My letter to the ADHD Assessor - CHADD's ADHD Pare...

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My letter to the ADHD Assessor

Concernedmamma profile image
10 Replies

I posted recently about my frustration with my 7-year-old daughter being pushed toward an ADHD diagnosis which I believe would be a misdiagnosis, and asking if there were any advocates out there who seek to help children avoid ADHD misdiagnosis, specifically. So far, no one has been able to answer that question and most of the thread has been general advice. Rather than add this there, I decided to put it out as its own post. The following is my concise and descriptive perspective that I will be submitting to my daughter's ADHD assessor, along with other letters from people who know or have cared for her for significant amounts of time.

Maybe you guys can let me know if you think I'm way off base here, since this is probably the best group to ask. If, however, you do find my perspective compelling, I'm open to any and all suggestions for how to make what I wrote better.

(One thing of note is that I have ASD.)

To whom it may concern

I am P******'s mother and I have spent possibly more active one on one time with her than anyone else in her entire life. Her father works, her step-mother has split the care time with day care and school, whose caregivers and teachers come and go. I have always configured my schedule such that I have almost never worked or been absent during her time with me. It may be a smaller timeshare, but I have always tried to be 100% present. I deeply believe that P****** does NOT have ADHD or ADD and I'd like to share my perspective of her and why I am certain of this.

Her father and I separated when she was 10 months old. Since that time, I have had concerns for how her family dynamic, living in a broken home, would effect her long term. As a toddler and young child following the divorce, she would cry, scream, and throw a fit for hours prior to transitioning between homes. She would often refuse to get out of the car or fight to stay in her carseat. Several times she hid behind legs, keeping someone interposed between her and the person she was supposed to go to. When she was 2 years old she told a CPS worker, when asked what she wanted at that moment, that she wanted her mommy and daddy to live together in the same house again.

I believe this highly contentious divided environment she has grown up in to be a cause for some deep seated and foundational emotional trauma, which is the basis of many of her behavioral 'issues'.

She shows many signs of attention seeking and thrives with one-on-one attention. Since her siblings in both homes were born in 2021, there has been much less opportunity for her to have that one-on-one attention she craves. She is often boastful with things like "I'm really strong, right?" or "I'm really fast, right?". She very frequently asks for adult focus on her "Watch this!", "Watch me!", "Watch what I'm going to do!", etc. She wants attention and if she can't get it by being 'good' or by excelling, getting it through misbehavior seems to be an acceptable substitute.

She wants people to love/like her and is constantly seeking reaffirmation of this. "Do you love me?", "You really love me, right mommy?" "Daddy loves me too, right?"

I believe this is a direct consequence of internalized feelings related to the divorce.

Mostly she is a kind and loving child, often thoughtful and sometimes surprisingly insightful. She has been referred to as 'Delightful' by many people. She is INCREDIBLY bright and has hit nearly all of her developmental milestones far ahead of the average. She often uses this intelligence to try to manipulate situations and people around her to best suit her. Her efforts in these situations are still unsophisticated so it's obvious when she's trying, but what's important is her proclivity for trying to get her way.

She is smart and she knows she's smart. When she decides something is a certain way, she believes fundamentally that she is correct, because SHE thought it through. Usually in situations like this the only way to get her to comply is by convincing her that she didn't take everything into account and that some missing piece changes the equation.

She also has possibly the strongest will that I have ever seen in a child. I have seen her refuse to eat for over a full day because the food offered was not what she preferred. She was banking on being offered something else when she transitioned to her other home. Only when she found that I had given them the same food for her to eat there, did she finally agree to eat it. When given tasks at home or at school which she does not want to do, she will often steadfastly refuse to do them or find every excuse to delay, even if it means forgoing something that she does want. She has a very strong defiant streak. She also scoffs at authority and will only grudgingly submit to it. I once smacked her hand after she touched something I had told her not to. Her immediate response, with an angry disposition was "That didn't even hurt!". At a loss, I asked her "Did you WANT it to?". She struggled with that for several seconds, eventually she submitted admitting that she didn't. I would say that the VAST majority of the behavioral problems she displays are a battle of wills, where she pits her will and defiance against the will of someone in a position of authority. She thinks she knows what's best and will not budge from that position until either forced or convinced.

Now here's why I believe she does not have ADHD or ADD.

