Is this a bad, bad psychiatrist? Or should I just take the drugs and run?

[BestICan]

Just wanted to follow up on this.

After speaking with two doctors and a nurse (all relatives - lucky me) and holding onto the prescription for a couple of weeks, we decided to give the medications a try. We've been trying to deal with the same dang behavior issues since difficult child was in preschool and my gut told me that the medications were a reasonable approach whether or not I liked the doctor.

We gave him a conservative dose, 36 mg with is on the low side for his weight. He's still himself, but we've noticed significant improvements in his impulsivity and ability to concentrate. He also seems a bit more invested in trying to control himself, even when the medications are worn off. I haven't been pulled aside to talk with the teachers since he started on the medications, which is a welcome relief! Who knows...could just be a honeymoon...we could all be falling for the placebo effect...but I'll take it for now.

We saw the psychiatrist again today...I think I need to take back my rather dismissive statement about his office being an "ADHD medications factory." I didn't realize until today that you can't get refills on a stimulant prescription, due to the fact that they are a controlled substance, so you have to go back once a month.

Thanks again for everyone's two cents!

*******************

Our pediatrician politely refused to deal with our ADHD concerns about difficult child because he felt difficult child's seizure disorder and anti-seizure medications took the situation out of his comfort level. He suggested we see a specialist.

Not wanting to pay approximately $4k out of pocket for a neuropsychologist exam, I've been calling around to find psychiatrists and tdocs who are covered by my health insurance. I'll spare you the details of why I have walked out of 3 different offices and never come back, but this new guy was so happy to give us pills that I took them, and now I'm wondering if I should have.

This new psychiatrist was covered by my insurance. I made the appointment by saying "I am looking for someone who can diagnose ADHD." When we get there, I can tell it's an ADHD medication prescribing "factory." Lots of teens in the waiting room for their 5-minute medication management appointments, lots of ADHD medication logo items...perhaps this is a familiar scenario for some of you?

After 5 minutes he sends difficult child out of the room, tells me difficult child clearly has ADHD, and says, "Let's talk about medication options." He decides on Concerta because "my health insurance probably covers it," then he advises me to start difficult child on one pill, then try two, then three if I think he needs it. Feel free to start him on a school day, don't worry about addiction issues (P.S. my father, a drug addict, killed himself this year...would hate to worry too much about that...), don't tell him the side effects because he'll think he's having them, don't tell his teachers because they'll fall for the placebo effect. Yes, they'll probably lower the seizure threshold. Then, "OK, come back in 2 weeks."

GAH! I'm so frustrated by this stupid system. Not even a teacher survey? My friend whose son is on ADHD medications is supposed to ask his teachers to fill out surveys ONCE A MONTH. She pays a ton out of pocket for her doctor.

If I weren't so certain that difficult child has ADHD I'd leave this doctor and never come back. therapist, who can't diagnose but spends 80% of his professional life with ADHD kids says my son is a textbook case. He's really great - we've been with him for 3+ years. I pay him out of pocket, of course.

So, what would you do if you were me? Give difficult child the medications and go by my own judgment about whether they work? Tell the teachers? Scrape together $4k for a neuropsychologist test? I'm told I can get a TOVA (Test of Variable Attention) from my therapist's office for something like $350 - do you trust this test?

I try the ADHD advice sites but I keep coming back here because the caliber of advice and caring is just so much higher here. Thanks so much if you have any advice to share.

Jen

 

[klmno]

I would run- and leave the medications behind. I get the jest that you feel it is ADHD, but some other diagnosis's cause hyperactiveness and can cause a kid to even meet diagnosis criteria for adhd, but the medications might not be the best for the child and you might not be to the "real" problem without a proper evaluation first. Even then, it can be a trial and error situation- and ususally is or we wouldn't have this board. But what is worse about your story- if this "psychiatrist" is rx'ing medications that fast without any evaluation, what would he/she do if the first stimulant doesn't solve the problem?- think this thru before you do anything. Personally, I would find a mental health clinic or ask the sd to evaluation my child before I'd accept a psychiatrist basicly handing medications out. Preferably, you would get a thorough evaluation, including neuropsychologist testing, but if you can't afford it, try to get an evaluation some other way, in my humble opinion.

