concern then there is. Welcome and please keep us informed :)

I agree with the second opinion. You describe my son in your post. If he wasn't on meds, he would be acting like that.

Social at school is very important.

Be careful, the kids are quick to label and bully. It happened to my son before we medicated him , and it has followed him through.

Children are so insecure with themselves, especially as they get older, that they seem to be looking for something to knock someone else about, to make themself feel better. So sad!!

It sounds like you kind of know what you know. Parents know their chidren best. I diagnosed our son, Hubby was in denial.

BETHANN39799.8987384259 [QUOTE=rfchevy11]

Hi all,

Quirky is sometimes genius, sometimes human distraction and sometimes incompetence. Hard to tell.

I had a nephew like that as a child. High risk impulsive and easily bored. He doesn't have ADHD, though. I prefer personally a careful medical professional than one that jumps right in with their pet theory.

To one of our biggest concerns, DS's social issues and not behaving like the other kids at school, the dr. simply said "Yep, 4th grade boys are tough on each other."

Is your son being bullied at school? That can cause anxiety and distraction...

Other key points - he said it takes some children much longer than others to grasp consequences to their actions, it takes some much longer to pick up on social cues from others, he doesn't have a high opinion of the overall school system, and names teachers as the primary reason for children being evaluated.

He's right there. Schools have no business attempting to do medical diagnosis. It's one of my pet peeves, too.

He may want to see if your son responds to the concerta?

He sounds cautious. Can you make an appointment again if you need it?

Thanks!

[/QUOTE]

He may be the sort of doc who prefers patients to take the lead. He did give you the concerta after you expressed your concerns. He may be waiting to see what happens over the longer term as well.

If it does not go well, I'd contact him again with your concerns. I also suggest a medication/behavioural journal so you have the information to present if you need a follow-up visit.

Thanks to all for your input. I really appreciate all of it.

The thing about the appt. I regret the most is being so thrown that I didn't ask all of the direct questions I remembered about 2.7 seconds of leaving the office.

I'm not sure what the official diagnosis was - one of the main things I was seeking. About the only things I know at this point is my son was prescribed medication and we're supposed to see how that affects him & to keep up the reward/discipline system we've got going.

Yes, my son has a tough time at school & with other children. I could have really used some suggestions on how to help him deal with that situation.

I can make another appointment, but was told it would probably take just as long to get in again as it did the first time (we've waited about 4 months for the appt). I will be much more prepared and armed with very specific questions when we do go back. And I am considering another opinion - DH says let's give it a couple of weeks before making that decision though.

A lot of here also have our children being bullied at school, and we help each other, including us!

You need to go to the school immediatly when it happens. You also need to have your son tell the teacher. It needs to be address immediatly right when it happens.

the kids will label him and the bullying will last years, as in our case. The others who do not bully will join in, again as in our case!

Stop it now.

Call the teacher and set up a meeting ( 1 on 1) and explain to her and ask her what she knows.

Your son needs friends, one is all he needs.

Please post as you need assistance. We are always here!!

[QUOTE=rfchevy11]

Thanks to all for your input. I really appreciate all of it.

The thing about the appt. I regret the most is being so thrown that I didn't ask all of the direct questions I remembered about 2.7 seconds of leaving the office.

Now you're smarter

I write a list or I'll forget to ask my doc the most important stuff.

Now you know for next time so ONWARDS! HO!

Yes, my son has a tough time at school & with other children. I could have really used some suggestions on how to help him deal with that situation.

Bullying is a major topic here for both adults and children. Go for it...

[/QUOTE]My advice is more or less the same: Get a thorough assessment and/or a second opinion. Give as many specifics as you can to the care provider--real life examples, ala:

Tuesday, May 1: DS lost 5 points on daily grades for forgetting homework.

Wednesday, May 2: DS had 2 time outs at school for XYZ and ABC.

Thursday, May 3: DS got a score of X on his spelling test.

Etc.

HTH,

dee

Quick question for those who have children on medication - how did your kids react when they started the medication? We started the Concerta today & I'm not sure what to think. Explanation to come.....Thanks!

I have more experience with doctors than I care to remember, lol. But I learned the hard way after a disastrous gall bladder surgery--YOU have the right to 1) get all (or at least most) of your questions answered, 2) the right to seek a 2nd opinion, 3) get complete details on the condition you're discussing, and 4) hear ALL the treatment options. Anytime I hear that "X is the only way to treat this, and that is the only thing I do" I get nervous.

Go ahead and set up a second doctor's appointment with someone. Maybe someone in your circle of friends or your child's teacher or someone in the medical profession in your acquaintance may know someone. Look in the phone book--contact the local children's hospital if there is one.

Our normal family doctor does not evaluate or prescribe for ADHD, so we were referred to the local child and adolescent clinic. It does take a long time to get appointments--this is why I suggest going ahead and trying to get one for a 2nd opinion OR getting another with this same doctor if you want to talk to him more (he sounded too vague for my taste, but if you like him, that's very good).

