We set up an appt for S21 with a neurologist and I am not sure what to expect at that first visit. He has always had a little trouble focusing and can seem immature for his age - fidgety, stands too close to people. We had talked to pediatrician about ADHD diagnosis when he was 11 but his view was that if we did not need accommodations, it did not make sense to go through it.
S21 is smart and through middle school always did well in school but I don’t think it took much effort at that level. Now in HS where they are not holding his hand and classes are more challenging, he is falling apart. Can’t get organized, easily frustrated. runs out of time on tests, “forgets” to hand in homework, forgot a permission slip for a trip that he really wanted to take (despite repeated morning reminders, midday email and text from me!). Right now, he is close to failing 2 classes. Found out we were the only ones not to get PSAT 9 scores - still figuring it out with CollegeBoard but he may not have put his name in correctly. At the same time, he is having trouble making friends and according to his older brother at same school, kids think he is “weird.”
It took us 6 wks to get an appt at the beginning of Feb and I am wondering what to expect. Is it mostly a questionnaire, is there a medical exam? Are they likely to prescribe meds or will that take multiple appts? I am just worried that by the time we get him on track, his freshman year will tank his GPA and hurt his college chances.
Thanks for any advice.
My sense is that s/he will take a history including developmental history. For diagnosing ADHD there are 4 domains and the dx is based on history not testing. They will ask questions about attn./concentration, distractibility, impulsivity and fidgetiness of mind and body. They may do a quick neuro physical exam but doubtful if it is for ADHD eval. This consists of touching both sides of the face, testing strength in arms and legs and balance, toe to heal walking etc. You can likely get a prescription for a stimulant on the first visit. Good Luck! treating ADHD can make a big difference!
Thanks @preppedparent. We had always been reluctant to go for a diagnosis bc we were afraid that meds would change/dull his personality. But, we realized that he is miserable and it may really help his focus.
If you are considering the need for accommodations, it might be helpful if the neurologist can make a referral/write a script for a neuropsychological evaluation. Sometimes, with a script, and if there is a reason beyond school performance, insurance might cover neuropsychological testing.
The kind of tests that a neuropsychologist will do (cognitive and achievement testing for starters) will be necessary for accommodations with the College Board in the future. A letter from a neurologist will likely be insufficient.
You will want motor skills checked if finishing tests on time has been a problem.
Also, the College Board and future colleges like to see a history of accommodations in school. So that will also be a step you will want to take.
It is very normal for bright kids with ADHD and learning issues to start to have more school issues in middle school and high school.
I will also very gently add that I think it can be worthwhile to ask to have high functioning autism ruled out. It is too often overlooked in smart, verbal kids who are mildly affected, but these are the kids who could most benefit from some help with social skills for their own happiness, social and school life, and future employability. There can be a very fine line between ADHD with social delay and HFA with no intellectual impairment. The ability to make and keep friends and interact appropriately is very important for a teen’s healthy emotional life. Don’t be afraid to ask tough questions to get the answers you need for his future success and happiness.
^^^good points. At one point College Board required neuropsych testing before giving accommodations like extra time for SAT for students with ADHD. Now, however I have had good luck getting accommodations with a letter from a doctor listing diagnosis meds and recommendations for additional time. I think they get that not all insurance will cover neuropsych testing unless there is trauma or other physical conditions and it can be a pretty hefty out of pocket expense for many families.
I’m surprised you are going to a neurologist for this rather than a developmental pediatrician. What is being said is true…you need a full battery of educational testing, which falls more in the psychological field. I have a long description about our experience in another thread. But what we found is that insurance will pay for the testing for ADD ADHD , which is likely to involve medicine, but not the rest that is needed to determine accommodations and/or therapy. And not to make things worse, but we waited a year for my sons appointment with a developmental pediatrician.
We additionally wound up at a neurologist due to migraines and they did medicate Him for that. But we were referred to them due to the headaches by the pediatrician mentioned above. Solutions beyond migraines did not come from them. I will say this, if your son is ADHD and the medications work, it will be like night and day. I have many friends who have gone through this, and when meds work, they work really well. When they don’t, there are typically lots of side effects that are worse than the cure.
My son never tested as ADD, just borderline, so we’ve never gone the med route, but I too felt as you do. At the very least you can rule this out as a solution. If meds are the fix, it can be a quick fix. Therapy takes much more time. Accommodations require an update every three years, so we are going back through it right now.
We used a pediatric neurologist who specialized in these issues for our oldest son. One of the diagnostic tools is the Conner form, which teachers are asked to fill out. You might want to call the office and see if you can get some to have his teachers complete and send straight to the doctor before your appointment so the information will already be there. For me, it was fascinating to see my son’s forms. His social studies teacher found him delightful, a font of interesting tidbits of knowledge and a joy to have in class while his math teacher described a kid who was tuned out, bored and asleep half the class, but who would blurt out a correct answer when awakened and confronted. The rest of the forms were in between, depending on how much my son liked the teacher and/or the material.
At various points, my son had an EEG, a brain CT and a bunch of other tests. Ultimately, we moved him from the local HS to an alternative school where he made friends that he has to this day. At 27, he works for USPS after dropping out of college. He’s still someone who can ace the categories on Jeopardy that he’s interested in and is thinking about returning to college.
One thing that really helped him was a course of biofeedback done in elementary school. We believe that it contributed to his needing a lower dose of medication. He is asking to do it again, but it doesn’t seem affordable at this point.
He was on meds on and off from 2nd grade through HS graduation.
@chattachia - we started with his pediatrician who gave us the referral to a pediatric neurologist.That was his recommendation for a starting point - I don’t know if they will send us somewhere else too.
@techmom99 thanks for the advice about the teacher questionnaire. I will call the doctor’s office to see if I can get some ahead of time.
@Momma2018, I want to echo @MACmiracle’s suggestion to consider ruling out things like high functioning autism.
Also, it is tremendously easier while he is a minor and living at home - when you have direct access to his teachers and people (doctors, psychiatrists, etc) expect to talk to you about him - to work on figuring out any things that could be impacting his functionality. It is so much harder down the road when your child is not a minor.
For those of you with diagnoses, do any of your children have restless sleep and issues with food? Our son has been waking up at 3 or 4 in the am and having trouble getting back to sleep, which leads to tired slow mornings. He also started bingeing on sugar and other sweets secretly in his room and has gained 15 pounds since Fall. I was working so hard making healthy meals and last month found a stash of wrappers and boxes hidden under his bed. Can’t tell if this is related directly or maybe indirectly (depressed eating?) to his other issues.
Thanks to everyone for their advice. We had the appointment and they took a thorough history and had me fill out a questionnaire. They also required confirming teacher questionnaires before they would prescribe meds. Very strict about the scrip - paper only, no mail order, only one month at a time. They started him on a low dose of Concentra and said it is likely it will take some trial and error to get the does correct. We go back in 2 months for additional screening. She did not seem to think HFA was likely but wants to explore at next visit. I will keep you posted!
Sorry - meant Concerta. missed editing window
Just an update, S21 is doing very well. The lowest dose of meds had no effect so they raised prescription to 36mg. Grades are coming up and he has already made new friends and joined two new activities for Spring. At this point, I can say that medication was definitely the right decision and I just wish we had done it sooner. His personality has not changed but his mood is much better. Thanks again for the advice.