Just want 2 dr's to agree.

Discussion in 'General Parenting' started by wildcat, Apr 14, 2011.

  1. wildcat

    wildcat New Member

    neuropsychologist says my 7yr has had Traumatic Brain Injury (TBI) on left side of his brain.
    psychiatric. says he has AS.
    Pediat. says it's ODD.

    He had a brain MRI last week and showed nothing...SO
    Now what do we do?
  2. JJJ

    JJJ Active Member

    The doctors almost never agree. And he could have all 3 of those at the same time. ODD is just a list of symptoms, it doesn't tell you WHY he has those symptoms but the Traumatic Brain Injury (TBI) and the AS answer the WHY, most docs drop the ODD label once they have a truer diagnosis. Peds are way over their heads with extreme kids. And, I would expect his diagnosis to change as he gets older. My guess would be that most kids go through 4-5 during their childhood. Without "blood tests" it is just a doctor's clinical impression (meaning his educated opinion) and there will be disagreements.
  3. rlsnights

    rlsnights New Member

    Peds has no business saying he isn't Autism Spectrum Disorders (ASD) if a psychologist has diagnosed it, in my humble opinion. No two kids will present the same way.
    neuropsychologist would be able to diagnose both Autism Spectrum Disorders (ASD) and Traumatic Brain Injury (TBI) based on behavior/responses to assessments. Not sure a Traumatic Brain Injury (TBI) would always show up on an MRI depending on how long ago it happened.

    More to the point - what did the neuropsychologist recommend for interventions?
  4. wildcat

    wildcat New Member

    neuropsychologist says change his Intuniv to Adderall and have Occupational Therapist (OT). We have to go back for the f/up visit and I think he will be giving us alot more information then. I was blown away with the Traumatic Brain Injury (TBI) diagnosis, that never entered my mind. Should you have a 2nd opinion when it comes to a neuropsychologist?
    Our family and friends seem to all think Traumatic Brain Injury (TBI) sounds totally wrong. His behavior is getting worse everyday and I am at a loss on how to get control of him. Peoples favorite thing to tell me is call Supernanny.
  5. JJJ

    JJJ Active Member

    Why do they say Traumatic Brain Injury (TBI)??? Was he in an accident?
  6. SomewhereOutThere

    SomewhereOutThere Well-Known Member

    My guess is he lacks good function from one side of the brain. So do I...I was asked if I had a stroke. I never have...I was just always that way, born that way...maybe an injury at birth?

    I would trust the neuropsychologist and Psychiatrist, not the pediatrician. Pediatricians are here for sore throats and headaches. They are not really trained to diagnose childhood disorders which affect behavior.

    I'm not saying this child has Traumatic Brain Injury (TBI)...just explaining why it might have been diagnosed. It is more likely to be AS. Good luck :)
  7. AnnieO

    AnnieO Shooting from the Hip

    I wondered for a while if Jett's problems were Traumatic Brain Injury (TBI), but no, that was ruled out (though they almost lost him at birth, so it's still, in my book, an option even if there's no obvious signs).
  8. TerryJ2

    TerryJ2 Well-Known Member

    What a disappointmentn after all those dr appts.
    I'd stick with-the Autism Spectrum Disorders (ASD) diagnosis for now, because you can do interventions. Try the Adderall ... you'll know if it works right away.
    Occupational Therapist (OT) can't hurt. I'd go for it.
    Let us know!
  9. rlsnights

    rlsnights New Member

    The Traumatic Brain Injury (TBI) thing interested me so I did a little surfing and review of recent publications on this subject.

    There are a couple of good studies - and a growing number of clinical trials/research on the impact of mild and moderate Traumatic Brain Injury (TBI) on children's development - that suggest there are long term effects of even mild Traumatic Brain Injury (TBI) in some children and moderate to severe Traumatic Brain Injury (TBI) clearly has long term negative effects.

    One strong study out of New Zealand showed that a Traumatic Brain Injury (TBI) deemed "mild" but that required an overnight observation of a child was strongly related to behavioral problems that escalated up to age 13 (the top age in the study). They were specifically looking at the incidence of ADHD and conduct disorder symptoms.

    The growing picture is that the child appears to be developing pretty normally - with only mild behavioral deficits - but they plateau at various stages of development and become increasingly unable to function the older they get. They are theorizing that the problems show up more as the frontal lobe (the part that develops last and is highly involved in impulse control and reasoning) develops.

    Makes me think about all those kids playing football and baseball who are getting mild head injuries. Shucks, even a fall off a bike or a scooter. My difficult child 2 had two falls as a young child where he hurt his head. Only one required stitches and was deemed to have caused a mild concussion. But if these results are correct it might help explain his emotional and behavioral problems now.

  10. timer lady

    timer lady Queen of Hearts

    Unless you have a connected (in touch & working together) treatment team the doctors will rarely agree on a diagnosis. Saying that, not all brain injuries show on a MRI. Just a small concussion can do much damage to a developing brain.

