Gifted Issues Discussion homepage Forums Twice Exceptional testing for ADHD - so confused!

DS 13 needs to be tested for ADHD. It is not 100% clear if that is his issue, or if some of his problems could be caused by other things (depression has come up, also could be some anxiety there, and he has always had sleep issues...). What is the best way to figure this out? FWIW, he's had a recent neuropsych eval at school, so likely doesn't need to the WISC type testing. I guess I don't have a clear picture of what a tester does beyond that and some questionnaires... Any clarity, suggestions, etc. would be much appreciated!

Quick I'm-not-aeh response :P

In our experience, as far as hard data it's really just the questionnaires for parents and teacher. However - big however - that data gets put in the context of clinical observation throughout a bunch of different kinds of tests (ability, achievement, memory, other more-LD specific stuff), and gets some additional substantiation from some of those results (e.g. working memory and sometimes processing speed tend to be lower in kids with ADHD - but also in kids with almost any LD). For my DD, our psych also recommended testing auditory processing, as DD had some flags, and ADP can look a lot like inattentive ADHD.

So it's a lot of diagnosis by elimination. Do they have the behaviours associated with ADHD, consistently in a variety of environments? Do test results and clinical observations show patterns consistent with ADHD, AND not suggest any other (or additional) causes?

There's huge overlap between ADHD, LDs, ASD, OCD etc, so all this is complicated by the fact that is more likely than not to be ADHD plus something else.

Platypus, you're doing just fine!

Pinecroft, the additional evaluative methods for ADHD that haven't already been administered or mentioned would include some direct measures of attention not always available to school districts, due to their relatively high cost, such as computer-based measures (TOVA, IVA, CCPT, etc.). I also prefer multiple semi-structured classroom observations across settings, days, times of days, and tasks. This may or may not already be in the school record, and it may or may not be something a private neuropsych would be willing to do (although most professionals will consider it if you are willing to pay them at their hourly evaluation rate). You also may or may not get push back from the district about allowing an outside provider in the building for observations.

Generally, I do prefer to invest some time and energy into teasing out other factors (as mentioned and others: depression, anxiety, poor sleep hygiene, medication reactions, auditory processing, core weakness, vision, etc.), as children have a tendency to present as inattentive or restless for a pretty wide variety of underlying causes. It's a bit like acting out behaviors--without the developmental skills to identify, articulate, and manage challenges, they reach for the more limited pool of available communicative behaviors, such as "misbehavior", inattentiveness/disengagement, withdrawal, emotionality, angry outbursts. The symptoms/behaviors alone really tell us only that a child is distress, but not what the nature of that distress is.

This! This! This! Not every evaluator buys into auditory and visual processing disorders, which can make things even harder. Through a good OT evaluation auditory and vestibular weaknesses were able to be teased out, which led to a full auditory processing disorder evaluation. I still have to tease out visual processing weaknesses for DS.

Thanks everyone. So I think my real question now is whether I need to be looking at a regular neuropsych who tests for things like adhd (and depression, etc.), or would a therapist who works with adolescents with adhd do this?

Here's the really long version -- DS13 is a quirky kid. He was diagnosed as having sensory processing issues at 8yo, and had a year of OT which didn't seem to make any difference. He has been on an IEP since then, but is resistant to any services in school.

At the end of last year (6th grade) DS had an eval done at school. Shortly after, the principal pulled me in to ask if we'd looked at ASD. But folks I know who work with a lot of ASD kids who know him don't necessarily think he is on the spectrum, along with our own experience of him not jiving with ASD checklists, so we didn't pursue it. This year I had a little extra testing done (VECHI, hoping he'd reach DYS numbers, but due to one score - the social comprehension one - he did not), and he fell apart during testing. We were called back in for another conversation with the principal and school psych that they were concerned about him being depressed.

HOWEVER, DS is very very resistant to any kind of therapy (we tried several years ago, he did see a therapist at age 9 or 10 for a brief time; in hindsight, she wasn't a good fit), and therapists in general. So in discussions about what to do with him, we (DH and I, and the school psych) thought it would be great if we could get him to see someone for testing for adhd (which, notably, DS thinks he has and would like to be tested for) who also does therapy so it could be 'snuck' in and the relationship could be started while DS was doing something he actually wants to do. Because we were looking for a certain kind of therapist to start, time passed while I waited for recommendations from the school psych and principal. Neither of which panned out. But that process left me concerned that it is really hard to find someone who does both.

