What kind of doctor to see... | ADHD Information

My DS (13) was dx'd by 2 different pediatricians as having ADHD when he was 5.  I would like to have him "retested" (or whatever you want to call it) but don't know what type of doctor to see.  I have heard people talk about psychiatrists and pediatric neurologists.  Child psychs are very difficult to find in my area.  My DS is gifted (per testing at 2 different schools), has ADHD (per pediatricians.  He stopped taking meds last year and continues to be a straight A student.  I had several conferences with his middle school teachers this year because I wanted to make sure he was okay off of the meds and none of them felt his behavior was a problem - he seemed to be a normal middle school boy to them).  In the last 6 months he has developed tics that seem to come and go ( I feel they may be stress/anxiety related) and I also think he has anxiety issues and maybe mild depression (again this only seems to be an issue sometimes).  I find it very hard to figure out what is normal puberty "stuff" and what might be something more serious.  We have an appt. with the pediatrician in a few weeks but while I like the pediatrician, I'm not comfortable with her trying to sort this out and then possible start prescribing meds.  I would feel better with a specialist but dont' know who to see and don't want to wait 6 months to see someone.  What type of doctor should he be seeing?

Thanks!

Usually Child Psychologists are the most knowledgeable about ADHD.  A Psychiatrist might be well suited to get you the answers you need.  Neurologists and other specialists will test for different things - not specifically an evaluation for ADHD.  It could also be possible that your son is NOT ADHD but rather has some other condition.  Generally, kids with ADHD have problems in all areas of their lives.  They don't do well in school and have problems at home.  If that's the case, then it's likely to be something other than ADHD. 

I don't know if this helps or answers your questions but sometimes it's helpful to just get feedback.  Good luck.  Hope other people respond as well.
In order to get a definitive diagnosis, a neurologist or a psychiatrist have the knowledge and expertise. A neurologist can in fact diagnose ADHD and rule in or out other things. A psychologist plays a role in treating depression and anxiety and a pediatrician does not have the knowledge or expertise to give a definitive or differential diagnosis. A pediatrician is good for treating physical medical conditions, not child disorders of this nature. Because your son is experiencing tics, a neurologist should be the doctor of choice. Good luck and please keep us posted. Hope this helps.In my area, with problems like this the pediatricians send patients to a group of child psychologists who specialize in child disorders like ADHD to do all the "non-medical" testing for things like ADHD/depression/anxiety etc..  My son's psychologist did all of the testing and reported back to the pediatrician.  When we had problems with getting the right medication he referred us to a psychiatrist because they are medicine specialists.  My son has not been to a neurologist, but that may also be a good option.  Good luck!

I would stay with a pediatric neuropsychologist, even at his teen age. Depression comes and goes with those who suffer from it, however, if he has something like that, as well as anxiety, they are treatable.

He could have the depression and anxiety over teen stuff with friends. Is that a possibility? There is so much peer pressure for our kids out there, it really is hard!!

Hey Sink...lighten up a bit, o.k.?!  Nobody's  posted  a diagnosis for Greyhoundmom's son that I can see...just folks sharing their thoughts and responses to Greyhoundmom's questions.   Perhaps my post gave you that impression, but I think if you read it again, you will see that I was questioning the value/need for retesting her son...already diagnosed by two doctors.  Unless Greyhoundsmom feels there is a need to try to clear he son of the ADHD diagnosis, seems best to leave things as they are and not risk having the re-testing results coming up negative for ADHD which might trigger the recision of any helpful accommodations at school contingent on the diagnosis.

I think most folks sharing thoughts on this board are pretty savvy and sensitive and, despite appearances, aren't offering diagnosis when they offer their thoughts or opinions. Those responders that do try to diagnose become enlightened quickly that this doesn't work!   Anyway, some of us might get scared away from posting out of fear that the advice/thoughts we offer could be found annoying to others (in other words, can't we be just a little impulsive in our posting?!).
I was just thinkin' that John D...

Please everyone, continue to share your thoughts and experiences. This message board is a supportive environment and I don't want anyone to feel intimidated in terms of letting your voices be heard. Most parents who come here know that our experiences or thoughts are not substitues for professional advice and I often encourage people to gather the information they read about here and discuss it with a professional.

If anyone is disturbed by a post please take it to a pm because words can become combative and our goal here is support and unity, not division.

Greyhoundmom, how is everything going? Please let us know

Sorry!!!!!

Certainly didnt want to come across overbearing.

