Diagnosis 911: Is it really ADHD?

After 5 months of counseling, we have a working diagnosis of Attention Deficit Disorder (ADHD without the hyperactivity) with secondary Anxiety, a touch of perfectionism and perhaps a smidge of OCD. I see the Psychiatrist to get the official diagnosis for the 504 committee and to get the modifications and accommodations.

With barely a glance at the 15-page patient history and 11 minutes of casual questioning – including what I think is the clincher: Q: What does her teacher say about this? A: She says in 16 years of teaching she’s never had to redirect a child more than she does my Old Soul – the Psychiatrist proclaims the diagnosis of ADHD without the hyperactivity component.  He moves quickly to the treatment phase saying there are 4 ways to treat ADHD. 

 1. Medication and therapy (best approach)

 2. Medication only (2nd best approach)

 3. Therapy only (doesn’t work)

 4. Do nothing (does nothing)

He describes the meds and recommends Concerta, an addictive narcotic with nasty side effects (my edification based on the paperwork he gave me because he didn’t want me “getting misinformation on the internet”) followed by a 5-minute Q&A with me:

Me: What about homeopathy?

Him: Might as well eat the mushrooms on my lawn! Doesn’t work!

Me: Are there non-narcotic drugs we could consider?

Him: Yes, but they don’t work!

Me: Can we talk about the side effects?

Him: They’re not a problem.  We can medicate them away.

Me: What about the potential for stunted growth?

Him: We’re talking about a half to one inch on averages.  You don’t really know how tall she was going to be anyway.

Me: Was it something she said/did that clinched it or is it your experience that brings you to this diagnosis so quickly and definitively?

Him: The latter!

He says she’ll get worse, with increasing anxiety, if we don’t medicate her.  He says “her anxiety is not a big deal now” and it will disappear once we medicate the ADHD.  He says her brain works differently (parroting her words) and we need to medicate her to fit her into the existing education system… in front of her! Talk about a self-fullfilling prophecy!

He had not received a copy of our BASC evaluation prior to the meeting.  He didn’t know that she cries 5-6 times per day because she works too slowly and falls behind, especially in math.  He didn’t know that she excels in the gifted program where that teacher says her “daydreaming is not a problem here” and is “often part of the giftedness”).  He didn’t know she has a few good friends but doesn’t try to “fit in” with the crowd, doesn’t like what the other girls like (i.e. Hannah Montana) and would rather talk about snakes, cats, dinosaurs and other animals, save earthworms, find 4-leaf clovers, read books and go on nature/exploration walks.  He didn’t know that her 2nd grade teacher berated her in front of her peers EVERY SINGLE DAY, driving her to tears until she finally shut down and refused to do anything. He didn’t know that we didn’t have these problems last year.  Nor that her grandfather, and closest companion, who picked her up from school every day of her life was put in a nursing home a year ago and just passed away.  He didn’t know that my Old Soul is a quintessential optimist: under-reporting the bad and focusing on the good in her life… EXCEPT with school and academics.  And that, aside from school, life is “fun!”

I explain to the Psychiatrist — who, I realize, doesn’t really know very much about my Old Soul as he proclaims her diagnosis –that I have to do my research before I can make a decision.  He sends me home with “accurate”  and scary information about Concerta.

Following up with our regular Therapist, we discuss the teacher’s BASC evaluation which actually indicates my Old Soul is only at risk for ADHD (no H) but statistically significant for anxiety and depression while my evaluation identifies attentional issues.  (Note: my responses were entirely about her 3-hours of homework per night.)  The Psychiatrist did not have this information for our meeting.  I wonder if it would make any difference given his confidence in his diagnosis.  I doubt it!  But, for me and her Therapist this new information makes an already unclear diagnosis even fuzzier.