Long story short - we need to do *something* here, but I'm just not sure what the best route is long term. The only thing I *do* know is that every day I wait, is another day we aren't getting his needs met. So I'm suddenly panicked as I've let time slip by...

I guess I'm looking for recommendations of the best path, and thoughts on whether it would be better (timeline-wise) to find a neuropsych to test and then convince DS to see a therapist if needed, or whether it is reasonably common to find therapists who test as well (and I just need to keep searching). Also should I be hoping to find someone who has some knowledge of giftedness in all this too?

Full disclosure, I am a parent that is on the hawkish side of having my DS evaluated. A neuropsych is the gold standard for and ADHD diagnosis. If the reason you are hesitant to get a neuropsych is financial, you should ask for a neuropsych at district expense. Some districts are harder than others to provide a neuropsych, but I have been successful at getting IEEs for my sons at district expense through impartial hearings. I was also able to choose the popular PsyD in my area. $6500/per evaluation x 3 DS is beyond my pay grade.

Feel free to PM me, if you need help.

Thanks EmmaL! Hawkish is likely a good thing here!!!

I'm not necessarily hesitant, just trying to make sure I'm going the right/best route. That is what I always thought, that a neuropsych is the right person. I think we may be able to get it partly covered by insurance (but if at the end of the day this is the right route, and we can't, we'll pay).

It just got confusing with trying to figure out if therapists did this, and the whole depression/therapy angle. And then my husband was asking 'why this over that' and I felt like I couldn't answer knowledgeably enough!

ADHD is one of the most difficulty to accurately diagnose because there is SO MUCH overlap with other diagnoses/conditions. As a therapist, I see kids to assess for ADHD daily. The difference between a therapist and a neuropsych test is that the therapist will not use nearly as many screening or assessment tools, but will be able to learn who your child is, their unique quirks, and how they respond to things over a course of time. A clinician doing testing will have more tools at their disposal to assess the functioning of different parts of the brain, and can give a snapshot overview quickly after one day. I look at testing frequently with my patients, and it does give good information that I will never get from them through therapy. However I also see results at times that I highly disagree with because it doesn't always catch the overlap of symptoms (i.e. a trauma kid/gifted kid/anxious kid looks just like an ADHD kid, which is not usually caught in a neuropsych because the symptoms and brain responses are so similar).

twallace - thank you so much for your reply!! This sounds like what we really need, honestly, BUT I'm sort of at a loss for figuring out who/how/where to find the right person. Do you have any advice for finding a therapist who can do this? It would be the ideal for us, as stated initially -- if we can get him to work with a therapist under the guise of testing for ADHD, then he'll be willing at least in the beginning. It would be wonderful to find someone who can put a few things in place to help him vs. starting with a neuropsych and then being back where we started. A neuropsych is just an easier route, as I feel they are easier to find.

I do think a therapist with some background in gifted children would be helpful, though given your son's previous experience, it sounds like finding someone who is a good fit is more important. I always tell people (especially children) that they need to go to the intake with the expectation that they are interviewing the therapist, and may need/choose to go to several therapists before they find someone they are comfortable with. As a parent, you guys can sit down with your son and go over some of the surface screening tools to give him and yourselves some insight. Here's the ones I would suggest:
Vanderbilts (ADHD): https://www.nichq.org/sites/default/files/resource-file/NICHQ_Vanderbilt_Assessment_Scales.pdf
SCARED (anxiety): file:///C:/Users/tessaw/Downloads/Screen%20for%20Child%20Anxiety%20Related%20Disorders%20Child%20Version.pdf
PHQ-9 (Depression): http://www.cqaimh.org/pdf/tool_phq9.pdf
I would also suggest conversations with him (which you have probably already had) about how stimulated he is at school. If he has a desire to be challenged, and is bored instead, it might mean an environmental issue rather than internal.
Good luck!