ADD for a straight A 10th grader?

Parent Cafe
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<p>Harvestmoon.- to answer your question on why my son saw a big difference when he went on meds, and then did not notice a difference when he went off…I attribute this to a number of things: </p>

<ol>
<li> Maturity. He is was no longer 11, but was 14.<br></li>
<li> Physical Growth- lbs and inches</li>
<li> We started with a low dose and kept it there, never really increasing </li>
<li> He has learned tools and techniques on his own to manage his issues without drugs</li>
</ol>

<p>One of the most important things my S has learned is he needs balance. He needs downtime, which means he does not take on too many ECs. If your D really has ADD, then school, concentratin, learning take a lot of effort. For my S this means, one sport or club, not multiples. </p>

<p>We went to meds with my S because he was suffering terribly socially as many ADHD kids do. Keeping grades up were the least of my concerns. Meds were a last resort and were used to provide some relief while we worked on skills development and rebuilding his self esteem.</p>

<p>I will be honest, when I read your description, my first thought was that your D sounds like a normal 14 year old that has too much going on. </p>

<p>IMO High School is where you learn to manage yourself, and some of that come from learning when to say when. It is okay to remove activities because you need downtime. And sometime it is okay to get a B because it is a really hard class. (Don’t let my kids know I said that)</p>

42

<p>Nellieh,
With ADHD - hyperactive type, with or without impulsivity, it tends to go away over time. Kids either “outgrow it”, learn coping mechanisms, or symptoms fade over time. Additionally the medication originally gives positive self feelings which often can help a kid’s view of themself and make changes intrinsically to work against the ADHD. With ADHD - inattentive type, kids often don’t “outgrow” it and it’s more difficult to find compensting mechanisms that work.</p>

43

<p>“A psychiatrist basically will see if ur D fits the DSM4 criteria for ADHD inatt type.”</p>

<p>Hopefully that is not true. Maybe if you present it as “I want to know if my child has ADHD, and I don’t want to hear about your opinion on anything else”. As it says in it’s cautionary statement, the DSM is offered only as a GUIDELINE FOR MAKING A DIAGNOSIS. </p>

<p>Unlike a neurologist, pediatrician, or education specialist, a child psychiatrist is able to evaluate your child for a number of problems, and across five axis, including clinical disorders, personality disorders, general medical conditions, and psychosocial and environmental problems. That’s not to say that psychological testing is not extremely valuable.</p>

44

<p>Shrinkrap, so which do you think would be better to evaluate Helpsilteplait’s D:
a child psychiatrist or a child psychologist?</p>

45

<p>Hopefully OP you will learn something about your D and perhaps learn something about yourself as you go through this process. Like some others I cannot dismiss the age gap. Fortunately as your D moves through this early teen years the differences will dissipate but really while she says she is ‘comfortable’ with her school friends it’s entirely possible she has stress and turmoil. Two years at her age IS a maturity gap. I hope your family doc can put her in touch with a psychiatrist or someone that can help her with all possible issues in a holistic way.</p>

46

<p>I’m biased, but psychologists have much better training for ADHD evals. They are extensively trained in integrated assessment using clinical interviews and well-validated psychological tests and can assess for and rule out learning disabilities and other psychological disorders in the process. They can refer to psychiatrist–who can’t ethically do psychological assessment–for medication discussion if necessary.</p>

47

<p>"Shrinkrap, so which do you think would be better to evaluate…a child psychiatrist or a child psychologist? </p>

<p>"I WAS going to say “it depends”, on what you have in your community, and whether you want just evaluation, or also “treatment”. </p>

<p>I agree that psychologists are the only ones who should do psych testing and are best at ruling out learning disabilities, and if that is what you are looking for, that is absolutely the way to go.</p>

<p>But if your goal is to find out what role medication will play, or whether there is something other than “ADHD” playing a role, it is less clear. In my community, psychologists do these ADHD assessments, but they do not accept insurance, and they never do the week in, week out treatment. They do not say “here is what I can offer, outside of medication”. It tends to be “go get meds”, and " I will tell who ever is prescribing what I think she should do".</p>

<p>But in my practice, it tends to go far beyond “a medication assessment”, and in my neck of the woods. I think there is something to be said for what that adds to the evaluators perspective. </p>

<p>But I will leave it at that, for the purpose of the OP’s question. This varies a LOT, depending on the community.</p>