My plan is to continue therapy while we go forward with an official diagnosis of ADHD (no H) and get the 504 modifications/accommodations to relieve the anxiety.  The teacher and I have already begun modifying class and homework assignments and we see an amazing turn-around in her ability to attend and complete tasks at school and home.  She hasn’t cried at school or over homework in 5 days! She says because she doesn’t feel pressure about the workload. We’ll see if she can maintain this. 

My GOAL is to get my child through the day without significant redirection from the teacher.  To have her not feel the need to cry about anything school-related and to NOT feel depressed on school nights from the dread of having to go to school tomorrow! My hope is that she actually begins to like school (or at least parts of each day/week).  My goal is to find an education system that fits her better.  I won’t medicate my square peg just to force her into the round hole that is the public education system. If she needs medication to survive and thrive, I’ll oblige… but only after I’ve tried the non-medicinal possibilities, and not at the risk of her health. 

Maybe it’s ADHD (no H).  Maybe its anxiety, perfectionism and/or behavioral. Maybe she’s smarter than all of us and her behavior has been a purposeful path to decreasing nonsensical academic busy work from her life. 

So, I’m doing my research! Do you have any experience with ADHD (no H) in school?  Academic Anxiety? I want the good, the bad and the ugly!  Treatments? Meds? Side effects?  What about treatment for Anxiety disorder?  Lay it on me, please.

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About Maggie

I'm a stay-at-home mother of 3 children including a 15-year-old daughter, the Old Soul, and 11-year-old identical twin boys who've been blessed with an extra 21st chromosome (aka: Down Syndrome). I happily spend my time doing all that I can do -- breaking the proverbial box wide open -- to foster my children's development and then sharing what I learn with you through this blog.
This entry was posted in attention deficit, Education, Uncategorized. Bookmark the permalink.

22 Responses to Diagnosis 911: Is it really ADHD?

  1. Marie says:

    My son Chris has ADD (without the H)…I’ve commented before. He’s been on concerta for several years after having heart racing issues on Ritalin. Concerta works well for him…it helps him focus and he’s done well in school. He hasn’t had any issues with sleep or eating, and he’s growing like a weed. He only has minimal anxiety issues, though, and most of those have cleared up. He went on an IEP for math and organizational issues on 5th grade but just graduated from it because he’s doing so well. I can truly understand your concerns about medication, and you should weigh the risks. But in my son’s case, it has really helped him.

    • Maggie says:

      I know that meds have helped so many children. And I’m not discounting the possibility of having to manage this with meds. But I’m dedicated to trying non-medicinal interventions first. We’re not dealing with clear cut ADHD/ADD so jumping directly to medications for that right away just seems premature to me. Identifying all the choices and combinations therein, then choosing the best option for her/us is the right path for me…. for now. I’m sure I’ll be asking you pointed questions again… but here’s a few to start: Was Chris functioning in school when you started the meds gGetting work done, achieving high grades, non-disturbing to others)? Did you try non-medicinal interventions first — homeopathy, mods and accommodations, alternative school environment? Do you forsee Chris stopping the meds at some point? Email me at marshallhagan with the “at” sign and verizon.net. Thanks for all your help and information.

      • starrlife says:

        Well, I have to say I too can see that Dr’s perspective but keeping in mind that he only sees those who don’t improve without meds- his perspective is skewed. Many kids dx’d with ADD/ADHD outgrow the symptoms (I know because I see the more complex cases) which means that they may never have had it or it just is a side effect of an immature nervous system that matures. Also, many people in the system for these dx are really in the category of lack of resources (on so many levels) and are really kids that have abuse hx’s and other genetics for BiPolar disorder etc which create a perfect storm of complexity that are difficult to treat/fix (with or without meds). You are a great mom Maggie with great instincts and your family had wonderfully rich resources so I think that staying on the “don’t want to break her spirit track” is the way to go, whatever that may be.
        (I certainly hope that you don’t mind my thoughts in this area- don’t mean to be pushy or opinionated, just sharing).