 

[gcvmom]

What about a pediatrician neuro? Very often they can manage both seizure and ADHD issues, if you are pretty certain that's all that's going on. Who manages his seizure medications?

 

[Marguerite]

If you're really convinced, and given your health insurance system, I woud be tempted to take the medications for now but keep looking for something a bit more scientific and thorough.

The first pediatrician we saw with difficult child 1 seemed great to begin with, although he diagnosed ADHD about as readily as the bloke you describe. He even came to difficult child 1'sschool to talk to them about ADHD and give the teachrs some understanding of what difficult child 1 was going through.
But ten eh went a bit strange and started focussing on me and my tendency to stay dead calm on the surface, raother then get labelled as emotional and hysteric. He started trying to upset me or make me angry, experimenting on me despite difficult child 1 being the patient, not me. He then began to blame me for difficult child 1's mental state, accusing me of being a "primary depressive" who had 'infected' her son. I took myself to see a psychiatrist at the time, purely to test this hypothesis - and I was cleared. The ratbag pediatrician then declared that I really MUST be mentally ill, if I was skilled enough to fool a psychiatrist!

When we moved on, the new doctor doubled difficult child 1's medications.

I put up with the first pediatrician's mucking around, because we needed a supply of medications for difficult child 1. I didn't have anyone else I knew about that we could see. I stayed with the first bloke until I found a second one. I had a list of names, I had a third bloke to go to if the second one didn't work out. We're now with that third pediatrician. The second blokewas great for a few years, then started to beave a bit more bizzarely than usual. He also couldn't take on any new patients and we needed to find someone for the other kids.

Sometimes you have to make less-than-satisfactory choices.

Marg

 

[LittleDudesMom]

I have the same beginning question as gcvmom to begin with - who manages his seizure medications?

Your therapist can certainly do the the adhd testing, especially if there is a history and trust issues. My son's therapist did all the testing. I had questionairs for his teachers and sunday school teachers and his father and myself. She gave him two seperate testing modules in her office. Once she had time to analyze the data and the forms, we went in the diagnosis appointment.

Since she could not rx, she gave us a bit of basic info on adhd medications and the differences (although I knew the diagnosis was coming so I had researched them on my own). Then she referred us to the peddoc for the script as well as giving us a lits of 6 different pedpdocs for the future.

Quite frankly, I would not give him the medications. I would call a local children's hospital or teaching university to see if they can help you out cost-wise. Also, since you trust the therapist, have you asked for referrals? Also, your insurance company usually has a staffed nursing line. That is another option for finding a doctor or discussing your options. The pediatric psychiatrist stuff is a real nightmare.

Good luck.

Sharon

 

[Janna]

I dont know anything about seizures. Does the Concerta have any affect on them? That would be my only concern. My youngest is on Concerta, doing well too, but has congenital heart disease. He has to have EKG's, because the Concerta can stimulate his heartbeats - causing him issues. So far (year and a half) so good.

If things are OK with the seizures, I'd take the drugs. I mean, tdocs can't diagnosis, true - but not always does a psychiatrist diagnosis and it's right LMAO! So, you feel comfy with ADHD, therapist feels it's ADHD, Concerta is quick in, quick out. Give it, see if it works, if not, go back to psychiatrist and tell him. If it does, then all you need is your 5 minute medication check for this bozo to write the script.

 

[BusynMember]

Any doctor who thinks he can diagnose a child after five minutes is in my opinion a big quack. If you are on Medicaid, like me, you can get a neuropsychologist evaluation at most university hospitals--they all take Medicaid and you get treated as well as somebody with insurance. The evaluations are well worth it. If you don't go to the right kind of diagnostician (which I learned the hard way), your child WILL end up misdiagnosed and/or overmedicated for something the prescribing doctor isn't even sure he has. ADHD has many mimickers and your child should be tested competely. I really hope you can find a way to resolve this. It really rankles me that so many psychiatrists are incompetent. As for pediatricians--they don't have the training to even begin to diagnose. The problem with plain Psychiatrists is that many don't update their training and they look for psychiatric disorders and often miss things like high functioning autism, which looks a lot like ADHD.... Don't get fixated on "it's ADHD" or some doctor will agree with you, whether it's true or not, and he won't look beyond that. Can you share some of his upsetting behaviors with us and tell us about his early development and social skills with his peers? I wish you good luck whichever path you choose to or HAVE to take. (((Hugs)))

 

[slsh]

Jen - I'm a huge wimp when it comes to seizures (we also deal with partial complex, with a status seizure thrown in every once in a while just for good measure) but there is absolutely no way I would give my kid a medication that would "probably" lower the seizure threshold unless it was a matter of life or death. It this guy kidding?!? Goodness.... that's just completely irresponsible in my humble opinion.