<p>psych_, I would love to hear how many child psychologists are doing weekly psychotherapy in your community, and how many take insurance, but that might be for another thread.</p>

48

<p>A psychiatrist is a medical doctor (MD or DO) that is licensed by your state to practice medicine and almost always has a DEA certificate allowing them to prescribe controlled substances which includes all ADHD medications I am aware of. A Psychologist has a PhD and is also licensed by the state to practice Psychology but they can not prescribe medications, only a licensed physician can do that without supervision.</p>

<p>If behavior modification is sufficient to resolve the problem either a psychiatrist or psychologist can offer treatment. If medications like Ritalin or Adderal are seen as the best course, those have to be prescribed by a psychiatrist. Sometimes a psychiatrist will refer a patient to a psychologist for evaluation before prescribing these medications. I am an MD but practiced Nuclear Medicine prior to my recent retirement, not Psychiatry, so there are probably therapies that I am not aware of for treating ADHD.</p>

49

<p>A psychiatrist can prescribe medication but it seems rare that they do psychoanalysis, behavioral therapy, family counseling…they will often refer to a psychologist. A psychologist provides psychoanalysis or therapy or counseling but does not prescribe meds…they have to refer to a psychiatrist. </p>

<p>It is unclear if Op’s D has ADHD - inattentive type vs anxiety vs depression vs stress vs totally normal. Thus, I was wondering which would be better to tease this all out by consultation…a psychiatrist or a psychologist.</p>

<p>If you found a child psychiatrist that was potentially able to provide family therapy, that might be the best route. But I don’t know if they are out there. Addenddum: I saw on shrinkrap’s ilink to child psychiatrist website that some do psychotherapy.</p>

<p>Again, my sense is normal but stressed out, overcommitted perfectionist kiddo with family dynamics who might need to talk with someone alone or in family therapy.</p>

50

<p>My child was diagnosed with ADHD when he was in first grade by a psychologist. Indeed, even at 22 he is the poster child of distraction. As he was a straight A student, engaged in activities, and did well socially, we didn’t even tell him though every teacher brought it up at conferences. Since he did well academically, no one suggested medication. People often ignore the point that there must be deficits: Academics, social, or family life, (I was taught at least two) in order to treat. He got re-evaluated at 18 per his choice as academics became demanding with 3 AP classes and looking to college. He did take meds off and on for college, but now during senior year, he feels that they are just a “crutch” and decided never to take them again. He is currently doing poorly on a content heavy class, but it’s his choice.</p>

51

<p>I’m still in the camp that this is most likely an issue with what would be an 8th grader in most schools being compared to 10th graders. There is a HUGE difference.</p>

52

<p>So there is a big difference between a 14 year old and a 16 year old? What about 16 year old and a 18 year old? - I’m educating myself here. I have a 14 year old who groups with 15 -16 year old. I always wonder about it.</p>

53

<p>OP’s kid is 13, and yeah, there’s a big difference between a 13yo and a 15-16yo. Even between a socially mature 13yo and an average 15yo - and I’d guess that the high-achieving kids OP’s kid is placed with are relatively socially mature 15yos. </p>

<p>“There’s a big difference” doesn’t mean “one or the other is placed inappropriately.” When you’ve got a way-out-there kid in either direction, you aim for the least-worst placement, which minimizes, but doesn’t eliminate, things like “there’s a big difference.”</p>

54

<p>We talked to the pediatrician through email. She thinks we should do the packet. Not only her school teachers should evaluate her, but also her private teachers. </p>

<p>I don’t know if we even should bother the school teachers. They probably wont think she has any problem because of her good grades. The school teachers teach big classes. They don’t pay attention to each student’s individual problems.</p>

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<p>It sounds like the pediatrician is suggesting the “ADHD evaluation”. If the packet contains rating scales, be aware that most of the teacher ones were probably not designed and normed with private teachers in mind. Hope it all turns out well!</p>

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<p>Thanks. </p>

<p>I’ll pick up the packet and take a look. The pediatrician will see us before we do anything.</p>

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<p>Shrinkrap,</p>

<p>psychology-focused PhD program and in a state with a higher than
average number of child, it’s likely not representative. Similar to
med management with psychiatry, many psychologists are moving away
from therapy because assessment pays more per time spent, and weekly
psychotherapy is becoming the domain of masters-level practitioners
more and more. If you want to do straight psychotherapy and have no
interest in assessment, researdh, or administration, a PhD probably
isn’t a good investment, tbh.</p>