  2. starrlife says:

    I’m not against meds per se, I work in psych so I’m familiar and comfortable – with adults. Personally the mood issue seems predominate based on your descrip. – if she’s a bit of a sponge emotionally than some kids just have trouble letting go of stress and become worriers (an emotional habit). My niece, around 12-13 started taking an anti-depressant (small dose) for perfectionism and anxiety. She only took it a couple of years (sometimes I think it is the differential development between the emotions and the intellect that create a gap there and they outgrow it) and is great since then! Yoga and meditation are both great tools, as is breathing and visualization. Does she have trouble getting to sleep at night? Does she chew on stuff? She certainly seems smart (sometimes ironically that is the problem, emotions are not as strong as the intellect). And to be berated by teachers- bad match and intolerable! I might consider a different school for sure. Psychiatrists- sigh. They all think it’s ADD. (another sigh). Sometimes it is….

    • Maggie says:

      I do believe that some part of the Old Soul’s issues are emotional immaturity (she’s one of the youngest in the class) paired with extraordinary intellect. The mismatch creates much anxiety for her. Her slow moving personality paired with “a touch of perfectionism” doesn’t bode well either. The interplay of the anxiety, attentional issues, perfectionism and slow pace is what’s causing the problems. And, it’s only a problem b/c of the truly crazy busy-work load and the teachers’ handling of her emotions. (I’m NOT insinuating she’s an easy child to deal with regarding her emotions pertaining to academics… I DO yell at her also… but NEVER berate her EVER! But she’s an amazing child and person and I do believe that maturity will help resolve much of these issues. Hopefully, her spirit won’t be crushed in the meantime!)

  3. Sorry, I don’t have a lot of experience with ADD. My nephew has it (he’s 24 now) and took Ritilin (?) for years. We noticed a difference in his behavior with his diet. I babysat him when he was little and his mom (my sis) would drop him off with a large baggie of sugary cereal. He was wired and bouncing off the walls! We’d take the bag away, give him a piece of toast and some fruit and he would be a completely different kid. He was quieter, he would focus on us when we spoke to him, etc. The low sugar diet didn’t make him a saint by any means, but we saw a huge difference when he ate less sugar.

    • Maggie says:

      Funny you say that! The Old Soul doesn’t eat a lot of sweets but I did remove the sugary cereals from her morning diet for a spell to see if it helped. Can’t speak for what happened at school but I saw no difference whatsoever in her behavior. (But we haven’t gone back to those sugary cereals… they’re just garbage anyway!)

  4. Mia W says:

    Your Old Soul sounds like my clone! My (awesome) mom pulled me out of public school when I was 9 because of similar issues–I was depressed, anxious about the workload, angry that I didn’t have playtime any more, sad because I had to give up all these activities I loved because of homework, nervous because I was having trouble making friends… the list goes on and on. I, too, had HOURS of tear-filled homework every night. I’m so glad my mom pulled me out… homeschooling gave me my love of learning back and I’m forever indebted to that.

    That psychiatrist sounds like a jerk. Is there someone else you can see? From personal experience, life is so much better when you can find doctors/assorted medical professionals that truly want what’s best for you and will work with and listen to you.

    Good luck! 🙂

    • Maggie says:

      Sorry you had so much trouble yourself. Homeschooling sounds like the favored option for so many. I’m investigating all options to see what will work best for my Old Soul (and me… I work 2 part-time jobs from home). As for the Psychiatrist, he was not so much a jerk as very sure of himself based on many many years of experience medicating children for psychological/chemical issues etc. I didn’t mind him so much… just that he expected me to be open-minded and take his recommendation but was not very open minded about the possibilities for alternative treatments for my daughter. Again, he’s got way more experience than I do in this field. However, I’ve found that I/me/mine will be the exception to every rule. That means, he could be wrong about his predictions for my Old Soul’s future. Regardless, unless I go the meds route, we don’t have to see him again.

