Newbie--Advice sought for possible ADHD diagnosis

[whiteraven]

Hi!

I'm new to the site, currently educating myself on ADHD, which my six year old is "strongly suspected" of having.

I am terrified of possibly having to medicate him. I've been so against medicating children all my life. But his behavior sometimes is so extreme that I feel he NEEDS something to make him feel better. But then I ask myself, "What if he doesn't have ADHD?" What if he doesn't have anything and the problem is not him, but my parenting techniques? I tell myself that this can't be the case... I'm an educated woman, I've read a lot on child development and behavior, I even took two university classes on early childhood development and behavioral management! But, who knows, perhaps it is me.

I am divorced and also have a 4 year old daughter, whose behavior is "normal."

My difficult child goes through cycles that consist of:

1. Good behavior, is pleasant, helpful, plays nicely.
2. Behavior starts to deteriorate: he loses focus on whatever he was doing or maybe he gets bored; he starts bothering/teasing/attacking his sister (I then ask him to stop and, as he continues, I end up yelling at him/scolding him) or asks for something that I cannot give him.
3. His reaction to both scenarios is a full blow out, crying, screaming, being destructive, or throwing things.
4. Then he calms down and goes back to Step 1.

On Step 2, he actually looks for things to be upset about (he will ask for things he knows he cannot get or he will start picking on his sister, my SO or myself in an increasingly unbearable way).

During his bad moments, he has said things like he hates himself because he can't control his behavior, that his brain doesn't work because it can't control his body, that he hates us all, that he wonders when he's going to die.

During his good moments, though, he is a genius: funny, bright, smart, engaging... a real pleasure to be around. He is doing very well at school academically (but having lots of behavioral problems).

I feel that something is just not right. I took him to see a LICSW who specializes in children and she suspects he has ADHD. Today I called his pediatrician and they recommended a neuropsychologist evaluation, so I called the school and they will do it. But then I read somewhere that the school's evaluation is not as comprehensive as a private neurologist's, so I'm not sure if I did the right thing.

I feel like I'm swimming in murky water, and I just want to do whatever is best for my son.

Any advice will be greatly appreciated.

-------------------------------
Me - 38, anxiety
SO - 45, normal
EX - 37, verbally abusive (mainly towards me), suspected ADD or ADHD
difficult child - 6, suspected ADHD
daughter - 4, normal

 

[smallworld]

Welcome!

Have you ever read the diagnostic criteria for ADHD? If you have, you might realize that what you're describing doesn't sound much like ADHD at all.

ADHD is not about meltdowns and saying you hate yourself and others and wondering when you are going to die. It sounds much more likely that there is a mood component brewing than ADHD.

A private neuropscyologist will do a more thorough job than the school for two reasons: more skilled professionals doing the testing and the evaluation is broader on the outside (not just confined to educational impact).

Again, welcome. You will find a lot of support here.

 

[pepperidge]

Hi

Others will be along with more to say. But most of us will recommend that you read the The Explosive Child because of its usefulness in dealing with temper tantrum type of behavior.

Generally schools are not equipped to do the full battery of tests that a regular neuropsychologist test would do--but they have the advantage of being free and may give you a place to start.

Many of our kids have more complicated diagnosis that "just" Adhd--but sometimes ADHD can be pretty extreme as well. Many of us also resisted medications for a long time and out of desperation eventually tried them. Often with some success, though perhaps not right away.

The good thing about ADHD type of medications is that it is usually pretty obvious whether or not they will help fairly quickly--within a day or two, though sometimes the dosages and different types need to be tried to get the optimal medication/dosage.

Probably a number of us have also started with ADHD diagnoses. For some it was obvious that that wasn't the whole story, for others diagnosis has been much more elusive and long term.

You sound like you you are approaching your child's issues in a thoughful and proactive manner. Welcome and I am sure others will have more helpful suggestions for you.

 

[Malika]

I do not yet know in detail what a neuro-pscyhologist does (trying to get my son tested; the waiting lists are long) but I'm sure it's a good idea. As someone who has been dealing with a "suspected ADHD" child for nearly four years, I agree that what you describe does not sound much like ADHD...
We live in an age where things are labelled, pathologised... Which is not to say that disorders do not exist, obviously. But curiously enough, for whatever it's worth, what went through my head when I read your post was a "normal" family I know containing two teenagers and a younger boy... well, the younger boy, who no-one has ever suggested has some disorder (and who has got SO much calmer over the years I've known him - he's now 8) used to have shouting and screaming fits a bit like that - a very passionate, argumentative, "spirited" nature... I would personally (you are on the ground, you are the one in a position to know, not me ) keep a weather eye out for the possibility that your son is actually "normal" but of a particular, highly-strung temperament...
I was very passionate and highly-strung as a child too... felt things very deeply... I remember having almost hysterical fits when upset, up to the age of nine or ten... I don't think I had any disorder - certainly it was never suggested!
I really don't know. I'm just saying we do rush to put a psychological label on things these days...

 

[BusynMember]

Hi and welcome.

