Gifted Issues Discussion homepage Forums Twice Exceptional horrible dr visit

At the request of his teacher took ds to pediatrician. The teachers did a behavioural worksheet. Dr read the worksheet out loud then wrote a prescription for Ritalin never once asking him questions or me. I had to fight her to write a referral for ot. She didn't do any tests then when I asked about sensory issues she said its common for gifted kids and usually they have issues with taste and textures. I had to tell her he was gifted! Its written on my paperwork that she never read! So furious right now!

You have every right to be furious Cola. Being prescribed a dangerous drug without appropriate assessment, including a full history and examination is inappropriate and unprofessional, whatever the diagnosis. It is easy to see why ritalin scripts have soared when this sort of medicine is being practised. I am sure you know you need to see a different doctor and don't fill the script.

From the FDA prescribing guidelines for ritalin:
http://www.drugs.com/pro/ritalin.html

Attention Deficit Disorders, Narcolepsy

Attention Deficit Disorders (previously known as Minimal Brain Dysfunction in Children). Other terms being used to describe the behavioral syndrome below include: Hyperkinetic Child Syndrome, Minimal Brain Damage, Minimal Cerebral Dysfunction, Minor Cerebral Dysfunction.

Ritalin is indicated as an integral part of a total treatment program which typically includes other remedial measures (psychological, educational, social) for a stabilizing effect in children with a behavioral syndrome characterized by the following group of developmentally inappropriate symptoms: moderate-to-severe distractibility, short attention span, hyperactivity, emotional lability, and impulsivity. The diagnosis of this syndrome should not be made with finality when these symptoms are only of comparatively recent origin. Nonlocalizing (soft) neurological signs, learning disability, and abnormal EEG may or may not be present, and a diagnosis of central nervous system dysfunction may or may not be warranted.

Special Diagnostic Considerations

Specific etiology of this syndrome is unknown, and there is no single diagnostic test. Adequate diagnosis requires the use not only of medical but of special psychological, educational, and social resources.

Characteristics commonly reported include: chronic history of short attention span, distractibility, emotional lability, impulsivity, and moderate-to-severe hyperactivity; minor neurological signs and abnormal EEG. Learning may or may not be impaired. The diagnosis must be based upon a complete history and evaluation of the child and not solely on the presence of 1 or more of these characteristics.

Drug treatment is not indicated for all children with this syndrome. Stimulants are not intended for use in the child who exhibits symptoms secondary to environmental factors and/or primary psychiatric disorders, including psychosis. Appropriate educational placement is essential and psychosocial intervention is generally necessary. When remedial measures alone are insufficient, the decision to prescribe stimulant medication will depend upon the physician’s assessment of the chronicity and severity of the child’s symptoms.

Did the doctor even listen to your child's heart or take a cardiac history to exclude abnormalities??
Poor medical practice upsets me greatly.

Serious Cardiovascular Events

Sudden Death and Preexisting Structural Cardiac Abnormalities or Other Serious Heart Problems
Children and Adolescents

Sudden death has been reported in association with CNS stimulant treatment at usual doses in children and adolescents with structural cardiac abnormalities or other serious heart problems. Although some serious heart problems alone carry an increased risk of sudden death, stimulant products generally should not be used in children or adolescents with known serious structural cardiac abnormalities, cardiomyopathy, serious heart rhythm abnormalities, or other serious cardiac problems that may place them at increased vulnerability to the sympathomimetic effects of a stimulant drug.

Report the doctor.

Don't use the medication unless a doctor that actually does his job properly prescribes it. And find another doctor pronto.

Weird. I'm curious what dose Ritalin he prescribed?

With my kids we had school inventories but I had to fill one out as well and describe symptoms. The dr. was also watching the child during the appointment. With DS, the school psych had also done an observation and measured the amount of time he was on task, and I took all of that info to the doctor. We also had computerized ADHD testing from the neuropsych with borderline results (neuropsychs can't prescribe medication).

My sentiments exactly.

When parents ask me about ADHD and meds, I have actually taken to collecting, scoring, and interpreting checklists that MDs will be most likely to recognize (but are still valid!), and sending them to the parents as a packet to take to the doctor, just to make sure that there is as complete a set of observational data as possible, from multiple teachers and staff, and the parents. This after too many stories from parents along the lines of, "I asked my pediatrician if my child might have ADD/ADHD, so they wrote a prescription for Ritalin (or Adderall...) and said to try it and see if it made a difference."

