diagnosing ADD in a puzzling child.

Karen, we went to a Neuropysch to have my 8 yr old evaluated, I wanted him to rule out ADD/Inattentive and other Learning Disabilities. As it turns out he does have ADD/Inattentive but No other LDs (thank Goodness). They not only use the connor’s rating to test. There are other tests that he did to check on the attention etc. It is not just anecdotal and observations.

My son could not read in 1st grade, and I worked with him at home on it too. He could not focus and had trouble putting his thoughts together enough to even tell me things. We did behavior modification since he was 4 yrs old, we did not know what ADD was, and my misguided impression of ADHD was that a child was hyper. My child is quiet and not hyper, nor is he a behavior problem. But he had trouble learning and his frustration level was very high.

As it turns out, when we did the evaluation, his IQ was High Average. The Neuropsych thinks it is even higher, but was suppressed by his ADD. Anyway, to make a long story short. We did the medication route, and I was suprised and so was his teacher (who insisted that he was NOT ADD) at the results and his ability to focus and learn. It did not change his personality. More of his personality came out, and he could put his thoughts into words. We did reading tutoring 3 days a week during the summer for 2 months. I work with him the rest of the days when he was not being tutored as a followup, so in effect he was reading 7 days a week. Well! he went from not reading to reading at a 3rd/4th grade level and he is only in 2nd grade. He was able to retain what he was taught and he was able to learn.

The Neuropsych eval was very important to us. I highly recommend getting one done but be sure to find a good Neuropsych. Mine was a very respected and well-known Neuropsych.

Good Luck.

If you are looking for a medical diagnosis of ADD and medication treatment trial, go to an MD; if you are looking for behavioral intervention, look for a psychologist. There are many routes to diagnosis, ask yourself what information would make a difference in your son’s life now. Sometimes more testing is not useful; what will your specialized school do with more testing(I’m assuming they do their own testing too)? Will they alter their program? Will you alter what you do at home with him based on the testing results? A neurologist will give you an opinion about the tics, other syndromes, etc.

SAR,

I guess what I am looking for is a way to tease out if his inattention is the type that responds to medication - “real” ADD, as opposed to other things that could cause inattention such as anxiety, learned behavior etc.

The school is isn’t the issue right now. I view them as a source of information, and hopefully someone who will partner with us in whatever path we decide is appropriate.

AFter chatting with my friends who are in the business I was left with different recommendations and am looking for more advice on how to best sort this all out. The neurologist is someone I think we need to see if we do decide to medicate because of the possible effects on tics etc. We weren’t going to go to a neurologist because of the tics alone because they are mild.

Can a neurologist diagnose ADD?

Do you think a neuropsych eval that’s 2 years old is too old to be meaningful?

Opinions welcome!

Hi Karen,

You are asking good questions, and there are probably no “right” answers. :-) We took our son to the “Child Development Center” and had a full range of educational, psychological, and social testing done for him. Yes, the Connors was part of that - but only part. The psychologist who did the psychological testing diagnosed him with “probable” ADHD and anxiety and suggested we go to a psychiatrist for a firm diagnosis.

Well, the psych didn’t have any appointments for another three months, so we went to a neurologist, who was able to diagnose based on a phsyical exam and the testing results we already had - and we put our son on medication. It’s one of the best things we’ve ever done for him.

However, the neurologist gave us horrible advice about educational issues, did nothing for the social issues, etc. Soooo……. we nixed him. Tried another one, who gave us equally bad advice - but loved prescribing meds ……… nixed her. Now we use our primary care physician for med issues - and have the right combination of meds for the first time.

I’ve looked for a psychiatrist/psychologist in our area who is knowledgable about our son’s issues, and participates with our insurance company. Every time I leave a message with one of them (I’ve tried about eight), asking for self-advocacy skills, self awareness of his disorders/disabilities, social skills, etc. - I never even get a return call. What’s a mother to do?

So, I keep researching, talking him through various issues (from why something might be funny to him and not others, to how to fold a shirt - he learns best auditorily).

Anyway, I’m rambling now. Just giving you some pros and cons from my experience.

