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    #87168 10/13/10 06:46 AM
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    We are pursuing having dd10 assessed for ADD (not the hyperactive physical type). Dh is likely someone with ADD who was not dx as a child. He said that sudafed has always helped him focus crazy and just has a lot of the symptoms.

    Dd has been IQ tested twice -- once with a GAI in the upper 140s, once in the upper 120s. Either way, she is likely gifted to some degree. The second psych who tested her assured us that she did not have a LD or ADD based upon her WIAT (achievement) scores all being higher than expected given the second set of IQ scores and based upon behavioral forms filled out by me, dh, and her teacher at the time.

    My behavioral forms did indicate a concern for ADD, dh's indicated that she had everything from schizophrenia to bi-polar, and the teacher's indicated nothing. Dh's assessments are basically useless b/c he is a hypochodriac and really negative. I recall one of the questions asking about her pulling out eyelashes and eyebrows to which he responded "frequently." When I asked him about it (she never pulls hairs out), he said that "she could." I told him that they were looking for what she does, not what she could do.

    The teacher's form put everything in the typical range but she really didn't get dd. She was the one who told us that the IQ scores were due to "good guessing" and she wrote that dd was "nothing special" on her forms for the psych.

    In any case, due to seriously erratic school performance, difficulty focusing, constantly getting distracted while reading (it takes her a good 9 months to finish a book), careless errors (including missing entire pages on tests -- i.e. completely turning past one page and not answering any of the questions on it b/c she didn't notice the page was there), and some other issues, I am really at the point where I feel like ADD is a real possibility. I am also feeling like it is significantly impacting her school experience.

    I contacted our insurance co to see if we could get them to pay to have her assessed. They were rather shocked that a parent would be self-referring and wanted to know why her school and/or ped wasn't making the referral, but they do seem willing to pay.

    The thing is that her teachers are unlikely to see a problem b/c, even at her worst, she is an average student and doesn't perform below "proficient" or the 50th percentile for grade. If we go the route of behavioral scales again, I don't think that we are going to get an accurate picture of what is going on.

    Is there any other way to dx ADD other than subjective opinions of parents and teachers? The psych at our ped's office seemed to feel so, but he is out of network and it would cost us $800 for him to assess her. We paid over $1000 a bit over a year ago for the last IQ and achievement test piece and it just isn't in the budget for us to spend that much again when we can have it done virtually free through insurance.

    Thoughts or advice?

    Cricket2 #87175 10/13/10 07:37 AM
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    I wish I could help, but I wanted to let you know that you're not alone. DS12 was always at or above standards in school and was not a behavior problem at all, so his lack of paying attention in school was rarely noticed, and when it was, it seems like it was just attributed to a personality flaw of some type. We suspected something was not quite right for a long time, since his school performance was so different than what we had seen from him before starting school and really struggling (despite always performing fairly well, if inconsistently). When he switched schools last year, the teacher noticed that he seemed to take a long time on tests and homework and suggested he might have trouble paying attention and suggested we might want to look into it. The school did not, however, make a referal, so we had to call our insurance provider and ask which psychologist would be approved to evaluate him. I actually didn't end up liking our psychologist much, even though he was educated in gifted children. The assessments we filled out (us, his new MS teachers who barely knew him, and his previous teacher who really didn't get him), came back all over the place, but suggested their might be a mild attention issue. In conjunction with an IQ test that had dropped 20 points from one he had taken years before, we decided that attention issues might be at play and the psychologist suggested a trial of Adderall. We then, of course, had to go to his pediatrician to actually get the prescription filled and had to head off the complete reevaluation she wanted to do on her own (we felt no need since we'd just done it!). In the end she agreed to write the prescription.

    The results for my DS were not dramatic, as we were told was likely since he was being treated for inattentive ADHD not hyperactivity, where the results are usually dramatic. But, we did see him not losing his train of though when he was speaking, he no longer forgot something in his locker almost every day when we picked him up from school (this rarely happens now), and we did see his grades go up. He still has to work really hard at school, but he does seem a bit more together in general now. It hasn't been a magic bullet for us, but it's helped a bit, and the success of the meds, mild though it is, does seem to confirm that the diagnosis was correct.