I don't believe its ADHD as my brother has been medicated for years for ADHD. But because there is a family history the teachers are to quick to recommend medication. In my opinion his issues could be sensory, environment, no stimulation, a number of other things. The Dr said according to the worksheet the teacher said he's fidgety. Yeah...because he sits at a desk all day with only one 15 minute recess. I would be fidgety too!

A doctor should do more than read a report from the teacher and prescribe Ritalin. I've had both kids tested for ADHD at different points of their life, one was by a pediatrician who specializes in kids with ADHD and the other was tested by a psychologist as part of his full neropsc workup. While I didn't see the details of the second, I was in the room for the first and it was a quite extensive session between my DD and the doctor.

I don't know what to do. I could spend a butt load of money to have ds evaluated by a professional but they want $2500. If I had that kind of money he would be in a private school lol. My gut feeling is telling me it isn't something that can be fixed with a pill or a quick and popular diagnosis.

Cola, I don't know your personal situation so I can not provide specific advice. However, there is no need to medicate your child unless you have had an appropriate and thorough assessment. You also need a clinician with whom you feel comfortable and who will provide a prolonged and supportive relationship. If the diagnosis of ADHD was borne out and medication prescribed it would need monitoring and adjustment and careful ongoing management.

How do you find a new paediatrician? As I say I don't know the specifics of your insurance or the services available to you but it pays to do some research, ask some questions and seek advice.

Others on this forum may be able to advise more specifically if you can narrow your location at all. Otherwise, hit the internet and look for specialists in your area. You mention your brother has ADHD, any information to be sourced in that regard for specialists in the area?

Thinking more broadly, in case as you suspect this is not ADHD, look for gifted specialists and neuropsychs who could perform assessments. Is there a University or hospital backed clinic you could access.

Doing some broad research on your own doesn't hurt, which I am sure you are already doing. You have time to investigate and ponder the path. While I am know you want the situation improved for your child right now, there is time.

The doctor failed miserably, because an ADHD diagnosis REQUIRES that the symptoms must be present in more than one environment. Otherwise, the problem is not the child, it's the environment. Your son's doctor only looked at one environment.

Assuming you got to read the school report, since you carried it in... How would you have scored him, based on what you see at home?

He has issues with paying attention in class and doing his work. But if its something he is interestedin he can focus no problem . I would have scored some things similar but not all of it. It was a sheet with a rating scale and the number 3 as being most problematic. The teachers wrote 3 on all including depression and anxiety and violent behaviour. He has no symptoms of depression and is definitely not violent. Funny thing is the teacher complains about him not paying attention or just doing the bare minimum but I have never heard of anything regarding depression or violence. His handwriting is absolutely horrible and they are doing common core based teaching. The class has been doing double digit multiplication and division for a month now. He's completely bored but the teacher says otherwise. I'm not surprised with what she put down but I am shocked a pediatrician would write a prescription based solely on one teachers input.

My son does best when he's able to get his exercise. Unfortunately they believe that at a 4th grade level kids only need one recess. I have been trying to tell them if they let him outside to even just run off the energy for 10 minutes they may see a difference. But...I keep getting the same response "I have been teaching gifted kids for 18 years I know what I'm doing".

For better or worse, you now have an ADHD diagnosis. Use it. Request a 504 plan for your child. In the plan, request "a sensory diet" of exercise and activity in the middle of his day, separate from his recess. It can include doing things like being sent on errands carrying books to the library or heading out into the hallway to do pushups and jumping jacks or whatever works for your child..

I know in my situation, my daughter was misdiagnosed due to rushed judgment. Like you, I have a sibling with ADHD. One thing that I would mention is that in cases where the child's symptoms are not a slam dunk ADHD diagnosis, doctors/psychologists will often suggest stimulant medication as a diagnostic tool. The thinking being that is if the child doesn't have ADHD, then they will not improve on the medication. I don't know if this is what your pediatrician was thinking? I was never ok with this. You should never medicate your child unless you feel there is benefit to be gained from them taking it.
If the school has completed questionnaires on your son, ask to fill one out too! If they don't allow you to, I would be suspicious. Most schools want parent input before making a decision regarding a child and offering them in school services.

As others have said, there is no need to quickly rush to judgment here. Unless your son is failing subjects, give it some time and do some research.