Lil

Karen,

We saw a neurologist 2 years ago who diagnosed my son with ADD-inattentive. We had been referred to him by our pediatrician who thought my son’s case was too complicated for him to evaluate. The pediatrican, at the time, was concerned about my son’s monotone voice and lack of eye contact with him and wanted the neurologist to rule out Asberger’s.
The neurologist concluded that he did not have Asberger’s, that he did have nonverbal learning disabilities, that he was probably dyslexic, and was ADD-inattentive.

I will tell you quite honestly that I don’t think at least the way the neurologist we saw (who is a local expert on ADD) approached diagnosis would answer your questions. I really did not feel like he teased out at all the other possible causes for inattention. He told me, for example, that kids who are severely LD, like my son, almost always are ADD.

I do think in talking to other parents that a neurologist would be essential for a complicated kid in dealing with medication but am less impressed with the diagnosis end, for ADD-inattentive at least.

Of course, this was only my experience with one neurologist but he is very well known in our metropolitan area as an expert in ADD.

Beth

We also used a neurologist. Our experience was different than Beth’s in that we felt that our doctor covered every other possibility there could be. The exam lasted five hours and included a social history intake, physical exam, neurological exam, and developmental testing. There were a multitude of tests. So I guess it really does matter who you see. Our daughter was diagnosed ad/hd inattentive.

However, I agree with the person who said that different doctors will approach things differently. I also feel your diagnoses itself can be different depending on the type of doctor you use.

Unless a lot has changed(loss of skills, etc) I wouldn’t repeat a huge neuropsych eval after a yr or 2; why not ask your psych. to use the BASC scales(behavior assessment system for children, has a teacher rating, parent rating and self-report scale) and get more data on the inattention. If you are asking WHY is he inattentive, I would ask the psych.MD you already see(or a neurologist) is he depressed, anxious, having seizures, lossing his hearing, etc…No I agree the MD won’t be the source of educational recs, but isn’t that why he’s in private school with lots of resources for special students?

As a teacher married to a pediatrician, we found the diagnosis of ADD in a child to be a round robin of hesitation and denial that could drive a parent crazy. I was told by my principal to NEVER suggest to any parent that their child might have ADD. I was only allowed to use the phrases ‘focus issues’ or ‘attentional issues’ to parents. Invariably many parents would then ask “Do you mean ADD?” Then I’d have to dance around that question.

Some parents would then take their children to a pediatician whose first question would be “What do the teachers say?” I guess not realizing that many teachers aren’t allowed to say much of anything…

In my experience, everybody ‘in the loop’ wants someone else to be the person to say to a parent, “Your child has ADD.”

ADD is a spectrum. Who has it and who doesn’t have it I something think is anybody’s guess. One of my sons was the kind of kid that truck drivers sitting next to you at McDonald’s would say, “Lady, your kid has that ADD thing” as my son would be running around under everybody’s legs. When I put that son on medication for ADD, it did nothing. It didn’t hype him up or slow him down or focus him or make him more alert or less alert. It did NOTHING. He was the same on medication as off medication and that held true of every medication known to human kind at the time.

I’ve come to believe that the only way to tell if a child would benefit from medication is to put them on it. If they benefit, wonderful. If they don’t, take them off it.

How much is your son struggling in school? That might help you as you think this through. Both of mine were struggling terribly in school and in life as well. One benefitted tremendously from medication - it virutally turned his young life around and he spends his young adult life wishing it would have the same effect on him now. As I said, it did nothing for the other one.

‘Round here, there are doctors who NEVER medicate anybody and there are doctors who medicate everybody. There are pediatric neurologists who medicate nobody and pediatric neurologists who medicate everybody. I once said to one of the pediatric neurologists who medicates everybody that crosses his path, “You’d medicate a dead cat” and his response to me was “And that cat would sit up and do better in school and have a happier life and one day likely go off his medication having learned how to cope and focus because of the help the medication was to him….”

It’s a hard decision. Good luck with it.

Wow, I was out for the day and came back a slew of great responses. Exactly the antecdotal info. I was hoping for.