I suppose that my own diagnosis came so late in life and I have suffered so much and due to that I feel very defensive if I feel anyone might not get the care that they need.

I felt it was necessary on the message boards. I didnt want anyone to feel put off staying with a concern because we told them not to worry about it. I dont use the pm but I think you are quite right lovemykids. I should have used a private messenger in terms of feeling annoyed and then dealt with it a bit more chilled. Thank you Kjl and JohnD. I suppose reacting inappropriately is something I am very good at, I genuinely did feel it necessary but in hind sight see that the way it is done is so important. I should trust in you all more, we all the want the best for each other. But I suppose we each bring alot of emotional baggage to this website. 

Sink - It's all okay.  We who have ADD/ADHD are a very sensitive bunch  and I don't think anyone ever intentionally says something hurtful or overbearing. 

Yes, we all want the best for each other, yes we all bring emotional baggage.  Sometimes it's hard to leave that baggage at the door and address topics objectively.  That's not a crime or a sin, it just is.

Greyhound, I hope you have found an answer to your original question in here somewhere.  Please let us know.  I apologize for my part in the distraction. (that darn ADHD!)
kjl269140033.5471643519

thank you Kjl, ...... yes that darn ADHD, you can say that again! I got all upset about this, have been carrying it round with me and your words really helped. I am glad I am not the only one here who knows where I am coming from.

I am really grateful to you for your understanding.

(Greyhoundmom- it is never like this usually.)  

I am afraid I cant help you at all with your original question about  who would be the right person to go to.

We went through a local child counselling centre who sent us to a family therapy counsellor who referred myself and my son to the university clinic where I was referred to the adult psychiatry department. I think from that you could say the professionals themselves are often not sure who/where is the most appropriate place for us. It ended up for me like that game where you hide something and the hints you  get are 'warmer/colder'. Each professional was good but felt it would be more appropriate if we saw someone else.   It took about a year to get both of us checked out. For mine they checked school reports, job and training references, student lesson evaluations, interviewed hubby, looked at curriculum vitae and questioned me on the last two generations in my family.

 Within two weeks of taking my meds I could hold general eye contact for the first time in  life, speak in complete units of meaning and stopped crying.

You might start off at the wrong place but hopefully you will get where you need to be in the end. It will be worth the trek.

FYI, I am in Germany and the many visits were nearly all paid for by the insurance.

 

sink40033.6555208333

I certainly dont feel awesome at all. But having got to know the board a bit better I am trying to take it as a compliment, thank you.

Greyhoundmom, when I got into the right hands it didnt take very long to get my diagnosis. They took ages though working out my meds. I was started on Strat , and after a bit of (very difficult)trial and error found the right diagnosis. I have lost my Ritalin which I was given recently to try out, cant find them. It does help me speak and focus but I dont notice a difference in getting things moving, I still procrastinate beyond belief. I dont think it is a good idea if I take it and drive, so i am not bothered by the fact that I have lost them. Does anybody know anything about that - driving with Ritalin?

The idea is that I take it on top of the Strat when I need it. For example, if I have to fill out a long, complicated form or pay some bills and want to get the right amount of money to the right company, or put different things into different envelopes, all terribly confusing, risky things for me. 

Greyhoundmum. I think Kjl was right when she said it has to affect lots of areas of your life. But he might just have developed excellent coping strategies which of course when challenged wont be so effective, which would mean, keep a check on him at times of crisis.

It would be very helpful if you could read up about it yourself. You, or his dad might know him so well that with your own research and some training you can help him more than any of the professionals.You will be able to make him feel supported without ever putting a label on him. I think when it comes to our children it can be very helpful to know all about it ourselves whether they get a diagnosis or not.

If someone has lots of the tendencies but not the full diagnosis it would still be incredibly useful (without any danger of self diagnosis)if the parent knew all about those tendencies and behaviours. You will also realise by reading up on it, if this this diagnosis doesnt fit in the case for your son. Then you can start checking out other fields which I am sure  you are doing anyway.

I would say try to keep a journal, haphazard is better than nothing. Jot down things you consider to be noteworthy and bring those observations to your reading and research. Stay with him, he will change and develop and one day might even thank you for being so proactive about his difficulties, with or without the diagnosis.

But really I suppose I  feel if he hasnt got a diagnosis you still need to stay with him and be proactive and preemptive in your support. Perhaps he is working so hard coping that he is challenging the diagnosis itself. If this is the case I think you would see stress levels rising ie. anxiety or panic or avoidance of the situations which might cause them  - here is me talking !!! This is guess work.

