What if it's not ADD?
February 23, 2011 7:50 AM Subscribe
What was your adult neuropsychological evaluation like, if you've had one? What should we be looking for in the process? I'm not sure my SO is getting the sort of evaluation he needs.
(Yes, I have my SO's permission to discuss his situation. Asking anon to reduce the discomfort factor.)
My SO's recently embarked on an attempt to figure out what, precisely, his specific learning disability/ processing problem is and how he can more productively address it. He has problems comprehending what others say, especially in noisy enviroments, but his hearing checks out fine; the very expensive audiologist we tried a year ago made some noise about "processing problems," and then dismissed it entirely, theorizing that maybe he'd had really good hearing before and now it was just good. He's fairly sure that this is not the problem-- he experiences incoming sounds as garbled, not as muffled or indistinct. In groups or under duress, he can't reliably comprehend what's being said.
He has issues expressing himself verbally, too-- he's quite reserved around 98% of the people we know, and he often says something that comes off tactless or arrogant, and then is immediately apologetic because it didn't sound that way in his head and he can't figure out why he would've said such a thing in the first place. He suffers from fairly major social anxiety, between the problems with comprehending speech and the occasional bout of "it seemed like a good thing to say at the time, but it was actually hurtful."
He also shows some symptoms of dyslexia-- he was surprised to learn that not everyone sees words and letters reversed, his spelling is a bit below-average, and he has severe difficulties learning foreign languages (he took three years of Spanish, but they were all Spanish I, over and over).
Given all that, we've enlisted a therapist who specializes in learning disabilities. It's been two sessions and an initial phone screening so far, and she seems very intent on finding reasons for him to have adult ADD. Everything we tell her-- she's very insistent that it is a couples-therapy situation-- comes back around to "it's probably attentional." We get a lot of questions about how he did in school (perfectly average aside from foreign language struggles, no acting out, no problems getting assignments done, no losing assignments), how his relatives did in school (same), how work is going (he's been in the same field doing reliable, technical, detail-oriented work for 15 years now without incident), if caffeine makes him sleepy (no), and so on. Everything he says doesn't sound like him, she says "well, you're smart, so you've probably worked around that." When discussing the misperception of written words, it was "Well, you're probably just not paying proper attention to what you're reading and you only think it looks wrong," which was emphatically not what he was telling her.
We've been sent home with DVDs of 20/20 episodes about Ritalin and adult ADD. We've gotten a copy of the Brown ADD Scale to do this week. Everything is about ADD, and, frankly, I am suspicious. I'm beginning to think we've run into an ADD specialist who has a great track record because she finds a way to make every single one of her cases an ADD case even when it's not.
Is it normal for adult ADD to come up this often in an initial-evaluation context, even when the patient isn't at all concerned about ADD? Should we really be getting all of this ADD-related material when we don't even know what the problem might be yet? Should we be looking into a second opinion? Are there more objective, evidence-based ways of nailing down this diagnosis that don't involve an hour a week in a therapist's office doing a weird mix of couples therapy and questions about ADD? What was your experience working with professionals about adult neuropsych concerns?
(We are in Southern California. Please do not direct me to the Amen Clinic; I am aware that Amen's SPECT-scan approach is insufficiently supported by hard scientific evidence and am not interested in wasting money on it. Thanks.)
(Yes, I have my SO's permission to discuss his situation. Asking anon to reduce the discomfort factor.)
My SO's recently embarked on an attempt to figure out what, precisely, his specific learning disability/ processing problem is and how he can more productively address it. He has problems comprehending what others say, especially in noisy enviroments, but his hearing checks out fine; the very expensive audiologist we tried a year ago made some noise about "processing problems," and then dismissed it entirely, theorizing that maybe he'd had really good hearing before and now it was just good. He's fairly sure that this is not the problem-- he experiences incoming sounds as garbled, not as muffled or indistinct. In groups or under duress, he can't reliably comprehend what's being said.
He has issues expressing himself verbally, too-- he's quite reserved around 98% of the people we know, and he often says something that comes off tactless or arrogant, and then is immediately apologetic because it didn't sound that way in his head and he can't figure out why he would've said such a thing in the first place. He suffers from fairly major social anxiety, between the problems with comprehending speech and the occasional bout of "it seemed like a good thing to say at the time, but it was actually hurtful."
He also shows some symptoms of dyslexia-- he was surprised to learn that not everyone sees words and letters reversed, his spelling is a bit below-average, and he has severe difficulties learning foreign languages (he took three years of Spanish, but they were all Spanish I, over and over).