Personally, I think it sounds like a lot more going on than ADHD. I wouldn't trust a social worker to diagnose. I'd take it to a neuropsychologist (6-10 hours of intensive testing) and then a psychiatrist. If you medicate him for ADHD and more is going on, it will probably make him worse not better. This is not an exact science. And don't question your parenting. Our kids are just born with different wiring and do not respond to traditional parenting methods. Some don't respond well to any methods at all, but it's NOT your fault. I'd explore much further.

I know in some countries they do not like to diagnose or label children. I respectfully disagree with that.in my opinion the best outcome is an early diagnosis and treatment. Without a diagnosis. you get no help, say, in school or the community.And the behavior usually escalates until you hit the teen years when the child can end up completely out of control and unwilling to help himself.

Hugs and glad you found us (but sorry you had to).

 

[HaoZi]

Has he been tested for food allergies/sensitivities yet as well? Some find a dietary change can help their kids a lot. I was against medicating mine for quite a while, too, and knowing that some food allergies can cause disruptive behavior, that was the first thing I asked to have done. Didn't help us, as all dietary changes do here is change create bathroom changes, but it's one more thing you can look at.

How often does he cycle? Is it more prevalent during certain times of year or month? Around the time he has tests at school and is feeling stressed out? When there is a schedule change he didn't anticipate?

 

[whiteraven]

Hi smallworld,

I did check the criteria for ADHD, and he meets many of them, but perhaps not in an overwhelming way... which makes me think that perhaps he is borderline ADHD:

(A) Either (1) or (2):
(1) six (or more) of the following symptoms of inattention have persisted for at least 6 months to a degree that is maladaptive and inconsistent with developmental level;

• often fails to give close attention to details or makes careless mistakes in schoolwork, work, or other activities -- Sometimes, yes
• often has difficulty sustaining attention in tasks or play activities
• often does not seem to listen when spoken to directly -- Yes
• often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (not due to oppositional behavior or failure to understand instructions)
• often has difficulty organizing tasks and activities
• often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (such as schoolwork or homework) -- Yes
• often loses things necessary for tasks or activities (e.g., toys, school assignments, pencils, books, or tools)
• is often easily distracted by extraneous stimuli -- Yes
• is often forgetful in daily activities

(2) six (or more) of the following symptoms of hyperactivity-impulsivity have persisted for at least 6 months to a degree that is maladaptive and inconsistent with developmental level:

• often fidgets with hands or feet or squirms in seat -- Yes
• often leaves seat in classroom or in other situations in which remaining seated is expected -- Yes
• often runs about or climbs excessively in situations in which it is inappropriate (in adolescents or adults, may be limited to subjective feelings of restlessness) -- Yes
• often has difficulty playing or engaging in leisure activities quietly -- Yes
• is often "on the go" or often acts as if "driven by a motor" -- Yes
• often talks excessively
• often blurts out answers before questions have been completed -- Yes
• often has difficulty awaiting turn -- Yes
• often interrupts or intrudes on others (e.g., butts into conversations or games)

(B) Some hyperactive-impulsive or inattentive symptoms that caused impairment were present before age 7 years. -- Yes
(C) Some impairment from the symptoms is present in two or more settings (e.g., at school [or work] and at home). -- Yes
(D) There must be clear evidence of clinically significant impairment in social, academic, or occupational functioning. -- I'm not sure what "clinically significant" means. It seems to me that he has trouble forming close friendships and he is suffering at school because of his behavior.
(E) The symptoms do not occur exclusively during the course of a Pervasive Developmental Disorder, Schizophrenia, or other Psychotic Disorder and are not better accounted for by another mental disorder (e.g., Mood Disorder, Anxiety Disorder, Dissociative Disorder, or Personality Disorder). -- This I wouldn't know...
Thanks for the advice regarding the private neuropsychologist.

 

[whiteraven]

I think that's what scares me... The possibility that he's "normal" and I end up doing a huge disservice to him by medicating him. But his behavior is interfering with school and at home we get no peace. And when I try things techniques like redirection or substitution, they just don't work. What worries me the most is his inability to control himself. Sometimes he looks like he's "lost it" and there's no way to make him regain control until he KABOOMS and releases all the pent-up energy crying and screaming.

 

[whiteraven]

I will get The Explosive Child today, thank you!

 

[whiteraven]

You bring an excellent point. Just as I'm worried about wrongly diagnosing with something he doesn't have, I'm also very worried about the fact that with-o a diagnosis, he is simply a "badly behaved" kid at school, and even though so far the teachers have been working cooperatively with me to find ways to improve his behavior, I think that having a diagnosis would definitely help him get more help and understanding from everyone... plus, if he does have a condition, getting treated is what will ultimately will help him the most.

 

[whiteraven]

Hi HaoZi,
How did you test for food allergies/sensitivities? Was it just thought trial and error (eliminating certain foods from his diet and seeing the effect?). Is there a website or book that you could recommend that explains how to go about doing this?

He cycles at least once a day, sometimes two or even three times. I interrupt the cycles by letting him watch TV or play video games for a while (an hour or so). They happen all throughout the year, but I will analyze whether they are more prevalent when he's feeling stressed out. Thanks!