Dont take my words as correct - I have no qualifications apart from having it myself, take them as ideas to play with in your head. 

My pms has subsided now, I am back on the track. Thanks all!

Sink,

Not for nothing, but I think you are awesome!     

I would hang out with you if I was in Germany. And I would also have hung out with you when we were kids.

You have friends on these boards, remember that - we are your friends!!

You have a lot to offer to the conversations!!

Is a Mental Health Counselor's diagnosis good enough? He works with children as well as adults. It depends on what certification this Mental Health Counselor has.  My opinion is that the higher their degree (MS, Ph.D.) are better.  It depends if this person specializes in people with ADHD.  If they're broad based, they may not have full understanding of ADHD.  They may try to "sell" their services anyway.  I saw "therapists" at a local college (Marriage and Family Therapy Center was the name of the place).  These people were graduate students who were supervised by licensed professionals but it's not the same as seeing the professional.  I sort of feel like I wasted 5 years and at /week, lots of money.  Never got diagnosed there.  There's something to be said for "you get what you pay for." Some professionals tout that they're experts in everything when they're experts in nothing.  You don't need to be as skeptical as I may seem but you do need to be careful and do your homework.  If something doesn't seem right, then by all means find someone else.  You can also check with the American Psychiatric (or is it Psychological) Association to see if this person is legitimate.  Or the state board of health may have some recommendations as well.  Sorry, I got off on a tangent.  Greyhoundmom...I'm curious why you want your son "retested" for ADHD.   From what you describe, it could well be that a qualified clinician would find that your son is no longer exressing traits (and negative outcomes due to those traits) to support an ADHD diagnosis.  Is that what you are hoping for, since previously your son had been diagnosed?  From what you've shared with us in your post, it sounds like your key concerns are to determine if he is depressed and/or experiencing anxiety, and if so, how best to address that.  And the tics...don't blame you for wanting to find out all you can about what might be causing them and how they might be diminished or stopped.   Perhaps you want the ADHD re-testing for you, and the screening for depression and anxiety, and investigation of the tics for him? 


On ADHD "tests", here's my thinkin'..... Show me a test, or a suite of tests, the results of which alone are diagnostic as to whether a child (or adult, your choice!) has ADHD and we have entered into a whole new era!  I'm not challenging any of the good advice/opinions above, just reminding folks that the diagnosis for ADHD, from all I've read and continue to see, is dependent on careful inquiry and interview with the person and (preferably) significant others first and foremost.    A conclusion of impairment in at least two areas, necessary for a diagnosis, cannot be accomplished by testing.  Period.  Test results cannot rule in or out a disorder such as ADHD in a person; test results can offer evidence supporting a diagnosis.  And I've not seen or heard of test results beinig used to rule out a diagnosis.   I'm talkin' neuropsych tests, not the brain scan stuff!

My final thinking about test results (for now!) (yeah, I know, I'm beginning to rant!) is that test results' highest and best use is to compel otherwise obstinante, obstructionist, unhelpful and unsupporting school authorities (supervisors for working adults) to  provide accommodations rightfully due the student.  It doesn't sound like you are confronted with this situation.

Given the situation described;
* Straight A Student currently
* Labled "gifted" by two schools
* Diagnosed ADHD by two doctors
* Experiencing tics currently
* Suspected of possible depression and/or anxiety

A need for educational or neuropsychological testing isn't jumping out in front of me!  Your gut instincts sound right to me:  don't rely on your son's pediatritian to get to the bottom of the tics and possible depression and anxiety; discuss with your pediatrician what specialist(s) or team she would recommend.   Hopefully it will be someone who your son can relate to and discuss issues that aren't often easy to discuss at his age, especially since some psychotherapy may be needed to "nip in the bud" anxious or depressing thought tendancies.

My final comment....You son is one fortunate kiddo...because you sound like the most wonderful, insightful and supportive Mom a kid could hope for!

Greyhound, I just wanted to add that his "tics"/anxiety may be his co-morbid of adhd. You and I have talked for several years now and you are a wealth of knowledge!

Do you believe your son is just adhd or could he have a co-morbid and this is what it is? My son has anxiety has his comorbid.

I also think that a lot of teens go through depression, especially adhd'ers.

Is there anything in his life that he is personally struggling with??

 to you both!!