These are characterized by someone whose brain chemistry does not allow them to shift focus easily or stay undistracted for the duration of a task, someone who is highly impulsive, someone who can be overstimulated by sensory input and who has a hard time regulating their responses to that overstimulation.

While P****** displays behavior sometimes consistent with this, she also often does not. Her behavior which is consistent with this can be easily explained by other sources, whereas her behavior that is inconsistent with it is hard to explain if ADHD is what the underlying cause is.

She can easily read a book which interests her, then switch seamlessly to helping me cook a meal, then again switch seamlessly to building a tower out of blocks with her brother, etc. She has no problem staying focused on tasks which she enjoys or feels are benign. She can watch a full length movie without fidgeting, even one she does not enjoy, then have a conversation about that movie to show that she paid attention to and understood it. I can explain math, science, history, writing, or language concepts far beyond her grade level to her in depth, with her listening with focused attention, and she will apply what I explained weeks or months later. Her attention only seems deficit when applied to things she is actively disinterested in. She only seems to have any sort of hyperactivity when presented with multiple options which she has an active interest in. I believe that P****** is not challenged enough at school, which causes her mind to wander to topics and thoughts which she does find interesting, and when pushed by authority things devolve into a contest of wills. When properly provided with new information, she has no trouble at all focusing, even if the topic is of no intrinsic interest to her.

Beyond that, she has zero behavioral problems when with my mom and stepfather, or with my dad and stepmother. She is by no means a 'perfect angel' with them, just a typical 7 year old. Her martial arts instructor describes her as one of the best students he's ever had and that she is in a completely different category than the kids with ADHD that he has seen come through his classes.

She does not carry these behavioral problems with her from environment to environment, which she would if it was due to an innate problem with her brain chemistry, rather than based on her own choices and proclivity to clash with select authority. This strongly suggests to me that her behavioral problems are learned or environmental rather than innate.

Something that you should know about P****** is that she is incredibly similar to me, both physically and mentally. We share so much in common with our mindsets, preferences, proclivities, and tendancies that P****** has more than once accused me of being able to read her mind.

When I was a young child my mother went to college for a degree in early childhood development. She was one of only a couple of students who had children so she was invited to bring me to school so that the class could get practice observing children. According to my mother I displayed nearly all of the traits associated with ADHD. The students and teacher told my mother that I should be medicated immediately because it was obvious that I had ADHD. I was a very bright and inquisitive child who was interested in almost everything and asked questions on many topics at a rapid pace. When others saw multitasking, they misread it as hyperactivity. When they saw rapid questions because of unbridled global curiosity, they assumed an inability to focus on a given topic.

They saw behaviors which led them to a conclusion of an attention disorder when in reality attention wasn't an issue for me at all, all of my behaviors stemmed from intelligent curiosity in an energetic child. I have spoken at length with therapists as an adult and it has been concluded that I am not and never have suffered from any sort of attention deficit disorder. If my mother hadn't known me well enough to understand where my behaviors came from, I might very well have spent most of my life on a medication I didn't need, under the umbrella of a diagnosis which did not apply. I am very grateful to my parents for understanding me so well and I strive to understand my daughter as well as my parents understood me. I don't believe any of her behavioral traits come from an attention disorder anymore than mine did at a similar age.

In summation, I think P****** is a highly intelligent willful child who suffers from boredom and a craving for attention due to deep-seated emotional trauma relating to the nature of her parents' divorce. If anything, I think she may suffer from an obstinate defiance of authority, but that has nothing to do with her ability to give attention or to focus. She is very much like me and I recognize all of her behaviors from myself. I never suffered from ADHD though people thought I must have and I don't think she does either.

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Concernedmamma profile image
Concernedmamma
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10 Replies
BLC89 profile image
BLC89

Hello Concernedmamma,This is very thorough and makes the case that you clearly know your daughter and have thought long and hard about this.

What I don't see is you explaining that you have ASD. That also explains much of her behavior if not all of it, correct?

I would definitely put that out there so they know that is part of the equation.

Otherwise, because she is bright and clever they may not think of it.

Keep trusting your gut like your mom did.

I hope that helps,

BLC89

Full disclosure: I am an ADHD Parent Coach. I have been married to ADHD for nearly 30 years and raised two kids who have ADHD

Concernedmamma profile image
Concernedmamma in reply toBLC89

It's definitely something I'm planning to bring up, but verbally when I speak with the assessor. I want to really make it about her and not about me. Actually, I ran my letter by my therapist and she suggested that I remove the last part about my experience with ADHD because she's afraid that adding that might seem to make it enough about me that they may dismiss everything else I have to say in the letter due to it seeming that I may be biased.