I'd also add an excellent related caution from our psychologist, who provided a tentative diagnosis of ADHD-I (to be formally confirmed only after testing to eliminate CAPD, plus getting LD accommodations in place). She noted that the "pending" status did not mean we couldn't, in the meantime, do a trial run of medication if it seemed appropriate after discussion with our physician. The effect of ADHD meds is pretty immediate, so you can see right away if they are helping, and how much.

BUT - she also pointed out that we are talking about *stimulants* - and almost anyone will be more alert and focused with stimulants. That doesn't mean they are medically necessary for your DCs well-being.

So in our own case, we need to think carefully about what problems are causing DD the greatest distress, and do everything we can to fix those problems. If it becomes clear that focus problems are keeping her from being able to use her accommodations or access her remediation (such as she can't concentrate well enough to get through her remedial reading training), then medication may need to be part of our solution too. Once we have figured out how to clearly define the problem we'd like the meds to fix, we'll be much more able to judge if they are doing what they'd need to do in order for the benefits to justify the risks. Sorry if that sounds preachy - it is not meant to be!

My dd looked ADHD til.., well, she still looks that ways sometimes. But she does not have it. She is super organized and can focus when needed, though it is painful and her threshold for boredom is low and she will become hyperactive when as a side effect.

I'm nodding here.

My DD very much looks ADD inattentive-- when she is listening to the perfectionism monster under the bed in her mind.

This is her personal demon. She even has some of the other features that (mystifyingly, to my mind, honestly) make it onto checklists-- the hyperfocus (I mean, really, what PG kid doesn't have hyperfocus??) etc.

But it's entirely situational and it's entirely dependent upon her own internal state of mind.

Do stimulants improve her ability to stay on task? No, not really-- but they do work to the same degree that they do on pretty much everyone. There is a reason that study drugs and caffeine are a thing on college campuses, YK? It's not because all of those kids have ADD.

I'm very very sure that ADD exists. I've known some people in my life who are clearly experiencing something profoundly different from normative in executive functions, and the impairment is such that they do not experience life the same way that others do. I have ZERO problem with psychoactive meds for those people-- but what I do question is the use of such meds in children who are (at most) borderline cases.

If the environment is the problem, changing elements of that environment and fostering flexibility in the CHILD seems to me to be the better long-term strategy, not applying some corrective measure to the child... I'm probably not stating that well, but it just really bothers me that classroom teachers are seemingly losing sight of the fact that there is a RANGE of normal development in children... and pathologizing parts of that range in the name of doing things the way that they like seems REALLY wrong.

So not providing large motor breaks? Whoah-- that's a red flag to me. This is something that even kids without actual ADD/ADHD are going to find hard in this age group-- well, some of them will, anyway.



Medications are not benign. They are a permanent choice-- you cannot "un-do" a trial of psychoactive meds. Period. There are persistent shifts in neurotransmitter function that occur when one of those stimulant meds is offered repeatedly.

That's fine if there is an underlying neurochemical abnormality. Not so fine when it's someone who didn't use to HAVE anything 'wrong' with that biogenic amine neurotransmitter system. Particularly so in those whose brain development isn't complete. Bad, bad, bad juu-juu.

I have VERY strong feelings about this. But I have pretty good reasons.

On this point specifically: the most common rating scale for ADHD used by pediatricians is the Vanderbilt. pdfs are freely downloadable for this. Here's one:

http://www.uwmedicine.org/neighborhood-clinics/Documents/03VanAssesScaleParent%20Infor.pdf

And here's the teacher one, if you want to get input from a different observer, like an afterschooling tutor, coach, or extracurricular instructor:

http://www.nspeds.com/_files/Vanderbilt-Teacher-Initial.pdf

Yes! I think that you should absolutely take advantage of the diagnosis and ask for accommodations from the school as suggested above! Make the best of the diagnosis the pediatrician handed to you for getting a 504 plan while you figure out if you want a second opinion or to pursue other options. Good luck.

Sounds good but I'm not sure if it would work. Having just gone through setting up a 504 for my son. The documentation for eligibility for the 504 required more information than a checklist from one teacher. It's worth a try and you have enough to start the process. Perhaps the school psychologist will do a better job in the assessment and can be instrumental in working with this teacher.

This is certainly something that goes more smoothly at some schools than others. We've gotten some traction on getting DS more physical activity during the day, but we're not yet to a point that will fully satisfy his needs. For us, it's been a cycle of bringing the need to the school, not getting much, then the teacher being frustrated and seeking help. Small interventions are being shown to help but not fix things. We're now in the process of making the case that more significant interventions can help further.

