Evaluations with Psychiatrist vs. neuropsychologist

Discussion in 'General Parenting' started by Sunshine1966, Oct 21, 2007.

  1. Sunshine1966

    Sunshine1966 New Member


    I haven't been on here long but I have some questions on the diagnosing and testing procedures. My difficult child is 4 years old and he was recently diagnosed by a psychiatrist to have ADHD and ODD. My husband and I spent an hour with him initially and then he met with our difficult child for an hour the next visit. There really didn't seem to be any 'testing' or real assessment other than getting the history of behavior and watching him there in the office. Which, by the way, he was almost an angel with the psychiatrist the first time. He showed some resistance when I had to put his shoes on after getting weighed but that's NOTHING compared to what actually happens at home.

    We are now on our second medication from the Psychiatrist and its one that most people have never heard of or know nothing about. Should that worry me? Is it because he's so young that the Psychiatrist is trying these different medications? And what kind of testing does a neuropsychologist do exactly? When our difficult child was still in foster care he was evaluated at the CHDD (Center for Human Development & Disability) at the University of Washington. He got examined by a pediatrician and then questioned by a psychologist (I think) and they gave me an age that they thought he was operating at vs. the age he was chronologically (at that point there was a 12 month difference). The last time he saw the psychologist at UW CHDD the doctor said that my son was untestable because he wasn't cooperating with the testing. Even if he knew the answer he wasn't cooperating and treating it like a game. I saw the doctor write down "spoiled" on a exam paper and underline it right in front of me! I was so upset by that I couldn't believe that he would be so bold as to do that right in front of me. He told me that I was going to have a lot of problems with him if I didn't get him help with behavior issues right away.. My thought was that he didn't spend hardly any time with him to even know what his issues were. That was when my difficult child was 3 years old, I cried on the way home and never went back.

    So, should I pursue an evaluation by a neuropsychologist to get a better more accurate diagnosis if the psychiatrist didn't do any testing or anything and is just prescribing medications? I am not dead set against medications any more like I thought I was but I certainly would like to feel confident that he's being treated in the right way for what he actually has.

    Any pointers or advice on this would be greatly appreciated. I am so thankful for finding this website and I can't imagine not having this place to go and read about things going on with other families and what they are doing to make things work or do better. I have read the "Explosive Child" but I think I'd like to read it again and apply all the younger children hints that were listed here on the site. This has become an invaluable resource for me and I'm so thankful!

  2. Sheila

    Sheila Moderator

  3. tired Cheryl

    tired Cheryl New Member

    Hi, Debbie:
    You wrote:

    "Even if he knew the answer he wasn't cooperating and treating it like a game." That is <u>exactly</u> what my son does!

    I did not get to observe the neuropsychologist evaluation which lasted about three hours but at his screening for Special Education Services with the SD I was present and got to see him at work. When he wasn't outrightly refusing he treated the screening like a game too. He would purposely do the opposite of what they asked, he would throw the bean bags over their heads, etc. They had to write REFUSED on one/four tests yet they passed him.

    He seems to relish in being manipulative and defiant. Especially with unsuspecting new people.

    You wrote:
    "I saw the doctor write down "spoiled" on a exam paper and underline it right in front of me!"

    Wow, that is shocking. When did spoiled become a diagnosis?! and this guy thought he was helping you? No wonder you cried all the way home.

  4. angels

    angels New Member

    <span style='font-family: Comic Sans MS'>Hi Sunshine1966,

    Welcome. New to this site too. Isn't it great!
    I am in no position to give advice. I too am searching for a diagnosis (another diagnosis)I am not feeling right either, getting that feeling... My son was diagnosed with ADHD by a physcopsychiatrist that his school referred us to. He said he was able to tell after "5" minutes . Can you imagine that? I am having doubts, being that the school gave me his name. My son does have characteristics of AHDD, but I also think he has ODD too, but still having that feeling that it's wrong or there may be something else going on.

    I also took him to see a psychiatrist and I did think about putting him on medications but had doubts I finally came to terms that it's what he needed. I cried for the 5 days that I gave it to him. The psychiatrist told me I should have noticed a difference and took him off and gave him a prescpription for two different medications This made me sick. When I got home, I threw it out in the garbage and never went back.

    I decided to see a preventative medicine dr. I had always, deep down wanted to do it naturally. It's not for everyone, this is just how I feel. He examined Michael and is starting with his nervose system. The Dr. picked up a couple of things. In his office it just felt right. He just started, but so far I am impressed.

    Have you read " Louder than Words by Jenny McCarthy)? If you didn't it is pretty interestng and easy to read. Read it. It makes you wonder. Does he have problems going to the bathroom? I'm searching on some of the things she mentioned.