    • Maggie says:

      Sorry you had so much trouble yourself. Homeschooling sounds like the favored option for so many. I’m investigating all options to see what will work best for my Old Soul (and me… I work 2 part-time jobs from home). As for the Psychiatrist, he was not so much a jerk as very sure of himself based on many many years of experience medicating children for psychological/chemical issues etc. I didn’t mind him so much… just that he expected me to be open-minded and take his recommendation but was not very open minded about the possibilities for alternative treatments for my daughter. Again, he’s got way more experience than I do in this field. However, I’ve found that I/me/mine will be the exception to every rule. That means, he could be wrong about his predictions for my Old Soul’s future. Regardless, unless I go the meds route, we don’t have to see him again.

      • Mia W says:

        Have you looked into programs like k12.com or flvs.net? Both are school-at-home types of homeschooling programs (though flvs is for middle school, so you’d have a few years to go). I have recommendations for homeschool programs (for you to do some with her) if you’d like, if you decide to homeschool. 🙂

        Also, if you’re open to the possibility of changing schools, is there a Waldorf or a Sudbury school near you? Waldorf schools are type of holistic (nourishes the brain AND the body) school that believes in delayed academics and a more peaceful existence. Sudbury schools are unschool schools–they are democratic and go by the philosophy that kids learn best when they study what they want to when they want to.

        Sorry for calling the doctor a jerk–that was rude of me. I just get testy with doctors who diagnose before they meet their patients, or ones that are cocky about their abilities without listening to what the family is saying. If you do go with the meds route, you still might want to think of changing psychiatrists because it’s not like one magic pill will fix everything, and you might need to play around with different medicines until you find the one(s) that work for her. If his attitude was so flippant towards other options your daughter, he might not be so receptive toward what is happening with you and yours. I’m sure he’s a wonderful psychiatrist, but that still doesn’t mean he’s a great match for your family.

      • Maggie says:

        There’s a painfully expensive Waldorf school about 30 minutes away and a progressive school (also expensive though slightly less painfully) that I’m looking into about 30 minutes in the other direction. As for the doc, I was forewarned of his couch-side manner and I do sorta get where he’s coming from. He’s spent his whole life medicating away severe, psych-related issues in children. He’s a locally reknowned expert/child diagnostician in this field… but that doesn’t mean he might not have jumped the shark with my daughter as he didn’t have all the information. Still, by the time a kid gets to him, generally, it’s because the child has developed a really bad functional problem… as in, CAN’T function in the school and home settings. We went to him very early in the process b/c I’m chasing it down in hopes of avoiding the “I can’t function” stage. I’m going for early intervention/prevention so we don’t ever get to the have-to-medicate-to-survive phase. He says this won’t work, says she’ll continue to get worse (nature of the problem) w/o meds and I should cut to the chase so she doesn’t suffer anymore negative consequences. I’m being the optimist, he’s either being a pessimist or a realist based on his experience. We’ll see who’s right. I’ve always lived on the edges of typical when it comes to statistics and what “usually” happens in life. Look at my boys (ID twins with DS… by some estimates a 1/2,000,000 chance). LOL

  5. Anne Calzone says:

    I’ve been following your blog for a few months now. I have a daughter, 11, with Down Syndrome so that is what led me to your blog.

    Besides Lydia, two of my other daughters have had learning disabilities and have growth issues, etc.

    I have a suggestion you may not like to hear, but I believe the best place for a child with the kind of problems Old Soul has is at Home. At home she can set her own pace. You are already spending hours each night doing homework – why not just teach her at home – you could spend that much time on “schoolwork” and spend the rest of the day doing wonderfully enriching, fun things.

    I’m not saying it is easy, but teaching your own children at home is a wonderful experience. And there are tons of opportunities for socialization out there and extra activities with other homeschoolers.

    There is also a wealth of information and help via the internet and other sources to help you find what curriculum would work best.

    I appreciate your apprehension about the medication.