<p>I completely agree that psychologists shouldn’t be trying to direct
psychiatrists re: medication. That’s not what we’re trained in, just
like an LCSW/LPC shouldn’t be giving psychologists assessment demands.
I sincerely hope all psychologist are ruling out probable “something
others” in ADHD assessment, although a psychiatrist will be better
able to assess possibly physiological issues that may be “mimicking”
ADHD. Are there psychologists who do less than full evaluations? Sure, just as there are in any profession. I have no issue with psychiatrists whatsoever–I just believe that psychologists have more complete training in psychological assessment, just as psychiatrists have a much better understanding psychiatric medication and all that surrounds that. :)</p>

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<p>psych_, I assume that reimbursement is also the reason why psychiatrists have moved away from psychotherapy and counseling as well.</p>

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<p>Here is a link to a parent’s questionnaire concerning ADHD:</p>

<p><a href=“http://www.essehealth.com/pdf/forms/407%20ADHD%20Parent%20Questionnaire.pdf[/url]”>http://www.essehealth.com/pdf/forms/407%20ADHD%20Parent%20Questionnaire.pdf&lt;/a&gt;&lt;/p&gt;

<p>If you google “ADHD questionniare,” there are many sites with this questionnaire as well as questions for the child him or herself. Teachers don’t need to be involved in this stage of diagnosis at all.</p>

<p>We have been to a well-known neuro-psychologist and an ADHD clinic at a major urban hospital and a private psychiatrist (there were other reasons for all this activity) and a questionnaire was used by all of them, to diagnose ADHD. You don’t need a full neuro-psych. evaluation to diagnose ADHD, but the evaluation can tease out other issues that may be going on, including anxiety and depression, or learning disabilities.</p>

<p>If I were you, I would first do some reading and do the questionnaire. Your family physician can probably diagnose ADHD from those results. But understand that there is no definitive test. The tests done by a neuro-psych. involve short-term tasks in a controlled environment, with one on one interaction, and do not replicate normal conditions for inattention. They may even help with hyperfocus (my own feeling). My kid has severe ADHD inattentive and it did not show up in the neuro-psych. testing because she does well with very short- term, intense tasks.</p>

<p>It would seem to me that your daughter may want ADHD meds so that she can keep up with expectations that are beyond her. Better to try to adjust the expectations. I grew up with the kind of pressure she has, and have aggressively prevented my own kids from suffering in the same way. Your daughter is not really old enough to have internalized values. She is very dependent on external feedback, not just from you, but now from teachers and others, and needs to rely more on internal motives for what she is doing. Tasks can feel boring and empty, as a student matures, if the reason for doing them is to please others. True interest comes when the student is doing things for the right reason, and that involves learning how to be authentic and following what one really wants to do. For a person, even only 14, who has always done things to meet others’ expectations, it can take quite awhile to find out who she really is, and she is also in the middle of adolescence when that is a central task anyway.</p>

<p>In middle school, grades don’t really matter for the future, as long as she can take the classes she needs. Tell her that hard work is important in life, but it is important also to relax and enjoy her life. Make sure she has down time. And I think having a therapist to talk with would help.</p>

<p>Her peers are ahead hormonally. They must be involved in romantic forays (to put it nicely), drugs and alcohol, and so on. How is she handling that?</p>

<p>Anyway, she may have ADHD. But even if she does, then there may be other issues to address. </p>

<p>So, I suggest: take the questionnaire, ask the pediatrician, consider a neuro-psych. evaluation though it may not be necessary, consider a therapist who is good with this age, with ADHD and with giftedness. The true picture of ADHD versus other issues may emerge with longer term therapy. Though ADHD is a truly brain-based disorder, diagnosis is an art not a science, and time will tell.</p>

60

<p>The questionaires are a good place to start. But we round them skewed toward hyperactive ADHD. </p>

<p>No matter what the approach sorting through the stew of professionals, do some reading on your own too to put it all into perspective. Hallowell books are a good place to start, but lots others too - take a trip to your library or bookstore. Or start with some websites - [ADHD</a> OVERVIEW Dr Hallowell](<a href=“http://www.drhallowell.com/add-adhd/]ADHD”>ADHD and Productivity - Dr. Hallowell)</p>