In parallel, we're working to help DS see how well he responds to physical activity. He's begun to advocate for himself as well, which seems to carry more weight than the 504 document.

The questions were odd to me. They wanted to know if he was fidgety so I said yes. But he's a 9 year old boy who gets one one fifteen minute recess a day and only has pe once a week so he sits in an uncomfortable chair all day. That would make me fidgety. We were asked if he's inattentive. In class yes. At home or in karate or gymnastics then no.. another one was emotion. Yes he's highly emotional and sensitive but he's the one who stands up to bullies to protect others and he often gives his lunch away to a child who says they are hungry. Is he disorganized? With school work yes but his logos and trophies are put away nicely and in a specific order. So I'm confused about the questions and wouldn't know what to answer.

Cola,

When the school gives a parent a questionnaire to fill out, you should comment on the environments you observe your son in (home, social activities, church etc.). If his teacher is reporting different behavior at school, don't comment on that because you are relaying her report. If your son is displaying different behavior across multiple environments, that is a red flag. Is there another restrictive environment you can observe his behavior in similar to a classroom? Like church, or the movies? Is he fidgety at those times?

Dump that doctor. Find a Family Practitioner. I find FP's to take more time, to listen more thoroughly, to learn about your entire family before jumping to writing prescriptions.

Cola, when I've filled out these types of behavioral surveys for my children (for neuropsych and counseling evals), I've always been told to fill in the bubble that I *think* fits my child most of the time, but to also circle the number of any that I have these types of questions about, and write comments on the form explaining the questions I have.

So for example, on the disorganization, I'd probably mark the "sometimes" (or whatever choice is closest), and add a comment that states he is disorganized with school work but keeps his trophies well organized. Remember that the forms are great for looking for overall patterns, but notes such as schoolwork is disorganized but your ds is organized in other areas of his life are where a professional can start to see important patterns that will give clues to what is up. That's why a good diagnosis relies on so much more than just a quick glance over a form filled out by one teacher.

polarbear

Another thought for you, since your ds is 9 years old. My ds has a diagnosis/challege that has symptoms/behaviors that overlap with ADHD symptoms. His elementary school staff was fairly certain he had ADHD, so in the process of trying to determine does he or doesn't he, one thing I did at home was go over a "children's checklist" of ADHD symptoms - it was a list he could fill out, and it was really helpful in understanding what was going on with him. It's been quite a few years since he was 10 so I don't have the book at hand, but maybe you could google and find something similar.

polarbear

I respect geofizz' opinion on this - our parent advocate in elementary also suggested we do the same when ds had an inaccurate ADHD diagnosis and an accurate "other" diagnosis and we were struggling tremendously to get him qualified for the services and accommodations he needed at school. We chose *not* to do this (although we could have), and I am glad, in our ds' case, that we did not - so please know I'm not disagreeing with geofizz and others, just offering an example of why a parent might not want to do this, when they are unsure of the diagnosis:

1) We were fortunate in that, when this was suggested, we already had private testing that showed clearly our ds had other challenges, so that we could target remediations and accommodations specific to his *actual* challenges. If you write up a 504 assuming the diagnosis is something it isn't, you are running the risk that the accommodations put in place aren't appropriate. While that usually isn't going to do any harm to a child, it also most likely isn't going to provide significant help, and it may result in time lost from class or other therapies that is really needed.

2) Paperwork is going to follow your child in school. Once the school has a record of your child having a diagnosis, you're going to have to prove your child *doesn't* have that diagnosis to get it off of their school paperwork. We actually had to do this (see why we did this in #3 below) by paying for a private ADHD evaluation, which, while it is good info to have (knowing that he doesn't fit an ADHD diagnosis), it was also something that we knew as parents already and that we didn't really want to have to pay for.

3) Having the ADHD diagnosis on his paperwork tended to focus the school staff on that diagnosis during his IEP eligibility review, when we really needed them to be focusing on his actual disability diagnosis. It was also used as a "possible reason" that he was having difficulty with written expression, when he has a diagnosis of a written expression disability. The impact of that was two-fold - the school tried to use ADHD as a reason to prove that ds' struggles with written expression were only due to focus and therefore he didn't need any individualized instruction in written (which he did), and the staff also tended to look at ds as a "kid with ADHD" rather than a student who was trying but unable to perform due to his LD not being addressed. We also had the school tell us he should be medicated in order to properly assess his written expression - and this is simply irresponsible. All the ADHD medication in the world would not have addressed ds' challenge simply because it wasn't ADHD. I won't go into how inappropriate it was for school personnel to suggest meds!

