ADHD diagnosis looms. What's next?
January 4, 2012 4:54 PM   Subscribe

My son's school has suggested that he has ADHD. We've long suspected this as well. Now what?

My son attends kindergarten at a very good private school. At a recent meeting, his teacher told us that she thinks he has an attention problem. We were not surprised by this news. I have Tourette Syndrome, and TS and ADHD go together like peanut butter and jelly. (I have never been officially diagnosed with ADHD, but I have always exhibited many classic symptoms.) Unlike me, my son is not hyperactive and does not disrupt class, but he does “space off,” and he has difficulty with tasks that require sustained attention and mental effort. The DSM-IV criteria for “ADHD-Predominantly Inattentive” describe him with eerie precision. So far he has not developed tics like mine. He seems to have a normal IQ.

His teacher wants us to send him to a local community clinic that specializes in testing and diagnosis for ADHD and has some sort of arrangement with the school. I am not opposed to this, but I prefer to take him to a pediatric psychiatrist that specializes in this sort of thing. I guess the snob in me thinks that a psychiatrist that practicing at a prestigious hospital will have better insights and more to say than an MSW at the community center. Nevertheless, we’re not rich, and it seems to me that my son’s case is pretty clear-cut, so it might not matter. What do you think? Certainly no one would ever suggest putting a five-year-old on something like Ritalin or Adderall, right? Right?

Also, it seems to me that this school is pushing kindergarteners very hard. My son has homework most nights, and he is doing things that I never did in kindergarten. The school (K – 12) prides itself on its academic rigor, and seems to emphasize order and discipline. I have no problem with this, but our parenting strategy emphasizes autonomy and creativity. My wife is terrified that he will have to repeat kindergarten, although no one at the school has suggested anything like this. She talks about putting him in a different school that specializes in children with learning differences. I’m not opposed to this, but the school is astronomically expensive and might not be necessary. Certainly if he was in danger of being held back they would be telegraphing this well in advance, right? Right?

What would you do if my son was your son?
posted by Crotalus to Health & Fitness (13 answers total) 5 users marked this as a favorite
Data point: when my school suggested that I either needed to go on ritalin or repeat kindergarten, my parents put me in a different school. It is something I thank them for on a fairly regular basis.
posted by Jon_Evil at 5:02 PM on January 4, 2012 [3 favorites]

> Certainly no one would ever suggest putting a five-year-old on something like Ritalin or Adderall, right?

Wrong! But you can always say no.

A psychiatrist will not necessarily have better insight; bad psychiatrists exist. My son, who was diagnosed with ADHD at about that age, got some great help from a clinic run by a local university. Why not take him to both the clinic and the prestigious hospital, and see which method works better for him?

"Learning differences" usually means more extreme things than ADHD, in my experience, but maybe it's different where you are. If you think it would be a better fit for him, you can try to get your local school district to pay (I'm presuming you're in the US); this is not easily done, but it happens. The school should be able to get you started on this process.

It's unusual for kids to repeat grades these days (again, this might be different where you live or at private school). I do know a few kids who've repeated Kindergarten, but only after lobbying by their parents.
posted by The corpse in the library at 5:14 PM on January 4, 2012

Same thing with our son, 15 years ago. Kindergarten teacher suggested testing, we started with an evaluation from his pediatrician. She found cause to send us to a pediatric psychologist, who administered a battery of tests. Psychologist advised drug therapy and we were soooo conflicted but after much thought and soul searching we did go ahead with it. IQ score before Ritalin: 89. Score after a year of drug therapy: 139.

It was a long, complicated road to get him through school. He stayed with the drugs all the way. I can't say that he was ever a good student, and I don't feel comfortable endorsing the drug therapy because every situation is different.

But our kid would never have made it through high school without it.
posted by raisingsand at 5:19 PM on January 4, 2012 [3 favorites]

It seems to me that you, but particularly your wife, are escalating to the worst case scenario very prematurely. Go to the clinic and see what you think. If you are not happy, go to the university hospital next. All of this talk about alternative schools is vastly premature when you don't have a diagnosis, have spoken to no diagnostic professionals, and have no indication other than your wife's fears that your son will be asked to repeat anything at all.
posted by DarlingBri at 5:23 PM on January 4, 2012 [3 favorites]

The thing about medication for ADHD is that you can always go off it. Your son should be able to tell you how he feels (after he gets used to it of course) and you can decide from there whether or not you want to keep going with it. You can take it once a week, or once a month, or every day, or only have it last for a few hours or for 8 hours - there are lots of options and it's not an all-or-nothing commitment.