It sounds like the neurologist we may see may , if he’s good, be able to lend some perspective on the whole thing. Maybe he’ll be able to tie together the various issues my son has into something that would indicate a particular direction . Maybe not, but so far noone else really has been able to. No, we don’t need educational or behavioral recommendations from him. We’ve got enough other people to do that for us! And should we determine that medication is an appropriate intervention we do want a local MD monitoring it. Our psychiatrist is not local, as we have moved this year.

Thanks everyone.

My advice is that you go see someone who is has a background in pediatric neurology and psychiatry and specializes in diagnosing and distinguishing ld/adhd. A good place in the northeast is the Kennedy Krieger Institute in Baltimore. YOu will find people there who really know their stuff. You would follow up the medical/psychiatric eval with an eval by an educational diagnostician. You are talking about a couple of days of testing to get a really good workup. This is the gold standard for diagnosis. It costs like the dickens but it is worth it!

Sometimes, there is a pattern that will pop out…A decrease in processing speeds or a very low processing speed in the 70’s. That is what was obvious in our child, she went from a 122 in first grade to 70 in 5th grade.

One can put all the tests scores on a spread sheet and compare the similarities and differences in getting a diagnosis…however, one can come up with different opinions on the medication. After what I have read I think you have nothing to lose by trying medication…why put your son through more testing if you can see a pattern through the tests that have already been done…I have also seen kids that are ADD can usually hyper focus with some of the tests and do well on them and when that happens you are back to square one… what is the problem???

I think one of the best indicators is how a child or adult performs in his day to day living and job/school. If inattentive behavior is interferring with a person being successful in their job/school then it is time to do something about it. And if a short trial of medication is in order then by all means go for it :wink:

DS spent this morning telling me that school is boring, that they teach everything the same way. Which in fact they probably do. Sigh. Despite all his difficulty in school the last 2 years , he never complained about it being boring.

Anyway, the real reason for my post is to brain storm a bit more with you moms’ of inattentive kids.

Do you inattentive children lose focus even during activities they enjoy? My son can play with a friend for hours and I see no evidence that he is zoning out or hyperfocusing. He tends to drift in between activities - as soon as he’s not actively engaged in something he can be gone. I intend to find out if his level of attention varies throughout the school day based on subject, to see if boredom is a factor (along with anxiety and neurology). Just looking for antecdotal info. from you all.

Karen,

My son can do all sorts of things at home and I never see evidence of boredom, unlike my younger more ADHD child who craves stimulation.
My 10 year old will sometimes even walk around the background and look at the plants and sit in the sandbox and happily build things. I have though seen him hyper focus at times on video games—he gets really upset if anyone makes any noise because then he can’t concentrate. With friends, he seems to have a longer attention span than most kids his age.

I will say though that my son also complains about certain subjects in school being boring. He hates English, for example, and seems to totally zone out. He tells me he can’t pay attention, it is too boring. He is in a parochial school this year and they emphasize the basics like grammar. He hasn’t had much of this in the public school, especially being in a resource room. He also isn’t naturally good at it, with his language weaknesses. But while he can come home from school and tell me all sorts of things he learned in social studies or the story they are reading in literature, or math, he seems to absorb absolutely none of the English. When he does his homework, I have to reteach it all to him and frankly he still doesn’t retain it. He still doesn’t get what a noun and verb are and I think it is because he thinks it is boring and stupid and at some level doesn’t really focus.

It is this inability to focus when things are boring that I do think is indicative of my son truly being ADD-inattentive as opposed to it simply being processing issues. My husband is the same way—but he isn’t LD so it didn’t matter as much. My son though has tons of interests and really likes to learn content matter like social studies and science. He is the only kid I know who has had us read his social studies book to him as a bedtime story!! I can see though that he might have some of the same sort of problems in the setting you describe. So ironically, some things may be better for your son in a specialized setting while other things are harder for him.