4) The school staff (in our school at that point in time) was used to seeing a lot of students diagnosed with ADHD (and I think correctly diagnosed, at least among the students I knew well), but they didn't see as many students with LDs and since there is such a wide range of LDs and how each LD impacts a student, it was just "easier" to see ds as a student with ADHD, and not acknowledge that there was something more/different going on - and ds really *needed* that recognition that he had something different going on - that was the first step toward getting ds help that was meaningful and effective.

So - food for thought re why *not* to use a diagnosis to get services if you aren't sure the diagnosis is appropriate. We definitely would have had an easier time getting accommodations for ds if we'd let the school write a 504 plan for ADHD, and some of the accommodations would have overlapped accommodations he receives for his actual diagnosis/challenge. But we would have also caused delays down the line in getting *appropriate* services/etc for ds at school.

I suspect that what you need at this point in time, for your ds, is an evaluation that looks at the whole student, and includes how he is functioning both at school and at home. You can initiate that type of evaluation through your school, or you can opt to have a private evaluation - but one visit to a pediatrician isn't what you're looking for.

Best wishes,

polarbear

Incidentally, if going through a process with formal ADHD rating scales, some of them have self-report forms going down to age 6 (notably the BASC-2; beginning from around middle school for most of the others), which can help to pull out not only some of the symptoms (or non-symptoms) that are not as externally-noticeable, but also some of the emotional effects and self-perceptions that often go along with some kind of classroom struggle.

I find this thread especially interesting because we were told recently that DS had ADHD and it was not correct. He had been having difficulty at school and I arranged a speech evaluation. The speech therapist said she had never seen a child fidget that much in 15 years and that we needed to get ADHD medication immediately; she said it had been a great help to her own daughter. The school agreed that ADHD was a likely reason for his difficulty, so they did a screening test on him. At the same time, our psychologist arranged a screening.

Even his teacher, who thought ADHD was likely, gave responses on the screening that weren't even elevated. He was solidly at the median. It was consistent for the school screening and for the psychologist's screening.

When DS was moved up to a higher grade, those particular symptoms disappeared. He still has certain difficulties (he definitely has some challenges), but the ADHD-like symptoms disappeared.

I think it really illustrates the importance of a proper evaluation.

I agree with polarbear. I think it is worth using the diagnosis for services if that is important (in other words, if you have to get something quickly and think the accommodations will help), but it's better to get services based on the right diagnosis because the accommodations and services needed are different. Even if you use the ADHD diagnosis to get the process started, it's better to really know what is going on.

We saw his teacher at a school carnival last night. Idid not mention the aADHD diagnosis but instead stated we would like him evaluated for possible dysgraphia by the school occupational therapist. First she says she's not familiar with dysgraphia but that there is no therapist on the school grounds as it has never been warranted. Then she makes a comment to our ds saying he needs to stop fighting her when she's only trying to do what's best for him. I secretly couldn't help but snicker at her comment and want to high five my son for "questioning" her. In fact, he "fights" her on the necessity of showing his work when he's clearly gotten the answer right in his head (going back to my dysgraphia concern) or why he has to read rats of NiMH quietly when he's already read it and there is no lesson to be learned by a rat in a war. I'm probably just as childish for giving him kudos for that statement lol.

I would tell them you want him evaluated for disorder of written expression and motor issues related to writing. They have to include that in a comprehensive eval if there are concerns. I hope she is wrong and there is actually an OT who can test him for writing issues. One of our special ed directors didn't even know what dysgraphia was when I was talking about it last year--it's really pathetic. And then if they do know, they will tell you that they are not a neuropsychologist and they can't diagnose anything. So stick with your specific concerns about how his academics are being impacted. They sound about as clueless as the school I was dealing with last year.

And to follow-up on blackcat: sometimes it helps to use the terminology that the school may recognize, such as "specific learning disability in written expression", or "physically impaired/fine motor", or get a DSM diagnosis and use "other health impaired".

Many schools instruct their staff not to make Dxs. That doesn't mean they can't either accept other professionals' Dxs, or make disability determinations based on the IDEIA classifications.