ADHD evals -? too subjective?

How old is your son? Our son was is 2nd grade when one of the teachers raised the ADHD concern. Everyone filled out the Connors forms and the pediatrician basically came back and said mild ADHD. Medication probably not warranted. He said his most important criteria are these three things:

- Is the child working at grade level?
- Is the child socially successful?
- Is his self-esteem strong?

He said as long as all these things are fine, too bad if the teacher doesn’t like his fidgeting. [Sorry, teachers out there—you have my sympathy!] He told us some teachers coped well with this type of child and others would be frustrated about being unable to control him. So we have not medicated him, and you know, not a single teacher has brought it up again in the past 7 years. He is still doing fine on all three criteria.

Now, we have another son that was diagnosed ADHD-inattentive in the 6th grade. No teacher ever complained about him because he was the quiet one. But he struggles in all three of those criteria. So we medicated him and it made a world of difference for him.

So my advice is to examine how your child perceives their situation and how much their fidgeting/distractibility interferes at homework time. If your child is unhappy and homework battles related to ADHD are creating a nightmare at home, then factor in the teachers concerns and consider medication. Otherwise, a behavior modification plan might be a better choice.

I happen to agree with you about the Connor’s—even though my son was not rated as ADHD according to it.

I know you have had a lot of evaluations done. A lot of psych types do something called a Continuous Performance test which evaluates a kid’s ability to pay attention to something boring. This is more “objective.”

Beth

Unfortunately, there is no “1” tool to properly diagnose ADHD. That’s why it is so important to use a variety of methods to diagnose ADHD. While subjective, the Conners survey can be useful if teachers fill it out properly. When we first tried to diagnose my 10 year old, teachers who worked with my son filled out the survey, as did we parents. It showed a clear problem with inattentiveness as compared to his fellow classmates.

As far as using the TOVA (a continuous performance test), while the test results are objective you can’t rely on this test alone to diagnose ADHD. My son, who loves computers and has that wonderful hyperfocus quality aced the test.

The first quack we went to refused to diagnose ADHD because my son did too well on the TOVA. She totally ignored the surveys, past report card comments, family history, etc. Fortunately, we continued and found a doctor who looked beyond the TOVA and took all of the information into his diagnosis.

JulieinSC

A good point. I know ADD kids hyperfocus. Had never thought of a TOVA being the type of thing they would hyperfocus on.

Beth

You have the right to make this decision for your son - regardless of what anyone else says. As a parent myself, I’d offer that first.

As a teacher, I’d be so bold as to make this suggestion. Spend some time in your son’s classroom. If you stay quietly for a while, the kids including your son almost forget you’re there and normal classroom life picks up around you. Follow them at a distance to recess and to lunch - the less structured times of day. See what you see.

Psychologists and pediatricians can have their opinions but the proof is in the pudding of the school day. A child alone in a doctor’s office or psychologist’s office is one thing. A child in a group with touchy teachers is another.

My caution and reason for urging you to consider going into school would be this. A teacher is responsible for many children and some teachers live on the edge because of that enormous responsibility. I’ve seen some ADD children made miserable by their school experience.

If your son looks forward to going to school and comes home happy at the end of it, that says more to me than the opinion of the psychologist or pediatrician. If other students regularly call him and ask him over, include him in their birthday parties, if he feels warmly received by his peers, that says even more.

But to comfirm that all is well as it now stands is best down by observing his class and its interactions. That way you don’t have to rely on the opinion of anybody else but can make an informed one of your own.

Good luck.

To answer a few questions: my son is in the 3rd grade. He underwent testing last year because his classroom teacher insisted upon it. He attends private school so we went for private testing. In addition to IQ /performance testing, he was given several tests dealing with a child’s ability to focus and filter out distractions.