BLC89 profile image
BLC89 in reply toConcernedmamma

I see, I agree with the therapist it may come across as biased. I would want the ASD in writing rather than verbal that way it is available to anyone who reviews the info.Something like: I have ADS and it presented in similar ways to my daughter's behavior - but with your elegant style.

That's my two cents for what it is worth.

BLC89

Concernedmamma profile image
Concernedmamma in reply toBLC89

Another point that makes me hesitant to include it in anything written is that I have only been informally diagnosed. I have worked with a therapist for about 5 years and we both independently reached the same conclusion. I haven't pursued assessment for it because my understanding is it can be nearly impossible to get a diagnosis when testing for ASD as an adult woman.

BLC89 profile image
BLC89 in reply toConcernedmamma

Ah, I see. Then sounds like your original plan is the best one. Just omit your experience with ADHD and chat with the doctor about your therapist's suspicion of ASD for you. It sounds like you are well tuned to your gut, stick with that it will lead the way.

Onthemove1971 profile image
Onthemove1971

This is a very detail description of your daughter. They will be asking if you or her father have ADHD or ASD, since there can be a genetic link. I would also recommend any tools you have given her ( therapy,

medication/supplements, also educational assistance).

It may also be good to list how she is in day care or school.

Trying1978 profile image
Trying1978

That looks amazing. I would make it about half the length and remove the reasons why you think she doesn't have ADHD in favor of a more bullet-pointed description of her behavior.

I hope that doesn't sound harsh. I'm worried, as someone said below, that such an extensive argument meant to be persuasive in one direction might end up pushing the reader in the other direction.

(I've been a writing professor for 21 years, by the way, so if any of that sounds annoying, blame it on professional habit--some of the above is just writing advice, and some of it is based on my own experience with needing to be more careful in saying things around this kind of folk!)

Concernedmamma profile image
Concernedmamma in reply toTrying1978

Thank you! That's really helpful. It's been about 15 years since I was in college and I think the best grade I ever got on a paper was 80% so I know I'm not the best at writing. I appreciate your feedback. I'm not sure how to make it quite half the thength without cutting out some of the meat of it, but I'll see what I can do.

seedybee profile image
seedybee

Hi, I think you might have a particular perspective on what ADHD is. One perspective is that it is as you said, a chemical imbalance, but this is a particular psychiatric view, which often labels mental conditions as this without really get into the why's. There's a book about this exact issue in many areas of psychiatry called "blaming the brain" by a neuropharmacologist who basically explains that although the medications he has helped develop plainly help people with a wide variety of mental health issues, especially in the short-term, to say these medications fix a chemical imbalance isn't true at all and is a shortcut of an answer that stops the exploration of the underlying causes that other interventions such as talking therapies may well allow for an uncovering and complete healing of the problem in the long term. For a different perspective Gabor Mate has written several books about ADHD that come from a much more sympathetic and understanding perspective in which rather than seeing it as a potentially lifelong "chemical imbalance" he sees it as a pretty straightforward coping mechanism for trauma around attachment issues as a child (which sounds like the kind of thing your daughter has experienced), and this is especially so for children that are more sensitive, basically because if a child is feeling insecure and isn't securely attached to a caregiver in a given situation, they will find ways to distract themselves from the anxiousness they are experiencing, and exhibit some or all of the symptoms of ADHD and so instead Gabor Mate offers much advice around how to heal this, mostly through attentive love and understanding, to help the child redevelop trust and be able to be fully emotionally engaged instead of distracted, which is what it sounds like you're doing anyway. So rather than shirk away from an ADHD diagnosis, which is really only the naming of a symptom, maybe you could use it to help engage the other carers in your daughter's life with the work you've been doing to help your daughter feel unconditionally loved, connected and attached so she doesn't get the anxious feelings that are driving her behaviour around these other people and can learn to regulate herself through their example. She is probably much calmer around you because the attachment is there to secure her, and acting out when you're not.