    You'll figure it out ~ it will take time & patience. Work toward a cohesive treatment team (do you have a local children's hospital or university hospital in your area?). It's done wonders here in my home.
  11. susiestar

    susiestar Roll With It

    I agree with the others. No way would I trust a pediatrician's diagnosis of these complex problems. They simply are not trained and educated to handle them. They are great in their field of study, which is to see if development is "normal" for the age, to deal with problems like colds and fevers, and to refer you to specialists when anything is more complicated than that.

    I would wait to see the written report from the neuropsychologist. Traumatic Brain Injury (TBI) is a possibility. We are learning more and more about the effects of head injuries every day. Now they say that a child with a concussion must take it easy until all symptoms are gone or long term problems can occur. Two days after I read this Jess slipped on a puddle in the tiled bathroom and fell straight back onto her head. The doctor said to keep her still, check her every hour to see if her pupils reacted the same and if she was coherent, to put a cold pack on the lump and to give her ibuprofen as she normally takes it. IF any of those things changes to take her to ER but otherwise just make her rest until she wasn't dizzy or sick Occupational Therapist (OT) her tummy. Said the ER visit and MRI could be done right away, but all they would do if they saw something was tell us what she had already told us. It took 3 days before she felt completely better and I didn't let her do anything that she had to read for or walk around for.

    Docs often give you one set of impressions/diagnosis's after they do the testing but before they get around to writing the report and a very different set in the report. I tend to wait for the report because those diagnosis's are made based on the test results. The first set of diagnosis's are given based on what they saw and how difficult child behaved during the testing. Important info, to be sure, but not info backed up by the actual tests because the doctor doesn't have those results to figure in. Some of the tests can be scored by the doctor but others have to be sent to the company that wrote the test. So by waiting you will be sure to have as much info as possible. I would write down what the neuropsychologist told you and when you meet to get the report be sure to ask him about how they fit with the test results - esp if any of the diagnosis's are not in the written report or are contradicted by the report.

    My experience with psychiatrists is that they tend to give a diagnosis and then give medications. If the medications work then the diagnosis is right, if they don't then let's try another diagnosis. It drove me nuts until I realize that it is how medicine works. Go to the doctor with a sore throat and it is red then you have an infection. here are antibiotics. The antibiotics didn't work? Then you have GERD and sinus drainage. here is an acid blocker and some antihistamines. Only with a sore throat it doesn't change your basic behavior and psychiatric medications really can.

    My other HUGE problem with psychiatrists is how they treat patients with bipolar, esp kids. There is a medication protocol that is published by the board of psychiatrists. It is the same for child and adult psychiatrists. Mood stabilizer (1 or 2) then atypical antipsychotics to control cycling. Once cycling is stablized, add a stimulant or anxiety medication or antidepressant - if symptoms are still there and warrant it. Only ONE medication change at a time and enough time between changes for medication to be fully effective, esp with regard to the mood stabilizers. They can take 6 WEEKS to be fully effective and shouldn't be changed much earlier than that, and certainly not at week 1 or 2. This protocol, or schedule or whatever you call it, has been established because it has been proven to be most effective. Often once moods are stable there isn't a need for stims or antidepressants. Stims and antidepressants have been PROVEN to cause increased cycling in people with bipolar and this is well documented and proven.

    For some reason I do NOT understand, all but ONE of the psychiatrists I have ever known has wanted to give my child a bipolar diagnosis and put him on lexapro or zoloft or prozac. Not only is he NOT bipolar, if he was there was NO WAY that it was appropriate to start with those medications. Especially as he was already on concerta!! Every one of them was NOT happy when I pulled out the protocol (copied from either The Bipolar Child or from the medical board's website) and asked why we would start with an antidepressant when it was clearly NOT the recommended protocol. I heard all kinds of excuses - including that the protocol wasn't meant to be used on all bipolar patients, that it was out of date and thatit wouldn't work with Wiz because he was an Aspie and not bipolar. The doctor who said it wouldn't work on Wiz because he was an Aspie and not bipolar was REALLY unhappy because I latched onto that and wanted to know EXACTLY why he wanted to say my child was bipolar and needed an a/d. It was sort of fun, in a mean way, to watch him squirm and try to tap dance out of THAT corner. I accepted prescriptions from him until the appointment with a new psychiatrist came around, but only exactly what Wiz was on.

    Anyway, docs are not often going to agree. Part of the problem is that if you have seen one psychiatrist and the treatment is working well but you have to see a new psychiatrist because insurance rules, moving, the old psychiatrist retired or whatever, the new psychiatrist will almost always want to do his own diagnosis. It almost always has to be different than the old psychiatrist's diagnosis and maybe it is to prove they are better. I don't really know but I HATE the way every psychiatrist I have ever met, except one of my psychiatrists, seems to be driven to re-invent the wheel for each patient even if the wheel was rolling along with no problems.

    After a while I stopped caring if they called it asperger's, bipolar, GERD or pregnancy as long as the treatment worked. (You should have seen one doctor spit his coffee all over the chart when I told him that as long as the medication combo and therapy/interventions worked I didn't care if he said Wiz was pregnant. It was funny to see his reaction, lol!)
  12. wildcat

    wildcat New Member

    I have been thinking about taking him to Vanderbilt. Can I just contact a large teaching hospital like that or do I have to be referred?