Results: Superior IQ, average performer, retrieval fluency deficit (I think that is the same as problems with word retrieval), good ability to focus despite distractions, did not meet the criteria for ADHD on any of the individual rating scales EXCEPT for the classroom teacher who had him in the “high” at risk range. My son’s school has a lot of “specials” that they attend daily so the kids are out of the main classroom alot or in split groups. His “inattentiveness” was considered to be atypical as it only seemed to occur in one situation. I did try to do some observation but it was not well recieved by the teacher. However, I did notice that while he certainly wasn’t the best behaved boy in the class, he was not the worst and his episodes of misbehavior were much less frequent than some of the others. His infractions generally consisted of running or goofing around in line when all were to be quiet , being too loud (?) or rough on the playground, talking when the teacher was talking, or clowning around, seemingly to get attention from other children. We were advised that these behaviors were those of child with little self-confidence and poorly developed social skills. He hated school.

This year he likes school, is working at grade level without difficulty, has some nice friends but doesn’t feel socially successful because the “cool” kids say he is a “dork” , “dumb as a rock” and a “loser”.
He is with a psych for social skills training. Since he met some of the criteria for ODD, we have also been working on that with good success - at least at home. While his classroom teacher tells us he is doing good, she seems to have taken a zero tolerance attitude with him and he feels that he is being singled out. When he asked her why she didn’t “yell” at the other boys who were walking up the slide, she said that she didn’t see them. When he asked “why do you always only seem to see me?”, she fumbled and had no real response - the unspoken answer, of course, is because she is ALWAYS LOOKING AT HIM! I’m afraid that he has aquired a label and that everyone will be scrutinizing him from now on which will surely set him up to fail. Do they really believe that medications will be the MAGIC that makes him behave better? I know that there are kids with ADHD who have truly been helped by medications but I am not convinced that his problem is ADHD. We remain discouraged and confused by all of this. Next week is vacation so it’s a chance for a fresh start, maybe.

Happy Spring to all.

Dear Susan,

I am appalled at your sons’s teacher! Your son sounds as if he is a gifted but frustrated child. Please don’t put him on meds before you have visited http://www.gifteddevelopment.com . This web site opened my eyes!! My child is ADHD and is on meds but we have been through hell with a variety of meds and side effects. If you, as a parent ,have not seen him as ADHD then I can assure you he is not!! It is so obvious that our son has ADHD and has been since the age of 4 mos. Even my mother couldn’t believe how he was hyperfocusing at that age. Of course ,over the years ,it has become more and more apparent that our child has a problem.Our son is gifted and ADHD and has some learning differences , that is why we HAVE to home school. We were not given a choice since the ps system only teaches to the profoundly disabled and average kids. It is a travesty but that is the way it is.Please don’t keep your child in a system that he thinks hates him and that is always looking for the negative in him. School should be a good experience ,not one that robs our kids of their self respect and self esteem. Why shouldn’t they be able to be themselves? I feel for you and your child. This is a long struggle but it will be worth it if our children can have successful lives. God Bless!! Jan

Jan

Thanks for the encouragement. Just when I think things have smoothed out, I find another bump in the road. I would like to change schools but our choices in private education (elementary) are very limited in our area and the public school system is abysmal.

We spent a looong…. holiday weekend out of town with family and friends who were surprised that this “thing” keeps rearing it’s ugly head. All thought we were on the right track - kiddo had a great time even though some of the events were really kid-boring. No behavior issues - cooperative, respectful. Patient and “uncranky” during a 12 hr car ride home!

Interesting article in paper today re: obstructive sleep apnea. My son had adenoids removed at 2yr due to this and tonsils/ adenoids(grew back) removed at 5 1/2. He manifested all the behaviors associated with this disorder( except bedwetting.) For 2 yrs after that he was beset by chronic sinus infections resulting in disrupted sleep patterns. Since then, we have noticed that whenever he is not properly rested or over-tired for whatever reason, he is more likely to lose control of his behavior. In his case, “A well rested child is a well-behaved child” and we try our best to make sure he gets adequate sleep but that is not always the case.

Hoping for a peaceful week.

Susan,

I too live in Florida and know first hand our public education system. I have two of my kids in parochial school and my LD child in public.

We are actually having a pretty good experience now with handpicked teachers. There is no doubt that the parochial school is more advanced but that isn’t an advantage for our son. It seems a big part of your son’s problem is the school— I guess I was wondering if the public schools might not be worth another look. There are worse things than not getting the “best” education—being beaten down and made to feel bad about yourself are far more important in my book.