I've got ADHD and I don't feel like it's a slur on my character. I know I'm intelligent (I have a very high IQ, and a good degree from a top art school), and I'm loved, liked and appreciated by the people that matter to me and am in a fantastic long term relationship and have children who are thriving. I think ADHD is a combination of a genetic element, i.e. a predisposition, e.g. psychological sensitivity, combined with attachment trauma, my dad left before I was 2. I wasn't diagnosed in childhood, but as an adult it's really got in the way of my life and getting a diagnosis gave me a lot of insights into it and has helped me a lot. I never had the hyperactivity, but I can get very distracted, as well as hyperfocussed on things I'm interested in (to the point where I can be oblivious to what's going on around me), but the big insight I never saw in myself before, but have since become much more aware of is my emotional volatility, I could really blow up at people if I felt criticised or controlled, and now I think I've really become a much easier and calmer person to be around because the awareness has really helped me learn to step back and find ways to regulate myself in these situations.

GhostOrchid profile image
GhostOrchid

From reading this, it is clear you love your daughter and want what is best for her. I think it is great that you are advocating for a proper diagnosis. Unfortunately, I doubt your letter—regardless of what it says—will sway any doctor's diagnosis of ADHD. ADHD is diagnosed based on responses to the Parent and Teacher Assessment. They are given a set of questions to which they answer either "never, occasionally, often, or very often". The evaluator adds up the number of "often & very often". If they exceed a certain number your daughter will be diagnosed with ADHD type inattentive, hyperactive, or combined. The diagnostic criteria don’t have much gray area. However, your letter might have an impact on whether the doctor will prescribe medication without requesting further psychological testing to rule out other conditions. Kids with ADHD often have other co-existing conditions like dyslexia, dysgraphia, anxiety, depression, ASD, etc. I recommend focusing your letter on requesting a full Psychological Evaluation for fear that ADHD symptoms might be overshadowing other issues. A good doctor should take this request seriously. A full PsychEval will look for IQ, ADHD, anxiety, depression, OCD, Trauma/Attachment, etc. In my area, ASD testing is an add-on service to the full PsychEval. Another advantage to a full Psych Eval is that it includes a Parent meeting, so you will have an opportunity to share all of your thoughts on P with the Psychologists without trying to fit them onto a 1-page letter.

l like Trying1978 's recommendation of bullet-pointed descriptions of P's behavior instead of your reasons for why you think she doesn't have ADHD. The shorter the letter, the more likely a busy doctor will take the time to read it. In addition, I would stay away from anything divorce-related other than noting you and her father separated with she was 10 months old; it is a highly contentious, divided environment; and there are new siblings in both families. For instance, don’t comment on how much time dad & stepmom spend with P versus your time with her. And don’t hint as to who has more quality time with her. Even if it is true, it reads as judgmental which is fine for this forum but may not be appropriate for the doctor at this time. I hope that doesn’t sound harsh. I have the utmost respect for those trying to co-parent with an Ex especially when it is contentious. This is the advice I’d give my sister and her ex is an a$$. You want the doctor to know your concerns are for your daughter, not perceived as tit-for-tat over the divorce. Don’t give them a reason to dismiss your concerns.

I would also stay away from self-diagnosis. Some doctors hate that and might dismiss your concerns. After all, they went to school for almost a decade or longer so they could make the diagnosis for us. 😊 Plus, my takeaway is that you may not fully understand ADHD. It is more than the name implies. You say, “brain chemistry does not allow them to shift focus easily or stay undistracted for the duration of a task”. A lot of folks with ADHD can shift focus easily and hyperfocus on things. I think how well they do this is related to their IQ and working memory. My son & husband can focus on everything around them and comprehend most of it. It drives me crazy because when my environment is busy, I’m distracted by everything; focus on nothing; and comprehend very little. I’ve watched videos from some well-known professionals in the field of ADHD and they said ADHD was originally named for a subgroup of kids that showed traits of attention deficit (ADD). Over the decades they’ve added to the umbrella of symptoms/traits, and it is no longer just about attention deficits or hyperactivity as the name implies. It is an Executive Functioning Disorder and will hopefully be renamed one day.

For what it is worth, I see a lot of your daughter’s behavior in my son. I completely understand the fear of a misdiagnosis, whether it is missing a coexisting condition or a complete misdiagnosis. No one wants that for their child! My son has an ADHD diagnosis and is medicated, but I think there is something else going on with him. My beliefs are so strong that I’m getting ready to pay another $3000 to get an updated PsychEval.

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