Given all that, we've enlisted a therapist who specializes in learning disabilities. It's been two sessions and an initial phone screening so far, and she seems very intent on finding reasons for him to have adult ADD. Everything we tell her-- she's very insistent that it is a couples-therapy situation-- comes back around to "it's probably attentional." We get a lot of questions about how he did in school (perfectly average aside from foreign language struggles, no acting out, no problems getting assignments done, no losing assignments), how his relatives did in school (same), how work is going (he's been in the same field doing reliable, technical, detail-oriented work for 15 years now without incident), if caffeine makes him sleepy (no), and so on. Everything he says doesn't sound like him, she says "well, you're smart, so you've probably worked around that." When discussing the misperception of written words, it was "Well, you're probably just not paying proper attention to what you're reading and you only think it looks wrong," which was emphatically not what he was telling her.
We've been sent home with DVDs of 20/20 episodes about Ritalin and adult ADD. We've gotten a copy of the Brown ADD Scale to do this week. Everything is about ADD, and, frankly, I am suspicious. I'm beginning to think we've run into an ADD specialist who has a great track record because she finds a way to make every single one of her cases an ADD case even when it's not.
Is it normal for adult ADD to come up this often in an initial-evaluation context, even when the patient isn't at all concerned about ADD? Should we really be getting all of this ADD-related material when we don't even know what the problem might be yet? Should we be looking into a second opinion? Are there more objective, evidence-based ways of nailing down this diagnosis that don't involve an hour a week in a therapist's office doing a weird mix of couples therapy and questions about ADD? What was your experience working with professionals about adult neuropsych concerns?
(We are in Southern California. Please do not direct me to the Amen Clinic; I am aware that Amen's SPECT-scan approach is insufficiently supported by hard scientific evidence and am not interested in wasting money on it. Thanks.)
While it's possible that it could be ADD primarily Inattentive (rather than hyperactive), her approach seems really off. I'd seek a second opinion immediately.
posted by canine epigram at 8:32 AM on February 23, 2011
posted by canine epigram at 8:32 AM on February 23, 2011
Oh, and a proper neuropsych evaluation is not done by a therapist - a proper neuropsych evaluation is done by a neuropsychologist.
I'm not sure if this is a preliminary to a neuropsych eval and you were fuzzy on the terms, but I'm hoping she's not selling this as a neuropsych eval, because it's not.
posted by canine epigram at 8:37 AM on February 23, 2011 [2 favorites]
I'm not sure if this is a preliminary to a neuropsych eval and you were fuzzy on the terms, but I'm hoping she's not selling this as a neuropsych eval, because it's not.
posted by canine epigram at 8:37 AM on February 23, 2011 [2 favorites]
'm beginning to think we've run into an ADD specialist who has a great track record because she finds a way to make every single one of her cases an ADD case even when it's not.
IANAtherapist, but it sounds like you've run into someone who has a hammer and is seeing nails everywhere. The field of learning disability studies has come a long way in just the past ten or so years, and not everything is ADD, and you can't throw Ritalin at everything and solve the problem.
Also, the idea that adults have undiagnosed LD's or never outgrow them is a new idea in many quarters. Many LD therapists are child-oriented and don't quite know how to deal with adults. You want to be sure that your therapist has experience with adults, not just kids.
Definitely a neuropsych evaluation and second opinion. Expect to put in some patient detective work to get a proper diagnosis, but it shouldn't all be a couples therapy thing - your SO will/should be going to a therapist on his own.
You live in southern CA - why not try contacting the professional psychology department at a university? Even if they are not attached to a professional medical center, they may be able to point you in the right direction, give referrals, and so on.
posted by Rosie M. Banks at 8:45 AM on February 23, 2011 [1 favorite]
IANAtherapist, but it sounds like you've run into someone who has a hammer and is seeing nails everywhere. The field of learning disability studies has come a long way in just the past ten or so years, and not everything is ADD, and you can't throw Ritalin at everything and solve the problem.
Also, the idea that adults have undiagnosed LD's or never outgrow them is a new idea in many quarters. Many LD therapists are child-oriented and don't quite know how to deal with adults. You want to be sure that your therapist has experience with adults, not just kids.
Definitely a neuropsych evaluation and second opinion. Expect to put in some patient detective work to get a proper diagnosis, but it shouldn't all be a couples therapy thing - your SO will/should be going to a therapist on his own.
You live in southern CA - why not try contacting the professional psychology department at a university? Even if they are not attached to a professional medical center, they may be able to point you in the right direction, give referrals, and so on.
posted by Rosie M. Banks at 8:45 AM on February 23, 2011 [1 favorite]
IANAD, but I have been a secretary/office manager at a neuropsychology clinic for five years so I like to think I've absorbed enough information to be helpful.
