Difficulty getting 11yo diagnosed with inattentive ADHD

[Lanego]

I was wondering what people's experience was with getting a child diagnosed with inattentive ADHD. Our daughter has very classic symptoms of inattentive ADHD.She was diagnosed with Tourettes 3 years ago and with CBIT has done fairly well. For the past 2 years math has become a real struggle for her. The school provides her a tutor, and we also have a private tutor that is working with her as if she has dyscalculia. She is a hard worker, and really wants to do well in school. Homework time usually results in tears. And she has googled,"why am I so stupid". She tells me that she spaces out in class and then panics to try and catch up with what the teacher is talking about. We read books together and she will often stop me and have me reread pages because she gets distracted.

She sees a pediatric neurologist but he wants someone else to diagnose her with ADHD and then he's okay prescribing the medication. When I had her assessed for ADHD by her pediatrician he had us and her teacher complete the Vanderbilt evaluation. He said she didn't have ADHD because the teacher's didn't report any problems and said she was doing fine in school. When I explained that she routinely gets 60s on the math tests but then gets to correct her test so her grade is inflated he said, "well maybe in a couple years we can reassess her."I think he just looks at the Vanderbilt score and doesn't take anything else into consideration. In a class of 22 kids it's hard for a teacher to notice one quiet child drifting off. Her teachers also say they never see her tic but she does.

When your child was evaluated for inattentive ADHD did the professional just look at the Vanderbilt score and say yes or no? I feel like there is so much that is subtle about inattentive ADHD. Her twin brother was diagnosed with ADHD in 1st grade and the same pediatrician wanted to start him on meds immediately.We were skeptical of the diagnosis and it turned out our son had more anxiety than ADHD. I'm wary of shelling out more money for an ADHD evaluation if all the provider is going to do is look at a checklist and say yes or no.

Any advice or similar experiences??

[Lanego]

Forgot to mention she does have a 504 in place due to her Tourettes.

[Knitting20projects]

Hmmmm. Do you have any child psychiatrist options? I am thinking your pediatrician may not feel comfortable making the diagnosis. Which is a shame because 60% or so of kids with Tourette Syndrome have ADHD. However, the training for pediatricians in more complex ADHD (eg associated with additional conditions like autism, Tourette’s, etc) especially is minimal. Is there maybe a pediatrician in your practice who really enjoys behavioral pediatrics and these issues? It can be really difficult for pediatricians to get enough information in a short primary care office appointment. Sometimes seeing a specialist gives you the luxury of a longer appointment. Also, maybe your doctor could talk to your child’s teacher (s). I totally understand your frustration, and just because a child is doing well in school doesn’t mean they don’t have ADHD. (See your comment above re grading). You must be so frustrated.

[Lanego in reply to Knitting20projects]

after your comments and thinking about it I got a referral for a child psychiatrist from her therapist. I think this approach will work best. Thanks.

[LAJ12345]

my son struggled with verbal explanations and zoned out when spoken to but is ok when he has visual notes. He is at uni now and has online lectures and he can stop them so his brain catches up with the speaking and replay them if he zones out. She might be more visual.

He is taking Hardys daily essential nutrients now and rhodiola rosea and is doing well. He finds he has to put his phone away as if he uses it his brain then doesn’t work for a while he says.

[Lanego in reply to LAJ12345]

thanks for pointing that out. She is definitely more visual. I might have to encourage her to get notes from class as she progresses in school. I’m trying to avoid giving her a phone until 15 or 16.

[LAJ12345 in reply to Lanego]

That is very smart. My son was always finding work arounds to rules so got a part time job as soon as he was able so he could buy things I banned and get his own internet access so he could use it all night without me knowing. Luckily he has come through it after wasting the last 2 years at school and is doing psychology at uni so has realized the importance of healthy habits.Some good podcasts to watch are Julia Rucklidge from Canterbury university on the importance of micronutrients in food and Andrew Huberman on dopamine, ADHD etc.

[Lanego in reply to LAJ12345]

I'll check those out.

Sometimes the best way to learn can be through experience. Glad your son figured out healthy habits!

[Trying1978]

Inattentive presents differently in girls. My 9 yo is super smart and a people pleaser, so she "masks" a lot at school. My son (7), on the other hand, doesn't "mask" much! Both ADHD. I second the child psychiatrist option + the more formal ADHD assessment. Those folks will know all of this and be able to help; we learned all this when switching to a behavioral health place vs our pediatrician. Hang in there!

[Lanego in reply to Trying1978]

mine too is a people pleaser and will rarely complain if she’s struggling, as if she should be able to handle everything the world throws her at 11 .She does say that she works hard at not ticking which also makes her lose focus in class.