I do agree with- not telling difficult child the potential side effects and I do agree with- not telling the teachers he's starting medications but I think there's a whole lot more involved here that the psychiatrist is brushing aside. I would run - fast.

The TOVAS test in my humble opinion is reasonable. I have to admit, with your dad's history, I would be worried that TOVAS might miss something else possibly going on - but that's just my opinion. You know your kid best.

I do agree with gvc and Sharon that whoever is managing the seizure medications needs to be a full (if not deciding) member of the team that determines what if any medication your son should try for ADHD.

I have to tell you my opinion is very much influenced by our life around here - seizure control for my oldest is iffy at best so I'm pretty touchy when it comes to messing with that. So... take my opinion for what it is.

 

[BusynMember]

Ok, I just reread your post. If your father was a drug addict and committed suicide those are actually big red flags for bipolar disorder. Bipolar has a huge suicide and substance abuse rate. I would definitely look beyond just ADHD if this were my child. The Connors Scale doesn't cover a ton of other disorders that co-exist or mimic ADHD. And stimulants can make some kids worse, not better, if the problem is really NOT ADHD, but a mimicker. JMO

 

[Josie]

The others have given you good advice. I just wanted to add that 4 years ago, therapist, psychiatrist, and I were convinced that difficult child 2 had ADHD. However, the psychiatrist suggested a neuropsychologist exam to be sure. The exam revealed that her "ADHD" was fueled by anxiety so treatment was different.

 

[TerryJ2]

Hi Jen,
this sort of psychiatrist seems to run rampant these days.
I think you've gotten some great ideas here.
What a frustrating endeavor. Is there any way you can negotiate that $4k fee for a neuropsychologist exam? I'd call the ofc and talk to the mgr. I good diagnosis is essential.
One good thing about the psychiatrist--he admitted it was out of his comfort level. I'll give him one for that.

 

[aeroeng]

I have found that as far as ADHD medications go, the Dr is only there to write the prescription. It is the parents that observe and decide what the child needs. Concerta is a common ADHD drug. When my child was prescribed it, I tested his attention on Monday without anything (How many sentences can he copy over). Then on Tuesday with the medication. Because I saw a huge difference, and without zoning him out. I agreed the drug worked. Any and all increases and decreases in dosage was based on my observations, not the Dr's. He should still see a Dr for side effects related to blood pressure and such. I would agree with not telling him about the side effects. I do not agree about not telling the teachers. They should be told. Yes he sounds like a bad, bad psychiatrist. I would look for another, but get the drugs and make your own decision on what he should take until you find someone you are happier with.

 

[BestICan]

Hi all, thanks so much for your advice. I have a lot to think about, that's for sure.

To answer a couple of questions, he has a pediatrician. neurologist who we'll be seeing next week for a regular checkup. We see this doctor only twice a year because fortunately difficult child's seizures are under control. I'll definitely discuss this with her but based on my discussions with this practice before, they only do neuropsychologist evaluations for pre-surgical patients, and I would never get it covered by insurance, or even be able to squeeze in an appointment, unless we needed an evaluation for surgery.

But I'll ask her advice about all this, especially about the medications/seizures situation, for sure.

Terry, a point of clarification: It was difficult child's pediatrician, not the psychiatrist, who admitted the situation was out of his comfort level.

Thanks, all! I hope to get husband to read this thread too...

 

[TerryJ2]

Jen, that makes sense. Still, it's better to have a dr admit they're out of their league than dispense medications and really hurt someone.