    I should also note that, since we had a private evaluation, we had the option to not inform the school of the results. We liked this. Eventually (after 5 months on the Adderall) we told his teacher that he was taking meds, but we have not told his current school because his behavior is not an issue and he now seems like any other kid in his class. We just worry, rightly or wrongly, about them looking for problems and don't want him pigeonholed or their opinions of him affected by anything other than what they see.

    HTH!


    She thought she could, so she did.
    mnmom23 #87187 10/13/10 09:20 AM
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    Originally Posted by mnmom23
    The results for my DS were not dramatic, as we were told was likely since he was being treated for inattentive ADHD not hyperactivity, where the results are usually dramatic.
    This is an interesting comment. Where did you hear that the results of meds are lesser with inattentive type ADHD? Inattentive type is what we suspect.

    I, honestly, haven't been gung-ho to medicate dd b/c she is very small and I don't want to stunt her growth. She's newly 10 and weighs 55 lbs. She's also short, so it's not like she's emaciated. Dh is just 5'6", so the genetics for big size aren't there.

    I am willing to consider medication, though, at this point. However, if it isn't likely to net a significant benefit, I would be less eager.

    Cricket2 #87208 10/13/10 11:35 AM
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    I have a child that has ADHD-inattentive type. After 2 years of denial and trying to rule out other issues, we finally decided to try stimulant medication. DS showed remarkable improvement immediately. We chose not to inform the school, but the very first week we got a call from both his teachers telling us how great he was doing.

    It has been 5 years and we have increased his dosage twice and are on the verge of increasing again as he has hit puberty and it seems to be metabolizing too fast.

    It was very uncomfortable for me to agree to medication and even consider the possibility of ADHD for my very calm and well behaved child. More uncomfortable since it is a clinical diagnosis with so much gray area. That said, there were significant indicators that we finally captured on the ADHD rating scales once I was willing to be honest and within his psycho-educational testing. (For him, very low processing speed relative to other index scores).

    Medication does not change him, yet he tells us he is better able to cope and follow what is going on. I notice that he stays more on topic during conversations, gets his homework done more efficiently and is able to complete tasks and remember what he is doing. He still has reading disabilities and difficulty planning his approach to new tasks. But, medication allows him to attend better and to remember the strategies he has been taught.

    Finding the right the medication and dosage is a trial and error thing. Sometimes it is hard to know if you have the right dose or if a bit more would be better. Sometimes different brands within the same class work differently from child to child. For these reasons, it is important to consult with a physician that is an expert in ADHD: a psychiatrist, neurologist, developmental pediatrician.

    And, there is always the possibility that medication does not work for your child. This happens more frequently with the inattentive type. Again, an expert can guide you and recommend alternative therapies and supports if needed.

    So, to answer your question - is there another way to diagnose? It is a clinical diagnosis based usually on rating scales, cognitive test results, perhaps observation and interview. Unfortunately, no simple blood test or x-ray that gives a definitive yes or no! You can rule out certain "look alikes" such as sleep disorders, Lyme decease, thyroid problems, learning disabilities. But the diagnosis is primarily based on the physician's judgement of the data. Again - this is why using and expert is so helpful. ( I do think that testing that is only one year old should be sufficient - perhaps they could take a look at some specific new testing, but it seems crazy to retest the entire battery. In fact, many tests cannot be used more than once a year and most experts suggest that the WISC should be given no more than every 3 years if possible).

    Cricket2 #87215 10/13/10 12:35 PM
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    Originally Posted by Cricket2
    Where did you hear that the results of meds are lesser with inattentive type ADHD? Inattentive type is what we suspect.

    I, honestly, haven't been gung-ho to medicate dd b/c she is very small and I don't want to stunt her growth. She's newly 10 and weighs 55 lbs. She's also short, so it's not like she's emaciated. Dh is just 5'6", so the genetics for big size aren't there.

    Both the psychologist and the pediatrician said that the results of meds are lesser with inattentive type. I'm not sure what the medical basis for that would be. Also, we were told that the primary risk of stunted growth arises from the decrease in appetite that can happen, and that it mainly happens when there is a significant decrease in appetite. We were lucky in that our DS12 is very very tall for his age so we were less concerned about that. When he went on the medication in the spring for the first time we did notice that he wasn't very hungry at lunch time. For several reasons he went off the meds for a time during the summer and interestingly, when he started the meds again in August, he was now hungry at lunch but less hungry at dinner. He's grown several inches since he started the meds and hasn't gained weight, but honestly, he was slightly chunky in the first place and has now just stretched out. But, in his case, he was still getting plenty of nutrition.