I have inattentive ADHD and was diagnosed in my 3rd year of university. I often wonder what life would have been like had I been diagnosed and medicated earlier, or at least had the option of taking medication. If you're opposed to drugs completely you could disregard this, of course.
posted by sarae at 5:34 PM on January 4, 2012 [1 favorite]

Isn't kindergarten a little young for a diagnosis? And homework in kindergarten? I know tons of kids who would not have had the attention span for that, and none of them had ADHD. Maybe he's just really not there yet. Go get a couple of opinions and see where it leads. You don't have make any decisions for a long while yet.
posted by ThatCanadianGirl at 5:53 PM on January 4, 2012 [2 favorites]

ADHD does involve a battery of tests for proper diagnosis. In my case, I was referred to a clinic like you describe, but it was only for testing. After I received the formal diagnosis of ADHD-Inattentive, I took that back to my general practitioner and my clinical therapist. My GP can feel comfortable prescribing me Schedule 2 meds without worrying that I am drug-seeking, and my therapist can discuss my issues as they relate to ADHD.
Most importantly, I can take myself seriously now because I have been formally tested and diagnosed. As someone who grew up believing I was just lazy and lacking discipline and sometimes stupid because I couldn't remember things, it is a relief. And the medications have been life-changing in the mere two months that I have been on them.

I would follow the school's advice: approach the clinic with an open mind, have him tested, and only then start down the road of expensive psychiatrists if you feel it is necessary. Perhaps the clinic will even refer you to an expensive psychiatrist. Just keep talking to the school this year, so they know you are aware of what's up. The school should be right for the kid, not the other way around. Even if he doesn't have ADHD, this school might not be right for him. He will still go on to live a kickass life.
posted by aabbbiee at 5:58 PM on January 4, 2012

Kindergarten is young for a diagnosis. Most psychiatrists/children's hospitals won't even see a child until he or she is 7. And I would caution against taking your son to a clinic that "specializes" in testing and diagnosis of ADHD. When we had our son evaluated, we went to a children's hospital and had a battery of developmental and psychiatric tests done; we weren't looking for ADHD and neither were they.

If I were you, I would talk to at least one child psychiatrist and see what he/she has to say. Again, I'd caution you against having him tested so young, but if one or more psychiatrists think it's worth exploring, by all means go for it.

(I am the mother of a child diagnosed with ADHD at age 8. We've been in therapy since then and he started medication at age 9. It made a world of difference for him.)
posted by cooker girl at 6:07 PM on January 4, 2012 [1 favorite]

I've been diagnosed with ADHD, and the diagnosis has been confirmed by another psychiatrist at least once that I can remember (My university requires a diagnosis in the last 3 years for all accommodations, even for lifelong conditions.)

Anyway: I was diagnosed sometime before grade 5 (My memories back that far are a bit indistinct, but it was around grade 3 I think). I was initially misdiagnosed with ADD, but my parents were very unhappy with how quickly that psychiatrist diagnosed me (Just by looking at me or something) and wanted to put me on ritalin. My parents managed to swing a referral to a much better child psychiatrist who did a bunch of tests, including a blind trial of ritalin: I was given pills each day that had either a full dose of ritalin, a half dose, or nothing, without anyone but the doctor knowing what was in each. My parents and teachers then kept a log of my behaviour, to see if I needed to be on it and if so, what the lowest dose we could use was.

It turns out that yes, I am ADHD, though just barely over the line between it and ADD. Now, I also had other issues (Asperger's for one) but the meds really helped me with a variety of things. I'm on Concerta today, am taking one of the most challenging programs at my university and am getting mostly As.

That said, my parents had to work with, and on occasion fight with, my school to get me accommodations I needed. Meds aren't enough; I needed a silent area to write tests, which was something they didn't get right for a lot of years. To them the other side of the classroom was quite....until I proved I could hear (and be distracted by) a thermostat clicking 3 classrooms away. It was also very frustrating having to work with someone who typically worked with down syndrome and other low functioning students, as she quite frankly came off as condescending.
Oh, and ADHD didn't come with any accommodations at my school. However, by working with my psychiatrist we got me listed as PDD (Which is so broad as to be meaningless, so he had no qualms about listing me as it, since I technically did fit all the criteria) which DID get me accommodations.
Even now at uni I get to write my tests in a separate room with less distractions instead of crammed into a lecture hall or gym with 600+ other students and exams ending at random times, people entering and leaving, etc. There are upsides to a diagnosis.

So I'd say go get the diagnosis at the clinic, though kindergarten does seem early, but watch how they do it. A proper diagnosis is several hours and, as I recall from my reading, requires a special blank room (To avoid kids natural distractibility) Even if you get a diagnosis and are happy with how you do it, you should have regular appointments with a child psychiatrist to monitor the amount of meds he is on, if you need to increase the dose or can lower it, etc. They can also work with you to get your child the accommodations they need. As I recall, I think mine came to my school to meet with my teachers and explain things at least once (I have Asperger's as well, which was not well known when I was diagnosed, and our school didn't really believe what we were telling them until we loaned them a bunch of books, had him come in, etc, when they finally went 'Oh, wow, this is a real thing')

However, be aware that the meds DO have side effects. I've met people with none, but some percentage of people can have some nasty ones. You are much luckier then I was, as there are now a number of medications on the market, whereas when I was young the only option was ritalin.