    Blessings,
    Anne

    • Maggie says:

      I am completely open-minded about the opportunities ahead for how to best educate my Old Soul. I totally appreciate your input and would love to receive actual links to homeschooling sites you’ve found helpful. Email me at marshallhagan, then that funny sign for “at” and verizon.net. Acknowledging that my work schedule may interfere with homeschooling, I know there’s a work-around for everything. I’m investigating all options. Thanks for the input!

  6. Eileen Radcliffe says:

    Hi Maggie,

    I am just starting to investigate ABA therapy for my daughter with ADD (no H, either). Have you heard anything about this? I know you are a proponent of it for your boys. I didn’t realize it was an option for ADD but just spoke with someone today about what they do. They come into the home and work on behavior modification…I spoke to her specifically about the problems we have with getting out of the house in the morning and getting homework done in the evening. I don’t know anything about how it benefits children with ADD but I look forward to hearing more from this therapist. I’m not against medication but we have not medicated yet (various reasons). My daughter has been seeing a therapist for “play therapy” and I’m not really sold on that either… it’s only been a short time but I have not seen any positive results from it yet.

    I will be following this thread in hopes of finding some answers myself!
    Eileen

    • Maggie says:

      Eileen – In fact, ABA is just really rigid behavior modificatin techniques with anal data capture to use as feedback to tweak the program. It can work for everything and anything! It’s a stimulus-response-reward system… human nature to respond even when they don’t want to. That doesn’t mean there aren’t some really tough cases. Trick is finding the right reward to garner the desired response. As for the “play therapy”, my experience (undergrad work) was that it’s a good way to identify issues but doesn’t necessarily resolve them… though thinking about it, I guess a therapist could model ways to handle exposed issues through play (kind of like practice or role-playing). I’ll share anything I find out and hope you’ll do the same. We are all in this together :o).

  7. Paul Azzam says:

    I don’t have any experience with ADHD, but I have a great deal of experience with how changing my diet made a tremendous positive difference in my life. After a diagnosis of Multiple Sclerosis 6 years ago my doctors recommended drug therapy. I wanted to research alternatives, and I kept seeing diet modification in the books and website I read on MS. I went on the MS diet (which is at its heart just a healthy, low-fat, allergen-free diet, no processed foods and lots of whole grains, veggies and fruits) and all my symptoms disappeared. When I fell off the wagon the symptoms returned. When I got back on the symptoms disappeared. I have been disease free (with no drugs) now for 6 years.

    So what does my story have have to do with you and your Old Soul? Well I kept seeing ADHD as a disorder correctable by diet in the literature I read. Check out the following article from the Los Angelos Times (below). From the article “A new study suggests that a highly restricted diet can be just as effective at reducing symptoms in a majority of children with ADHD.”

    http://articles.latimes.com/2011/mar/14/health/la-he-diet-adhd-20110314

    My new diet seemed very restrictive to me (hence my falling off of it several times at first), but it was restricting mostly things that were unhealthy for me anyway: saturated fat, trans fats, processed sugars, salts and grains, etc. I took the diet to my primary care physician and asked what he thought. He said he didn’t know what it would do for MS, but it would make me much healthier in every other way. His exact words were, “This is the diet we’re all supposed to be following.”

  8. Ecki Stern says:

    My daughter is 9 and for years has had what has been diagnosed as everything from PDD-NOS to Anxiety Disorder to ADHD. She’s cried over everything since she was in PreK and even had an IEP until the end of 1st grade when we moved to a 504. She scored in the 96th percentile when they did her IQ test, so no more IEP. We’ve been on a variety of psych meds: Prozac from age 6 – 8 and then it stopped working. We stopped meds over last summer, but THAT was a complete disaster. I couldn’t take her anywhere without a complete meltdown. And then she had some sort of nervous breakdown at the beginning of this school year which left her unable to walk for 3 weeks! We tried Wellbutrin, which made her suicidal and was probably the scariest thing I’ve ever had to go through. Right now we are on Zoloft and that’s been the “magic” pill. The change in her took a weekend and now she’s gone from crying a dozen times a day or spending half the day at the nurse or school social worker’s office to maybe one or two meltdowns a week. I’ve realized she can’t even function without it. I skipped a few days by accident and she had such an anxiety attack. Very strange. I know it’s controversial to give meds to kids, but I know that *my* kid can’t function without them.