    Medication is a huge decision and I think we all are hesitant to give our kids anything that they might not need. So, take your time and research it and just do your best. You always have to weight any potential benefits with any potention negatives.

    Also, I wanted to say that we had heard anecdotal evidence that Omega-3 fish oil could be helpful and, since it couldn't hurt, we started our DS on this as well. It's hard to say, though, if we've seen a change due to this. But, it is one less-medical way some people try.

    Last edited by mnmom23; 10/13/10 12:39 PM.

    She thought she could, so she did.
    Cricket2 #87217 10/13/10 12:52 PM
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    Thank you both for your suggestions. To clarify, we have no intent of retesting the WISC. The first time she was tested on the WISC (with the higher scores), she was 7.5. The second time, she was 8.5. She is now 10, so it's been about 1.5 yrs, but I, too, think that the data from those two testings should be sufficient.

    We are looking more at whatever other type of testing would be done for ADHD. The BASQ rating scale was what the prior psych used at 8.5, but due to the reasons I mentioned I am hesitant to rely on subjective ratings by dh and her teacher(s). I can't reasonably ask them to look only at my ratings, though.

    RE the appetite thing, I've heard that as well. That is part of what makes me hesitant about medication. Dd has a fairly poor appetite to start with. We can certainly try O-3 supplements, but they won't be fish oil b/c the whole family is strictly vegetarian. There are some vegan O-3 supplements that are algae derived and supposed to have DHA, though, so I can look into those.

    Cricket2 #87223 10/13/10 03:07 PM
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    Some ADHD meds will suppress appetite and lead to delayed (not stunted) growth. The children are supposed to grow to normal adult heights, just a little slower. If you decide medicine is the way to to for school, you don't have to use it over the summer. If you don't use it over the summer, she may do most of her growing over then. Some ADHD meds have been shown to suppress appetite for a short while after they're started, but the the appetite comes back.

    My ds takes Vyvanse. He doesn't eat much in the morning, unless I get the food into him early. He eats a small lunch, but many times he eats a lot for dinner (when the medicine has worn off).

    Cricket2 #87229 10/13/10 06:45 PM
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    The non-stimulant ADHD meds (Strattera) do not suppress appetite and so far as I know do not interfere with growth. They are less effective for some kids but very good for others. I wouldn't rule out any treatment until talking with an expert.

    DeeDee

    Cricket2 #87243 10/14/10 04:46 AM
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    Regarding the effectiveness of stimulant medication for ADHD-in: Russell Barkley has done some research in this area. He has found that lower doses of stimulant medication typically work better than higher doses. For those with "sluggish cognitive tempo" (SCT) - he believes is totally different condition from ADHD and patients often do not respond to stimulants.


    Last edited by mich; 10/15/10 10:51 AM. Reason: spelling
    Cricket2 #87417 10/16/10 07:40 AM
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    I would suggest taking her to a child psychologist to get diagnosed. We went to one after DH *refused* to do a trial of meds prescribed by his ped. The first meeting, the psych could tell DS had ADHD, but did several tests and had his teacher and both of us parents fill out (separately) a questionnaire.

    We went to the psych for over a month and started doing a token system for behavior. After MUCH reluctance we started a trial of Vyvanse (stimulant) at the lowest dose (20mg) because he's only 5 and is already very small for his age. We just made it through the first 30 days and the only side effect we've noticed is he's emotional (crying at everything) when the meds wear off in the afternoon. His appetite hasn't changed at all and his weight hasn't changed either.

    We went back to the psych to get a reevaluation, he wanted to up the dosage (to 30mg) because he noticed a difference on the tests, but they still weren't "normal". So we got a new scrip for the 30mg yesterday. We'll start trying those tomorrow.

    We were both VERY hesitant to do meds. I was never diagnosed with ADD/ADHD, but I know I have it. My parents refused to put me on Ritalin when I was little. I kind of wish they had done something though. I was mainly worried about the growth thing because DS is already small. So far he's doing fine though. The meds have made a big difference in his attitude and behavior though.

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