Beth

Beth, yup, that’s my son. Like your inattentive one. He too can and does spend time looking at trees, out the window, chatting with friends while they roam around our new backyard. He also freaks if people talk while he’s watching TV - If he weren’t LD he would thrive in an exciting multisensory school like his old one, and it would probably hold his attention more. I find it ironic that in this small, structured, quiet place that will finally teach him to read fluently his attentional issues seem worse. There probably isn’t a school that both excite his intellect and remediate his reading problems.

They are alike. Maybe if you can get the attention under control medically, he will learn to read well enough that you can put him back into a regular classroom. There maybe, like my son, attention won’t be such a big deal because there is more to catch his interest. It is hard to know but I do think that the current environment has probably made his attention issues worse. But you are right—there probably is no perfect place for him right now.

Beth

as it is that things that are challenging their weaker areas and taxes their attention is when they tune out and say…”It is boring.” I see it in kids especially when they are struggling to master concepts.

It could be that the structure and routine is boring but they also are making a decision to not engage and that is where the problem lies especially when you are trying to deal with remediation of the weakest links for kids with co-morbid issues.

Patti,

So what do you think it means when our kids say “I can’t pay attention. It is too boring.” I agree, for my son, it is for the things he finds difficult but they also are inherently boring. I mean how exciting is grammar, for example.

Is this ADD-inattentive kind of behavior in your experience? Or is this just it isn’t easy for me and I don’t like it and so I am going to tune out, even if they don’t see there is a decision? Or are they the same thing?

I mean I know I didn’t pay attention a lot in school but I had this way of being there and not being there. I even learned to read a novel while particpating in class discussion (just enough so it looked like I was interested). And I wrote many letters in class in college. I don’t think I am ADD—I learned just fine in boring classes—I just had to use more “coping” mechanisms. (I do think I have children induced, middle age induced ADD somedays. however!)

Beth

I have never accepted the “its boring” excuse when my friends talk about why their kids tune out. And my son , despite all his issues in his mainstream school, never said it was boring. So when he said his current special school is boring it got my attention. He correctly said they teach all subjects the same way and he’s right. But that’s what he needs to remediate the reading so its what we need to do ….

Inattentive ADHD kids do appear to be more easily “bored” than other children. These kids are less able to tolerate things that are difficult or tedious and tend to tune out from them. It takes incredible mental effort for them to stay with a really hard or repetitive task. It wears them down, as you can imagine. Its as though you had write all your sentences starting with the last word first. You could do it, but it would wipe you out after a time. They may say that they are bored when what they really mean is that something is hard and not immediately rewarding. They have trouble keeping on in those circumstances because their mental impulse is to stop doing the hard thing and to start doing something more fun, such as thinking their own much more interesting thoughts. This isn’t really a question of motivation, even though it looks that way. It really is a question of lacking the same ability as those who don’t have ADHD to persevere on difficult or uninteresting jobs. They just have extreme mental impulsivity, even if they aren’t physically bouncing around or leaping off of desks, or whatever. KarenN, when your son says he is “bored” is it possible he might be telling you that he is finding his new school difficult? He may not even realize this himself, or be able to put it into words. He might find it more difficult than his old school because now he is finally receiving the help he needs in order to learn to read. That is good, but it also requires him to run up against the very thing that is difficult for him pretty much all day every day. That would be hard to take for anyone, but especially if your son does have attention problems. I know that until my son began taking medication for his ADHD, he was never really able to benefit from the great class he was in, even though he was being offered exactly the sort of remediation that ultimately did work. He said what your son is saying: “it’s boring. They are always doing the same things.” What I think he really meant was “this is really hard. I don’t like hard things and I can’t make myself do them.” After medication, he was more able to keep on working even though something was really difficult for him. He began to experience success, which encouraged him to keep working and the whole thing just built up to the point where he was actually able to benefit from the good things being offered to him. Mind you, he grumbled the whole time about “stupid” this and “boring” that, but he did the work. He’s out of special ed now and is on the honor roll at school. He still grumbles, but he can keep on working without giving into the impulse to think or talk about or do something easier and more fun.