    • Maggie says:

      I JUST saw this comment (my computer crashed which is why I’ve been MIA) and I have to say, we create the controversy ourselves by acting like each of us doesn’t have the right to treat the issues/diseases/illnesses/afflictions/diagnoses/symptoms (call it what you want) our children present. No one walks in my shoes and I walk in nobody’s but my own. I’m not against meds per se. I’m just not choosing them for my daughter at this time. Her diagnosis is not clear-cut and not severe… except when it comes to anything academic. She’s in the gifted program but regular old school and all that’s related to it, for us, is a challenge. Only time will tell how we, and how she deals with it.

  9. Linda Sebek says:

    I would actually try to get a second opinion. Stating she will fail without meds in front of her is unproffesional. That he had not read the early evaluation is unproffesional. Disregarding all kind of therapy is unproffesional.

  10. I DO have a lot of experience with this and I’ve just two weeks ago started writing a website into which I can put my information. It’s REALLY NOT FINISHED (we have to get a different website tool, and it should have different menus for each page… sigh), but here’s the start of an ADHD page.
    http://brainparenting.com/problems/adhd/

    PLEASE put input and any editing in the comments!

    Some comments:
    1. Trust your gut. It’s obviously a good gut.
    2.. No doctor will spend enough time with your daughter to pick up all of the subtleties that you’ve mentioned.
    3. here’s the most important part of diagnosing a child with adhd. Right from the DSM itself. http://brainparenting.com/problems/adhd/adhd-summary-of-diagnostic-criteria/

    Thanks to your post, we’ll be modifying this to add anxiety and to add entire sections about how to run interference with your teacher. Getting a 504 is a great step. You can have a list of accommodations that they have to give, and you can require them. Do it. If the gifted teacher is saying that your child’s focus is good, then look at training for parents of gifted children.

    There are a lot of things to check. Allergies, sensitivies to things like food dye or types of food. How are her senses. Good sense of balance? Good handwriting? Can she hear properly? Does she rhyme well? Do the ends of her sentences dwindle off or are they clear?

    Not a crystal clear answer, but there rarely is. A developing child is a moving target. So like I said, go with your gut. and read this! Take care,
    http://neurodevelopmentalbathtub.com/?p=14

    • Maggie says:

      GREAT information… thanks. The co-morbid occurence of anxiety is almost a bigger problem with my daughter and her teacher’s rating considered her at risk for depression b/c of all the crying at school from the anxiety of never getting to finish anything. That said, the psychiatrist said the non-stimulant treatments don’t work for ADD/ADHD… HOWEVER, my research shows that the non-stimulant Straterra does help with the anxiety and depression symptoms. So, we may give that a try (have to research the side effects a bit more before we do). Additionally, everyone prescribes (as this Psych suggested) at the “average” effective treating dose which may be too much and NOT the way these meds were meant to be used. Supposed to start with the smallest dose and slowly build until you achieve the desired affect at the lowest dosage possible. Our plan, if we go forward with the Straterra trial, is to begin at a painfully low dose and take our time. Find my daughter’s optimal treating dose and then take her off for the Summer and wait until school starts (unless I find her anxiety level doesn’t drop over Summer… right now she’s experiencing a residual school anxiety). ALL of her issues are school-related. As for your final questions: No allergies, sensitivities and her senses are phenomenal. Her balance is great. Her handwriting is beautiful and she can pick out different bird chirps from 100+ yards away (bird-watcher). She rhymes and writes and speaks clearly, articulately and well above her age-level. And yes, I agree, no diagnosis is EVER crystal clear…. EVER.

      I’ll check your site and be sure to add it to my favorites to watch and contribute as we go through our own experience. Thanks for the info.

      Maggie

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