    I just want to share this with you.... If you are having "ANY" doubts go with your gut. Maybe some of the behavior is normal for a 4 yr old. Someone on the site mentioned a "multi-disciplinary evaluationn" which I want to have done on my son because of that "feeling". I can't think of who mentioned it but it's somewhere in this forum . I'm really not to good with the computer and if I come across it I will send it to you.I think someone needs to find the "cause" and this is what his preventative Dr. is doing. I just think medications should be the last resort. I'm sorry, I am not in your shoes so you do what you have to do but sometimes you have doubts and something just clicks. Listen to your heart. Sometimes you just have to keep searching until you have that feeling (a good one) and you will know, but if possible, save the medications for last.

    Good luck in your search.
    Angels</span> :smile:
  5. SRL

    SRL Active Member

    Sunshine, I don't think you can go wrong with getting the most thorough evaluation possible in a child this young. Given your son is adopted and initially had a 12 month spread in chronological age vs. developmental age, I'd definitely suggest getting more. A developmental pediatrician would be another possibility but the waiting lists in most areas are at least 6 months out.

    What medication is the psychiatrist recommending? Is that the Guanfacine listed in your signature?

    What you've just seen is pretty typical of psychiatrist evaluations--a neuropsychologist evaluation typically would be 6-15 hours of evaluation (depending on the age of the child, nature of the problems, etc.). Using that data the neuropsychologist would refer out to other specialists such as speech and Occupational Therapist (OT). The more accurate data you can collect on him through assessment at this young age, the more likely you are to get him appropriate interventions. I cannot emphasize this assessment phase enough, especially before starting down the medication path unless he is so unstable it isn't a choice.
  6. SomewhereOutThere

    SomewhereOutThere Well-Known Member

    I adopted a child from foster care and I strongly suggest the neuropsychologist evaluation, especially if your child was exposed to drugs and alcohol in utero. Any professional who writes "SPOILED!" about a foster child needs a reality check. These kids are hardly spoiled. If anything, they've had too many changes, which can affect them, or they had a hard start in life even before they were born. I think neuropsychologist exams are far more intensive and accurate than Psychiatrists. I've been thru the mill with both me and my son and that's is my strong preference. Don't settle for a plain Psycologist either. Good luck!
  7. Sunshine1966

    Sunshine1966 New Member

    Hi Angels,

    I totally hear what your saying about trusting your gut and leaving medications for the last, last resort. Over the past year or so I have gone down lots of different paths in search for something that would help. I did have my difficult child seen by a naturopath and we pursued the Feingold Diet (getting rid of dyes, preservatives, junk in the diet), we added cod liver oil to our daily regime. I have had all sorts of input from Occupational Therapist (OT)/PT which I have tried. I basically have always told people that I am game for any advice or tips they could give me because I'm in search of anything that would help my son be happier in life. I got so tired of seeing him so frustrated and unhappy too many times.

    I would wonder too about a psychopsychiatrist that admitted to knowing after only 5 min with your child. There is so much more to 'knowing' what is going on with a child and there are so many different avenues or areas to pursue to find out what's going on with that child. Put a child on medications almost makes me a nervous wreck inside because I'm watching things so closely and just don't want anything to hurt my child. I do, at the same time, hope for improvement in his life. It just broke my heart seeing his big crocodile tears of frustration so many times. It took me a long time to realize that it wasn't just my difficult child trying to drive me crazy on purpose. He doesn't get frustrated so easy because he wants to, he isn't overstimulated by big groups of people because he wants to be. Once I realized that and started thinking about what can I do for him to make things better or at least more manageable it was good.

    I also asked God to give me a special love for my child. I had some really tough times when my son was telling me he hated me or didn't want to be around me, etc. He'd be screaming at me, or throwing some fit in a public place and I was just stressed beyond words. I am happy to say that since that difficult point when I just told God that I couldn't do this myself He has given me a love for my son that comes from deep within my heart and is more love than I thought I could ever have for someone. Its amazing actually. We parents go through so much with our children, any of our children, and its truly a learning experience and can be a life changing experience.

    I saw Jenny McCarthy's interview on Oprah but I have not read the book. I have a best friend who has an autistic 7 yo and she was very upset by watching that show. Her road has been a very, very tough one. I'll look into the book though.

    My son doesn't have any problems with going to the bathroom. Other than he was potty trained late and at this point I'd say he's 95% trained even though he's 4 1/2 years old.

    Thanks for your reply. I will definitely keep pursuing natural alternatives and listening to any doubts I may have. I've always thought that if you have any doubts about something, then you shouldn't do it. We have to trust our instincts and motherly intuition.

    Debbie :warrior:
  8. angels

    angels New Member

    <span style='font-family: Comic Sans MS'> </span>

    Hi Sunshine1966,
    How is you son doing on the Feingold Diet? You din't mention it? I have heard about and am curious. How long has he been on it?