The unpopular middle ground:

Sometimes in life we all have to do things that are extremely dull and/or frustrating. I don’t like washing pots and I don’t like paying bills, but I drag myself through them because I can understand delayed gratification. Kids do need to learn this and to stick to something.
Look at what kids do in a sport or video game or hobby they like — do hockey or basketball shooting practice for three hours straight; play the same part of the game over and over until they can do it without conscious thought; sand and paint a palm-sized model for four hours; and so on. This kind of perseverence needs to be applied, in reasonable and age-appropriate quantity, to learning school subjects as well.

On the other hand, it shouldn’t be *all* boring tedium. Even grammar can be interesting, at least once you have foundation knowledge of the language — why do we say this instead of that, and can you explain the principle? Can you find the errors in these sentences and tell me what went wrong? I tend to amuse my students by either making a very loud game-show bzzzzzzz or screaming in pain when they repeat a common error — it makes them laugh, but it also makes them avoid the error the next time. Reading skills are tedious to learn, but once you have even the basics the reading material should have at least some interest, some things to talk about. No, I am the last one to advocate a fun-fun-fun play type classroom, but one of the things we hope to teach is that learning is fun and rewarding in itself.

I’ve found this thread, and the other related threads , very helpful.

Last night my son was moaning and groaning thru his math homework. He had to read a word problem, show his work (a combo of multiplication, division and addition or subtraction, multi part) and write the answer.

He complained ” did they forget I’m dyslexic? I can’t read it” . So I offered to help with the reading part.

It turned out he could read it just fine, and do the complicated math in his head perfectly. He didn’t want to show his work.

So I told him all the reasons why he needed to show his work (its good practice, the work will get more complicated etc etc.) But the final and most important reason to show his work –” The teacher told you to , and you must follow her instructions”

One of his saving graces in his struggle has been his perseverence. But you all are right - sometimes weyou just have to do your job, which in his case is to do the assignment as asked.

BTW- I’m starting to see some improvement in his reading. He’s decoding multisyllabic words (3 syllables +) with some greater ease. !!

I agree with what guest said. ADDer’s don’t have the skills to master their commander more or less, to keep trucking even when things are boring and take more than minimal engagement and initiative. Heard of another kid who’s been diagnosed ADD, has anxiety/obsessive compulsive tendencies and when he gets overwhelmed with everything has a meltdown…Parents think he is just obstinate and pulling their chain…Hmmm??? Perhaps…. but I think the anxiety stems from the disorganized ADD mind…

Patti-
My husband and I spent a good chunk of the evening last night mapping out our plan of attack for our ds.. And the fundamental question we keep coming to is - Is the anxiety causing the inattention or is the inattention causing the anxiety? I’m thinking its the 2nd, in our case, b/c my very verbal child is starting to articulate his frustration with his own inattention.

A neurologist or developmental pediatrician should be able to look at his history…ADHD is present from a very young age and in all settings to some degree; an anxiety disorder can start at any age, but not from birth and usually is more pronounced in a particular setting(my LD son was very anxious in class from reading and all subjects that needed reading yet was OK and focused otherwise. ADHD has been described as a PERFORMANCE problem, not a skill problem by Russell Barkley PHD. Did you look at this site in What’s New at Mel Levine’s discussion of The Myth of Laziness(his new book)? He talks about having to teach our kids to be workers.

Well we had meetings set up with the school, our psychiatrist , and a neurologist to try to sort out our son’s attentional problems.

Then much to our shock at our school meeting the teachers told us they feel the system for cuing my dreamy son seems to be working! They feel he is learning and that they can manage his inattention. (Bear in mind this is a special LD school, so they are particuarly well equipped to do so…) So we went to the psychiatrist today and he feels that if that is the case, and that DS is making friends , then its appropriate to forgo medication at this time.

Interestingly enough he did say if we wanted to do a medication trial he would start with ritalin because of its short half life in the body. I had assumed he was leaning towards straterra due to my son’s anxiety and tics, but he said he wouldn’t recommend starting with a med. that takes a while to build up in the system. Also feels more comfortable that ritalin is safe as it has been around the longest. This guy is very conservative when in comes to medication and I found his logic interesting.

We will probably keep the appointment with the neurologist just in case anything new comes up. That way we’ll have a base line , and a relationship with him.