 

[HaoZi]

Her pediatrician did the allergy testing, a skin test. If yours won't, see if they'll refer you to an allergist or whatever those docs are called.

 

[BusynMember]

Are there any psychiatric disorders on either side of his family tree? Genetics play a huge role in mental illness. Often difficult children have at least one difficult child parent or many mentally ill members on the family tree.

 

[Edconparent]

From your description, it sounds as though ADHD should be tested. I think your best bet is to go to a local Licensed Psychologist who can perform a ed/psychiatric evaluation. and has experience testing younger children. You should ask for an IQ using the WISC variant for younger children. Weschler IQ tests have a number of sub-scales (verbal, memory, performance) that are compiled to create the composite score. Typically, ADHD conditions will show lower scores in the Working Memory sub scale and/or Processing Speed sub score. Since you suspect ADHD, the psychologist will no doubt do some additional ADHD-specific tests. Between the IQ and ADHD specifics, I think you'll get a pretty good idea of what you are dealing with.

 

[Malika]

Hmmm.... this is interesting. The most specific guidelines to diagnosing ADHD that I've come across - can I ask how you know about this edconparent and what sources or studies have substantiated it? Part of the reason for my own scepticism about the ADHD diagnosis is that it seems, essentially, vague and unscientific. The questionnaires do not seem particularly helpful - eg my son scores hardly any on the "inattention" side of things but many on the "hyperactivity" side so that would technically seem to rule him out for ADHD. But... there is clearly something going on with his constant, constant physical motion and with his strange inability to identify colours no matter how much "teaching" about it he receives... (he is not colour blind). So I am very interested to hear that there could be some more objective test.
For your son, whiteraven, I am clearly stabbing in the dark... you live with him, you know whether there is something really "wrong" or not... And, of course, getting a diagnosis is a way of getting help. If the diagnosis is reliable...

 

[AnnieO]

I have a husband who I'm darned SURE has ADHD, and a daughter who probably has a mild version, and a son who has been labeled ADHD - but I don't think that's the whole story!

Jett's bio-mom medicated the snot out of him. Giving this child stimulants did, indeed, make him worse. He went from mildly annoying to SEVERE.BRAT. while on them. Not to mention side effects. Weaned him off, and have been working with him. neuropsychologist says Fetal Alcohol Syndrome... I'm not so sure. I'm not a doctor, but I'm thinking PTSD + possibly Aspergers.

NOW, that said - Onyxx. Ohhhh, my lovely daughter. She will be oh-so-cooperative and then... Out of nowhere... Whining, fit throwing, violent, screaming, picking fights... And hers is very much PTSD and a mood disorder...

So my thoughts here - PLEASE take him to a neuropsychologist. It's not a perfect science (we're dealing with the brain, here, and it does things no other body part could possibly do), but it's a starting point. And while one medication may not work, another might. We've been through tons of different combinations... And are still trying to figure it out. And I know many others here have been on MANY more medications than my two have.

Hugs - and welcome. No matter what, it ain't easy!

 

[HaoZi]

Here's the DSM-IV criteria, which is what is professionally used for diagnosis: http://www.cdc.gov/ncbddd/adhd/diagnosis.html
Keep in mind also that many things LOOK similar, especially in children. This is why the full evaluation is needed. It can also be co-morbid (as in occurring with other things).

 

[BusynMember]

No good neuropsychologist (which is who mostly does the testing in the US) only goes by, say, the Connors test or even by the DSM. They observe the child for many hours, take a family history, and make their best guess. You can not get help without a diagnosis. A therapist is not trained to diagnose and can not legally do so in the US. Nor can a social worker. They don't have the training. We had to fill out a gazillion forms for my son, but most of his diagnosis (which turned out to be right on the money) was observing him. NeuroPsychs often have long waiting lists and are in demand, and they see a ton of children with disorders and are good at spotting things that other professionals (even psychiatrists) tend to miss. In my son's case he was misdiagnosed with first ADHD/ODD (wrong) then early onset bipolar (VERY wrong), but spent years on heavy medications. I don't like them either unless the diagnosis is clear. The neuropsychologist gave my son ten hours of intensive evaluation. This included far more than filling out tests.

We had always felt our son was on the autism spectrum and he is. At 17, he would not be the young man he is today if he had not gotten early interventions for the right disorder. Talk therapy did nothing for him. He could not relate to any therapist and did not have a psychiatric problem (autism is neurological). There is no blood test, but there are tendencies. in my opinion use your mom gut. You can look around and see if your child is a typical child or over-the-top. My daughter has a diagnosis. of ADD and I'm sure she has it, but she is fourteen and refuses to take stimulants (she doesn't like the way they make her feel). She is doing well with school interventions and no medications at all. She has a 504 that is working for her but without the ADHD diagnosis., she would not have the 504 and would really be struggling. I might add that she has no behavioral issues. ADD/ADHD does not make a child violent. That is usually something else, possibly co-morbid with ADHD.

Good luck, whatever you decide to do!