About what I experienced on ritalin: Your doc can give you far better experiance.
Various doses as I aged: First half a pill, then a full, 1.5, then 2, taken twice a day. Lasts for about 4 hours each, takes 30 min - 1 hour to come off of it, take twice a day. Don't put in the same container as other meds- I saw it react once with a painkiller.

Ritalin had much stronger side effects for me:
Firstly they drop your mood spectrum. This is a good thing, as it drops you into a useful space (From super angry or super happy, get into fights or don't do any work) BUT when it shifts the entire scale down. Not my mood persay, but the scale I'm measuring on. So if I'm happy, no change. However if I get upset, frustrated, etc, it is strongly magnified, and the depths I hit were much lower. That was the worst part, but a lot of it was strongly, strongly enhanced by bullying-- Once I moved to high school and that mostly stopped this side effect was greatly reduced.
The next is appetite loss. I was always skinny (Still am, though...less so), enough so that I had to drink boost shakes for a while in elementary school. Make sure your son eats 3 good meals a day, and healthy food. Lunches worked better when small bits, so I could eat them without seeing a bunch of food at once.

There were probably others, but the symptoms all dropped when I moved to Concerta in grade 11 (Mostly as it only wore off once a day) and have dropped off more and more since then, so I don't remember all of them right now. Admittedly in the last year or so it doesn't feel as effective as of late either-- I've been considering checking that my dosage is still right at my next doctors appointment due to the fact I've gained weight.

Anyway, if your son *does* have ADHD meds aren't something to be scared of; They really help me, and I've tried leaving them a couple of times, only to come back as I can't get my work done without them. Also remember that you only have to take them when you want to focus: I don't take them on days I don't have class or much homework, on weekends in the summer (i.e. when I am not at work), that kind of thing. They will not fundamentally change who your son is, turn him into a zombie, or anything like that. I still write fiction, daydream, flirt, etc while on my meds, I just have better control of what I am doing.

Feel very free to memail me if you want: I could even put you in touch with my parents as we make sure to try and help out people with stuff we have already gone through.
posted by Canageek at 6:58 PM on January 4, 2012 [2 favorites]

My kids saw a neurologist who was also board certified in psychiatry. I wouldn't trust anyone else, including "just" a psychiatrist. ADD/ADHD is brain chemistry--not behavior, not family issues, not "acting out". Chemicals.
And they started meds in elementary school. I wouldn't keep a diabetic kid off insulin.
posted by Ideefixe at 7:45 PM on January 4, 2012

Kindergarten is young for a diagnosis

Seconding or thirding this.

Homework in Kindergarten?

Get out now! ESPECIALLY if you do think it is possible that your son does have one or more possible learning dissabilities.

We made that mistake with ours - yes, they tested two years above their grade-level to get into an advanced school. Unfortunately, due to their learning dissabilities, they could not keep up with the workload - it was a constant battle - and ended up driving my daughter into having panic attacks so severe that the doctors recomended pulling her from school (which was in November of 2010, so... she essentially is 1-year behind now). Every medication we have tried with her has had side-effects to severe to make it worthwhile. (Sleep issues, appetite and a general over-emotional reaction to any/all situations) Admitedly - I have ADHD, diagnosed as an adult and have found medication to be incredibly effective - however, my dose is low (in comparison to what I have read in online forums for people with ADHD) - so I am thinking that perhaps my daughter is even more sensitive than I am.

So - this year we switched them into a school which can handle their disorders - with or without medication. Yes, it is not free - but we can claim it against our taxable income due to the fact that it has been prescribed for them - both by medical therapists and by their formal school.
posted by jkaczor at 9:03 AM on January 5, 2012

Hmm - and yes, while ADHD is chemistry - always start with the lowest possible dose and work upwards in tiny increments - there is no need to over-medicate, finding the right balance (and type) will take time - possibly years even - and of course that will change as you son grows.
posted by jkaczor at 9:08 AM on January 5, 2012

Okay, when my mom was a new immigrant and didn't speak English, she had to repeat Kindergarten. Her language skills just weren't there. In the long run, it didn't hold her back. She is retired now, but was a very successful RN for a long time, working first in Pediatrics, then the community, and finally in Palliative care in a hospice. My mom is really smart, is what I'm saying. And successful.

Now, that doesn't address the whole ADHD thing and homework in kindergarten and a kid who is that age who can't sit still for long periods of time. I'd be wondering about the classroom more than my kid. Maybe the teacher is just expecting too much out of him, developmentally (that sounds weird, but kids mature at different rates is all I'm trying to say).

But I did want to reassure you that if by some chance your kid ends up taking kindergarten twice - its not a big deal, in the grand scheme of things.
posted by sandraregina at 1:37 PM on January 5, 2012 [1 favorite]

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