 

[BusynMember]

Are you sure a neuropsychologist evaluation is for surgery? It's a battery of tests, taking up to 10 hours, to evaluate the child's function in all areas of his life. I don't see where it would have anything to do with surgery...a neuropsychologist is a Psychologist with extra training in the brain, therefore he can intensively test and diagnose everything from bipolar to autistic spectrum to ADHD. That's how many of us got our best diagnosis. If a child is given stimulants, because ADHD is presumed, and he actually has an impending mood disorder or is on the autistic spectrum, stimulants can cause more problems than they solve. It is in my opinion better to be safe than sorry before trying ANY medications. We learned the hard way. Our son was first dxd. with ADHD and that was not the actual issue, as we found out later on. A pediatrician referal should be enough to have insurance cover it. Good luck!

 

[Ropefree]

BestICan: With a condition as specific as seizure disorder the track I would want would be a top end clinic or hospital with specialists doing the diagnostics and treatment oversight, and someone local (if it is a far away place)offering the monthly evaluations including the snap evaluations from school and you for the main treating physician to also review annually or semi annually.
I also hesitated with the medication treatments for adhd. For me the turning point had to do with how my child was feeling and percieving himself do to the social recrimination from others and the PRESSURE FROM TEACHERS. These conditions do impact learning and it is vital that we are all working to create the best possible outcome for each child who is being a subject to these meathods.
It is a guingey road being the parent and making the desitions for our child. Caution and courage and making the choices when and whom to trust.

 

[BestICan]

Hi MWM, in the case of my difficult child's pediatrician neuro clinic, apparently they do a lot of brain surgery. My understanding is that they do neuropsychologist evaluations to assess functioning prior to brain surgery in order to gauge the effects that the surgery has on the child's ability to function in several areas.

After SUCH a struggle, I did get a referral, covered by insurance, to a psychiatrist's practice who claimed to do neuropsychologist testing. But I posted about him here ages ago and most people (including difficult child's neurologist) thought he was a quack because he was pushing some unproven treatment..was it neurofeedback therapy...? and he also "diagnosed" my son after 5 minutes of seeing him. I just have terrible luck finding good professionals.

I've talked to a couple of good practices around here - ones that offer thorough neuropsychologist evaluations. Unfortunately they aren't covered by my insurance.

 

[CrazyinVA]

I wanted to say that neurofeedback can actually be quite helpful for kids with ADHD, I have a friend who practices it (she has a psychology background and works for a psychiatrist) and she's treated her own ADHD child with remarkable results. She treated me for depression and anxiety, with great results, as well. Every patient is different, of course, but I wouldn't call someone a quack because they recommended it, necessarily. That's not your question, though.

I would ask the pediatric neurologist for a recommendation of a psychiatrist. Has your therapist recommended one? Sometimes doctor-to-doctor referrals are good resources, since they frequently work together to coordinate a patient's care.

 

[Marguerite]

It seems crazy to me that your insurance covers the duds, but not the good stuff. Probably because the duds keep their costs down by making 5 minute diagnoses...

Can you telephone te pediatric neurologist for some fast phone advice? Rather than wait for the next appointment.

Good luck with your decision. I understand your dilemma. Medicine is an inexact science, and there's no magic bullet. All you can do is make the best choice you can for your child, and hope.

Marg

 

[BusynMember]

Wow, it reeks that you can't get a neuropsychologist done without paying. I'm really sorry. Just keep an open mind. As parents, we are not equipped to know if our children have ADHD, bipolar disorder, autistic spectrum disorder, or other disorders. Very often they look the same. I was told ADHD, which is usually the first diagnosis. for a child, and I gave my child medications right away. Rather than improving his focus and behavior, he got mean and aggressive. When there are possible mood disorders in the family and if his development was atypical (which you didn't tell us--speech, eye contact with strangers, interaction with same-age peers)--it is so hard to know if a medication will help or hurt. I hope you can get the kind of testing you need. Warning: The Connors itself is not diagnostic. My son scored off the charts on the Connors and all of his teachers said "ADHD" too. The thing is, the Connors comes out off the charts for Autism Spectrum Disorders (ASD) and bipolar too and teachers are educators--they don't know how to diagnose. What kind of behaviors do you see? How was his early development? We can't diagnose either, but we can put in our .02 if you give us a bit more insight. NeuroFeedback could help many disorders, but I'm not sure I think a child can do it--I had trouble as an adult. It takes a lot of focus, which I never had. Plus it's not a stand alone therapy. I'd go with traditional therapies for now. JMO
I sure wish you luck.