Beth

There are other medications. Have you ever read Dr. Daniel Amen? His books are gaining popularity and can be bought in the psychology section of Borders. He also has a website that is informative. ODD is brain-based. For the person who has it, it is almost impossible to “let go” of the opposition when triggered. I know, I started seeing one of his colleagues closer to my home almost a year ago when I recognized certain symptoms in myself. I am ADHD with some other issues. I am NOT on a stimulant. His book delineates several subtypes of ADHD and the area of the brain that is usually understimulated or sometimes overstimulated. He also makes good suggestions for nutritional approaches to the various difficulties. I highly recommend reading his work. Check him out on the internet if you wish.

www.amenclinic.com I believe

Anitya,

Checked out Dr. Amen’s website - impressive credentials. I noticed quite a few publications. Which book are you refering to in your post? I liked his paper on “101 Best Things you Can Do For Your Child”. Has anyone out there had any experiences with him or his theories? He is an Army trained neuropsychiatrist and while I’m always a little suspect of the military they do have the funds for research. Thanks for the reference.

Susan

I went to a seminar awhile back on ADHD. They talked alot about the various ‘triggers’ to ADHD - there’s like 22 different reasons kids get ADHD. You need to find out what causes it in your child (and that some meds can actually made the symptoms worse if you are not treating the right issue).

But anyway, they brought up the hyperfocus issue and they indicated that it is a cause of CAPD - not ADD/ADHD.

Do you mean symptom of CAPD? Interesting—my son has CAPD and I have noticed this with him.

Having CAPD just makes it easier to TUNE out to sounds and be in your own little inattentive world…

That makes sense. BTW, the sound field system did not seem to help my son at all. All he said was it made the sounds louder. Sigh. He has an integration deficit (CAPD) but I had two audiologists think that it would help to improve the loudness of the sound.

He is having a continuous performance test done this week by a neuropsych.

Beth

In my son’s case, I would have to disagree. He has no CAPD issues, just ADHD-inattentiveness. He does have the ability to hyperfocus, especially on computers, which he loves.

Although kids with ADHD (combined, with hyperactivity or with inattentiveness) can have CAPD, not all of them do.

As far as kids “getting” ADHD, I’m assuming that you mean certain triggers that can make the ADHD worse. ADHD isn’t something that you can get rid of. Hopefully, with combined treatments (behavior mods, meds perhaps, etc.) you can deal successfully with ADHD.

JulieinSC

the individual personal FM units… There isn’t as much coming into your brain, just the person that you want to hear and not everything else. The sound-field just notches us the teachers voice but what happens is that the rest of the class will sometimes get louder to compete with the loudness of her voice. I really prefer an ear-level personal FM system. I am extremely distracted by sounds even though I am hearing impaired.

I agree with you completely about the Conners Test. My son’s kindergarten teacher filled it out and I later had him evaluated in 1st grade. My son has problems with language and comprehension and I took him to a psychiatrist who specializes in ADD and learning problems. Conclusion - He was certain he did not have ADD and should never take ritalin. My school apparently did not like that answer and had his 1st grade teacher fill out the form (6 mos later). According to the school - my son was now in the 1% for hyperactivity, attention and social skills (99% of children would be better in these areas) indicating he definitely had ADD. (The fact that symtoms did not appear in any other setting did not matter to them either.) It was absurd since my son was not hyperactive at all. I was harassed by the school so much that 2 yrs later the psychiatrist suggested I put him on Ritalin to prove it would not work. It was a disaster - yet some still wanted him on it! Years later my daughter was given this also. My daughter, who while in kindergarten I was told was the best listener and most attentive student in the class was now, according to the Conners scale, considered to have ADD. I would never trust the results of any school giving this test.

Pattim,

I have been in the classroom and the teacher maintains pretty good control. There isn’t excess noise from kids. So I don’t know what to think. He seemed to just think her voice was louder.

Kids are such a riddle sometimes.

Beth