  9. SomewhereOutThere

    SomewhereOutThere Well-Known Member

    Just a comment. Jenny McCarthy's son is five. She in no way can say he is "cured." Five is too young, but it's also an age when autistic kids improve by leaps and bounds (mine did). That show made me roll my eyes. in my opinion she has many challenges down the road for her son. As they get older, without interventions, they show different challenges, even after they learn to talk. I think it's wisest to stick with Autism Spectrum Disorders (ASD) interventions. If you want to do a diet too, it can't hurt, but I think it can hurt A LOT to decide your child is cured and only do a diet and cut out the therapies. This is for Autism Spectrum Disorders (ASD) only--my son does not need medications. However, I strongly believe that some kids do. And some adults. I have bipolar. I tried the natural route and it did nothing for me, kept spiraling out of control. I can live a rich, fulfilling life with medications, but not without them. Matter of choice, but I wouldn't close my mind about the possible need for medication. But, yes, go slow--get a second opinion first.
  10. waytootired

    waytootired New Member

    Psychiatrists and medications certainly have there place in treatment plans, but I have found that a lot of psychiatrists prescribe medication based on the behavior that they hear from parents, no real test information. We started with this route. Five years later we got a neuropsychologist evaluation done and learned that our difficult child more than likely was misdiagnosed early on. I would highly recommend a neuropsychologist evaluation. It sure can't hurt. We have been mediation free for four months and doing great! :whew:

  11. I'm going crazy!!!

    I'm going crazy!!! New Member

    i'm normally in the general forum but decided to check this one out JMO but when my son was 3 he was tested very thouroughly but everyone felt he was too young and not "bad enough" to go on medications so we tried behavior modification this didn't work too well and i didn't understand why until someone explained it like this and it was just her opinion but here it is "How do you expect behavior modification to work if they're minds can't focus on what you are saying, with medication you get through a lot better and later after the behavior modification has started working then maybe you can take them off of the medications." Could you imagine not having control over your thoughts, actions, and emotions. I know as an adult I would take whatever I had to to gain even an ounce of control how could I possibly not give that to my son. This is NOT a guilt trip by any means I will NEVER judge a parent for their choices again when I don't know the whole story (use to do that a lot before difficult child). From everything I've read ADHD/ODD is like a learning disability and they have to be taught these "skills" little by little. I also feel that it's a chemical imbalance. You said you were scared of anything hurting your child, how harmful is it for him to never feel in control and how heathly is it for you to constantly have to deal with the ups and downs. My difficult child went to a psychologist for cognative testing, an education specialist for education testing, and he was seen 3 times for about 30 minutes each by a psychiatrist then we met with her and filled out dozens of forms. She diagnosis difficult child with ADHD which he was originally diagnosis by pediatrician doctor. After school started she added the ODD diagnosis. He was started on Adderall 5mg once a day for a week then increased to 7.5mg once a day then 10mg with clonodin 1/2 .1mg in the morning and 7.5mg in the middle he has taken benadryl for about a year but with stimulant he has to have 2 to sleep and he also gets a 1/2 .1mg of clonodin. Last year he had 8 different medication changes over the course of 1 school year. I know how tough it can be but I truly feel it is in his, mine, & my husbands best interest for him to be on medications. I have also read that you have to get the hyper behavior out of the way in order to treat any other issues. Chris was on Strattera it's a stimulant i believe and the other is the generic for Tenex which was originally for high blood pressure but has been known to help with impulsiveness and aggression when accompanied with an ADHD diagnosis. You can find some awesome information on http://www.webmd.com hang in there God is on your side and through him all things are possible I'll be praying for you and your family
  12. hopeful

    hopeful New Member

    "He doesn't get frustrated so easy because he wants to, he isn't overstimulated by big groups of people because he wants to be. Once I realized that and started thinking about what can I do for him to make things better or at least more manageable it was good."

    These are words of wisdom... Somewhere inside their little bodies they are noticing the snide comments, the looks of shame and frustration, they understand that people don't like them and they feel bad about it.

    When my daughter first went on ridlin she was six. Every morning it was a fight to get her to take it and I was sick with guilt and anxiety. At the end of the first week on medications she came running to the fence where we met after school. I thought immediately that something was up because she was running really fast and looked really upset. She hit the fence, climbed over it and threw her arms around my legs. (she wasn't physically affectionate so this surprised me too) She burst into tears, deep sobs and I croached down and held her for a moment. She looked up at me, eyes swimming in tears and said, "mommy I never got in trouble in school once this week..." Then she raced to the van and yelled at her brother to get out of her seat. She forgot the moment so quickly that I wasn't sure it happened. In that moment I changed inside, my resentment eased up, my heart swelled and I knew I could do it. It wasn't personal and she did care, she just couldn't help it. Her brother a year older explained it to one of his buddies in this way, "its like she has no legs. we wouldn't ask her to run if she had no legs, right? so we can't expect her to stop being the way she is... she just can't help it."