Keep a log of the days' activities and how well the Concerta works. Remember that to have a diagnosis of ADHD, there must be documentation of at least two settngs (i.e. home and school) where the aberrant behaviors occur).

Good luck and keep us posted.

dee
My son has only ever taken one medicine - Metadate.

He is less talkative but not flat. Without the med he talks to himself a lot and he doesn't do that so much when he takes it.

It kills his appetite so he hardly ever eats lunch, especially when he is at school where he is rushed and has something he may not like as much. He eats breakfast, after school snack, supper, and before bed.

The first 2-3 weeks he starts them he has terrible insomnia. It is the pits. That happens if he stops for 5 days or more so we probably won't do that anymore. We were only giving it on school days.

Bounce, we also tried giving it only on weekdays--and found that weekends were awful, awful, as was the Monday it was time to go back to school. It's like the meds were starting anew each week with the same side effects. Bleh!!! We now give meds every day, and weekends flow as well as weekdays.

Dee

Thanks guys!

I asked about the medicine because the first day my son took the Concerta, he was WIRED. I mean - super hyper nervous energy non stop. And I don't think he slept at all overnight. Now, with that said - I think most of the changes in him were psychological - I think he thought he was supposed to act differently, therefore, he tried to do so.

Now, we along with the doctor have explained to him that he is still in control of the choices he makes, etc. The 2nd day on the medicine has been better. He isn't attributing EVERYTHING to this pill. (The first day it was "oh, I'm not hungry because I took a pill, everyone treated me different because I took a pill, people were nicer to me because I took a pill" - the exact thing we didn't want to happen) But, I know my son, and he is a worrier. Any change to his routine, and it weighs HEAVILY on him for a day or so.

I'm sure I'll have many questions and spend many more hours on here reading about different experiences. Thanks again for all of your advice, suggestions, and support!

I had to chuckle rfchevy11 on your son's statements about "Everyone was nice because I took a pill"--if he was right--I'd hand my Ritalin around at all the Christmas parties

LMAO Rebel - I too wish that was the case!

I think I'm favoring a 2nd opinion more and more. I got an official write up of our appointment & the doctor made notes of what we said, but basically made it sound like my son gets in trouble every once in while, and is reprimanded at school occasionally, his grades slip every so often, etc. And after all that we went over speaking with the dr, all the frustrated days, tears, confusion, etc, I wanted to scream!

The thing from the dr also says he suggested therapy for my son's lack of social skills (he never said this during the appt - he handed us some info on Autism & things that may help those kids). We really found out more about how the dr felt by reading this document that we did on the day of the visit.

I told a friend of mine about what we've been doing and the help we are seeking (her son is now 19) - she said she had him evaluated when he was young & the dr did a series of tests, questions, one-on-one time with her son. I guess we were expecting more of what she described than what we got.

You might want to try for a fuller assessment somewhere if it will ease your mind or get you more information.

I'd also start a behavior and medication diary. That will help the patterns and frequencies of behaviour. That might also help tell you what sets him off or what to avoid or what to do more often to get his compliance.
When I first spoke to my ped about my son's issues and suspected it might be ADHD. She did an exam and then gave me forms (Connors I think) to be filled out by me and my husband and his current and former teacher. She had me make an appointment with a dev ped and bring those forms with me. The dev ped was with him one on one and did several test. He concluded that my son had ADHD along with a difficulty in Lang Arts. He wanted to try meds. I was hesitant but decided I could try and if it didn't work I could discontinue them. He started on ritalin and I saw an immediated positive result. I asked to have my reg ped follow him and continue to prescribe the meds because it was easier to get appts with the ped. He was in 1st grade when he was diagnosed.

I implemented the marble system at home. He had been behind in his reading. After about a year on meds he finally caught up to where he should be. We had issues at school because he refused to do any written assignments. His handwriting was not very good. At home he still had meltdowns and go very angry easily. My ped recommended I see a dev ped again.

My first appt with this dr was at least 2 hours. He did a lot of neurological tests. Had him walk, run, stand on one foot, touch his finger to his nose, etc. He told me he had executive planning issues along with ADHD. He agreed with a diagnosis of sensory processing disorder that we had been given earlier by an OT. He insisted that I have the school do testing on him. My son had a 504 at the time. He said things would only get harder in school for my son. He suspected that he might have other LDs. He gave me a written diagnosis that day to take to the school and showed me how to write a letter to request testing from the school. He mailed me and the ped a more thorough written report. He wanted me to make an appt after i had the results of the school testing.

The school testing revealed that he had a LD in written expression, slow processing speed, and anxiety along with the ADHD. My ped referred me to a psychiatrist because she wasn't comfortable adding any new meds for anxiety. The dev ped and the psych both referred me to a behavioral specialist. Now my son sees the behavioral therapist every week and the psych. I only check in with the dev ped when something new develops.

Sorry, I rambled on. It just seems from what you said that the dev ped didn't do a lot of testing or take your concerns seriously. I would definitely recommend a second opinion. If your child has ADHD so often there are other things that come along with it.