I am a bit annoyed by what I read here. The reason is I get the feeling that site members are saying that it sounds as if he hasnt got the right diagnosis. ie.'he cant be ADD - can he?'

First of all, you cant , yourselves, diagnose a child by the reports of a parent on this site.

Secondly, havent we all suffered long enough from not having our diagnosis identified much earlier in our lives. I was a 'good girl' , a dreamer, very good at school in subjects I was awake to (in the beginning of my secondary phase of education , from 13 on) and slowly got boarderline good to extremely bad, only in areas that didnt interest me. I was the joker in the classes where I wasnt motivated. In the subjects I was good in I proved myself and went on to get a university degree.

As a 45 year old after years of counselling and treatment for depression and suspicion that I must be bipolar I started on ADD medication to be told by my psychologist, herself  highly specialised and experienced  in the ADD field,  that she had rarely seen such a day/night improvement in a patient induced by medication. Since starting my medication my life quality, and that of my family's, has improved noticeably.

I do not want anyone to be robbed of the chances of a happy life because they are good academically. If people who were academically bright, ie. good at school,   could not have ADD the whole diagnosis issue would be alot easier. That would be a very clear signal for a diagnosis, unfortunately it isnt the case.

My son is showing the same  behaviour patterns as I had. He will not allow himself to be diagnosed - I support him in that (12 years old). We are there for him. Me getting medicated has of course helped him enormously because he now has two parents who can function, not just one.

If at some time in his life he isnt able to move on, which I presume will come , I will be there to support him. Up to that point 'he is not ADD' (although the reports have not ruled it out). 

What am I saying? I begrudge very much the children who are not trouble makers, (a gender issue - often the dreamer girls who make no fuss in the class) being denied the attention and care that the 'difficult' children are given, the interest from qualified psychiatric staff and doctors. I never got any of it, I had a horrible childhood. So horrible that it was the motivating factor for me to get my whole family to go for evaluative checks which resulted in my own individual diagnosis.

Generally, kids with ADHD have problems in all areas of their lives.  They don't do well in school and have problems at home.  If that's the case, then it's likely to be something other than ADHD. 

Kjl, I have to disagree. This is also not supported by the research I am familiar with (tell me if you know some). It might be true for the ADHD 'Attention Deficit Hyperactive Disorder' but not for the ADD without the H. I dont even know if that is true, but can only presume it.

Our academic coping strategies take us as far as university degrees and the like,  ADDers are a creative, resourceful lot. Take Hallowell and Ratey! But we dont do it without any cost.

I would ask greyhoundmom to keep an open mind. Be there for your son. It is most important that he has a picture of himself that is a healthy, happy boy. Whether he has ADD or not. Stay with him, support him and his self image, either with or without diagnosis.

If you turn to page 206 of your Driven to Distractions you will see how difficult it is to diagnose ADD, if we get some quality 1:1 or a novelty setting (maybe much loved family guests for a week or two at home, or a scout camp week), we flourish and the signs of ADD seemingly disappear! This is a difficult thing to diagnose and I dont think we can do it here.

 

  

sink40031.6736921296sink - thank you for your comments.  I don't have any research per se, but what I was trying to point out is that in order to have an accurate diagnosis, the individual must display symptoms (wether they're ADD or ADHD symptoms) in more than just one area of their life.  For instance, if Johnny does well at school, can sit still and pay attention and play with other kids at school and then comes home and all heck breaks loose, then it may not be ADD/ADHD. ADD/ADHD has affected all areas of my life from home, work, relationships, school (when I was in school).  I believe it's important to keep an open mind as to what the problems are. Also, in order to have a complete, accurate diagnosis, one also needs to address the standard questions in the Diagnostic Manual (I don't know if this is a world-wide guidebook).  And if the individual meets the criteria, then a diagnosis can be made. Yes, careful, understanding interviewing of the individual and other significant people in the patient's life is also necessary. Of course, there are other "tests" as John D has mentioned but are those really necessary for a diagnosis of ADD/ADHD? (i'm talking about the brain scan stuff he mentioned) 

Everyone displays their own variety of symptoms.  That's what makes it so difficult to diagnose.  I, too, have been misdiagnosed and under-diagnosed and treated for the wrong conditions.  It is my suspicions that too many people are being misdiagnosed or not getting diagnosed at all but getting "labeled".  I also feel that many people are being diagnosed with ADD/ADHD when indeed it is inaccurate because the professionals diagnosing these people are misinformed or only see dollar signs.