Here's what a neuropsychological evaluation is like, in our clinic:
Phone consultation with the doctor, to set up the appointment.
Interview with the doctor. Usually 45 minutes.
Cognitive testing. Usually 3 to 4 hours.
Second appointment to go over the results. Usually half an hour. If the doctor thinks it's appropriate, they'll refer you to other providers (therapists, rehab counselors, whatever) for more treatment. Our doctors don't do therapy or treatment.
The doctors I work for actually won't do adult ADD testing- the clinic director believes adult ADD is abused as a "catch all" diagnosis and she won't even consider ADD unless the patient had a strong history of ADD-like problems as a child. So in my experience, it's definitely not the norm for a provider to be pushing ADD this hard. Sounds like your therapist is doing an evaluation in reverse: diagnosis, then testing to prove the diagnosis.
I'd find a new provider. Basically, if you're not happy with her treatment, there's no reason why you should stay with her.
So: look for a neuropsychologist or a neuropsychology clinic. The doctors should have a PhD or PsyD. Affiliations with universities or hospitals are often a good sign. Avoid clinics who really hype that they specialize in adult ADHD and offer their own patented treatment program or whatever. I am nowhere near SoCal and so I can't make an informed recommendation, but these guys look like they do something very similar to the clinic I work for, and their doctors have similar credentials to our doctors.
posted by castlebravo at 8:51 AM on February 23, 2011 [4 favorites]
Here's what a neuropsychological evaluation is like, in our clinic:
Phone consultation with the doctor, to set up the appointment.
Interview with the doctor. Usually 45 minutes.
Cognitive testing. Usually 3 to 4 hours.
Second appointment to go over the results. Usually half an hour. If the doctor thinks it's appropriate, they'll refer you to other providers (therapists, rehab counselors, whatever) for more treatment. Our doctors don't do therapy or treatment.
The doctors I work for actually won't do adult ADD testing- the clinic director believes adult ADD is abused as a "catch all" diagnosis and she won't even consider ADD unless the patient had a strong history of ADD-like problems as a child. So in my experience, it's definitely not the norm for a provider to be pushing ADD this hard. Sounds like your therapist is doing an evaluation in reverse: diagnosis, then testing to prove the diagnosis.
I'd find a new provider. Basically, if you're not happy with her treatment, there's no reason why you should stay with her.
So: look for a neuropsychologist or a neuropsychology clinic. The doctors should have a PhD or PsyD. Affiliations with universities or hospitals are often a good sign. Avoid clinics who really hype that they specialize in adult ADHD and offer their own patented treatment program or whatever. I am nowhere near SoCal and so I can't make an informed recommendation, but these guys look like they do something very similar to the clinic I work for, and their doctors have similar credentials to our doctors.
posted by castlebravo at 8:51 AM on February 23, 2011 [4 favorites]
It does sound like your evaluator is trying to bend your partner's symptoms to her preferred diagnosis and that diagnosis is ADD. I mean, I share many of your partner's symptoms (including many years repetition of Spanish I!) and could just as easily tell you he has dyscalculia. Which, you know, he probably doesn't.
posted by DarlingBri at 8:57 AM on February 23, 2011
posted by DarlingBri at 8:57 AM on February 23, 2011
UCLA's Neuropsychiatric and Behavioral Health Services center is excellent, but its website makes it seem like you have to sign up for a particular diagnosis or what have you. Call the ACCESS Center at 800-825 9989 and explain more about what you're looking for, and they will probably be able to offer you something.
re: castlebravo's post, it's actually kind of the point to diagnose the major problem areas FIRST and test things relative to them. Making the ADD diagnosis off the bat is obviously not appropriate unless testing supports it, but the way cb described that process is actually the way it's supposed to be, because it costs people needlessly huge amounts of money to test them for autism if they have OCD symptoms--makes sense, right? That's the point of the clinical interview coming before the neuropsych testing.
OP, if you want a specific recommendation for clinicians in the LA area, I know a few great neuropsychologists and would be happy to share their info with you.
posted by so_gracefully at 1:56 PM on February 23, 2011
re: castlebravo's post, it's actually kind of the point to diagnose the major problem areas FIRST and test things relative to them. Making the ADD diagnosis off the bat is obviously not appropriate unless testing supports it, but the way cb described that process is actually the way it's supposed to be, because it costs people needlessly huge amounts of money to test them for autism if they have OCD symptoms--makes sense, right? That's the point of the clinical interview coming before the neuropsych testing.
OP, if you want a specific recommendation for clinicians in the LA area, I know a few great neuropsychologists and would be happy to share their info with you.
posted by so_gracefully at 1:56 PM on February 23, 2011
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posted by decathecting at 8:09 AM on February 23, 2011