[Adhdmomof2]

I have twin boys both with ADHD, one diagnosed through a full neuropsych eval (which we initiated due to suspected dyslexia so the ADHD came as a surprise!) and the other just through that Vanderbilt questionnaire with the pedi. I was kind of surprised that you can get a diagnosis and meds from the pedi with such little “testing”. I would recommend pursuing a neuropsych eval if your insurance covers it and that’s an option. The testing was much more extensive and we received back a huge report with lots of valuable recommendations for both home and school. Good luck!!

[Knitting20projects]

PS I’m actually a pediatrician myself and can confirm that our training for detecting the less obvious ADHD kiddos is insufficient. Also , the emphasis on productivity in a regular primary care pediatrician office (out of necessity) makes it very difficult to have the time needed to evaluate these less classic kids adequately. I have learned lots from living with my own children and doing my own self directed education. Because of my experience with my own 2 kids & a strong interest in these areas (behavioral & developmental disorders), I would actually love to go back into subspecialist training but unfortunately it requires 3 years and possibly committing to an academic (publish or perish) career. I promise, there really are those of us out there who would love to spend all day seeing your kids and trying to help them reach their potential 💕💕💕💕💕

[Chicagomom]

My daughter was diagnosed after formal testing by a neuropsychologist. We (her parents) and her teacher also filled out questionnaires. The formal testing was about 6 hours long. After her diagnosis, we were referred to an OT, psychiatrist and therapist. Medication has been life changing for her.

[Lanego in reply to Chicagomom]

That's impressive testing. I feel like we're heading towards needing medication.

[Crazyboymomma]

my son was diagnosed by our pediatrician when he was in first grade. We got very lucky - our ped is amazing and very well-versed in adhd and meds, as his son also has it. He had a rough year in 5th grade this year, so we decided to do the neuropsych testing. It was great, so much valuable info! Also very helpful to have this information when dealing with the school. With a neuropsych diagnosis, I don’t think any dr would deny her medication. Also the doctors that administer the neuropsych tests can be a really great resource and point you toward the best person for her to see for possibly managing meds. Btw, ours was covered by insurance.

[Lanego in reply to Crazyboymomma]

Thanks I hadn't thought about neuropsych testing.

[Crazyboymomma in reply to Lanego]

I put it off for a while bc I didn’t think it was necessary. I already had the diagnosis. A couple other moms I know recommended it, one of them is a child psychologist. The report they give you is SO extensive, you wouldn’t believe it. Very interesting to see all of your child’s strengths and weaknesses academically too. Also so interesting and helpful to see HOW they do and don’t learn due to adhd issues. This is administered over two days of “fun” testing and games by a Dr - a psychiatrist. It’s about as official as you can get. The end of the report is full of recommendations for school! I even got feedback regarding my sons medication. I’d strongly encourage it!

[kdali]

No, we completed the neuropsych testing battery with a trained psychologist.

[Aloysia]

We have insurance with Kaiser. The way they do the evaluation is to send the questionnaire to the parents and the teacher. Then they also have the kid attend a group mtg where about 10 kids are being evaluated at once by like 5 specialists while the kids are asked to do different activities (math worksheet, etc). They use this group mtg to break any ties that might occur between the parents + teacher.

This system worked great for my son who was diagnosed with hyperactive/impulsive ADHD when he was 5 (everyone agreed).

But this system didn't work great for my daughter in 2nd grade. The parent questionnaire showed ADHD, the teachers (there were 2 who shared the classroom) saw nothing, the Kaiser folks saw ADHD. But because there were 2 teachers who reported nothing AND because she'd been evaluated for learning disabilities that year by the school psychologist who saw nothing with ADHD, Kaiser felt they couldn't over rule the teachers. Even though they felt she very clearly had Inattentive ADHD.

The next step was for her to see a Kaiser psychologist for over 6 months until that person felt they could diagnose it. It turned in to much longer because of COVID hitting. It was very frustrating but eventually we got the diagnosis and then the 504 plan.

This is really all because the teachers didn't notice the spacing out my daughter did because there were so many boys with more obvious ADHD symptoms. And because girls present very differently.

Best of luck to you!

[Lanego in reply to Aloysia]

This sounds similar to my experience where the teachers didn't identify any problems but the parent questionnaire was positive for ADHD. The checklist approach seems to put inattentive ADHD patients at a disadvantage. unless a teacher has a lot of one-on-one time with a student or very few students it would be very difficult to identify inattentiveness.