Kate's Temperament Newsletter about High Maintenance Children

A Newsletter About Caring for the High Maintenance Child by Kate Andersen, M.Ed. Issue Theme: Is it Temperament or ADHD? Volume 22, Number 11, July, 2020 https://b-di.com/newsletter.html

Letter to Kate

Dear Kate,

My seven-year old son's teacher suggested that we do the Conners test to help determine if my son has ADHD (he constantly fidgets and blurts out in class). The Conners test result total score for the teacher and us was near the clinical level. The school psychologist suggested that I look at the chadd.org website. If my husband and I thought that my son might possibly have ADHD then we could further speak to a psychologist.

I got a referral from a psychologist for an ADHD psychologist expert. My husband and I even went to a talk that this psychologist gave at a PTA special ed meeting (background information on ADHD). My husband definitely felt that my son was smart and manipulative and did not have ADHD (academically he is two grade levels above). I thought that there was a possibility that he could have ADHD as he can't seem to "help himself" to behave.

When I scheduled an initial appointment with this psychologist, he said that he was not quick to medicate or diagnose because he had already had enough clients. This psychologist talked about a great behavioral incentive plan that he could establish, but did not produce one. The psychologist criticized the behavior incentive plan that I set up with the teacher by saying that it was too simplistic and that we needed to further target two behaviors (which the teacher had commented on in a daily notebook with a rating). My son was behaving somewhat better with this incentive plan.

After the psychologist heard about the results of the incentive plan, he said that he was pretty sure that my son was developmentally socially delayed (I forget the actual term). We thought that he would suggest a better incentive plan. Instead, the psychologist referred us to a psychiatrist to medicate my son to eliminate the possibility that he has ADHD!

After thinking about everything that we went through with this psychologist, we felt that he was taking the "easy way out" in order to diagnose our son. In fact, my husband pointed out that he never even met with the child!

My question is: Is ADHD that difficult to diagnose? The teacher told us that she has two students that are ADHD and on medication in her class (she can't give us names or any information). Is this a legitimate practice to use our son as a guinea pig?

Please give us any advice or feedback.

Thanks,

Parent

Kate's Answer

Dear Parent,


I referred your questions "Is ADHD that difficult to diagnose?" and "Is this a legitimate practice to use our son as a guinea pig?" to Dr. Sean McDevitt, Editorial Consultant. This is his reply:

"There is a set of published criteria for diagnosing ADHD in the DSM-V and the evaluation of the child's status against those criteria is the only legitimate way to determine whether it is present.
The criteria include the presence of certain specific behaviors, the determination that the behaviors are adversely affecting the child's adjustment, that they are seen in more than one area of the child's life and that they have been present since childhood. Only when those criteria have been met can ADHD be diagnosed. Often professionals will obtain behavioral ratings from parents, teachers and possibly other caregivers prior to determining whether the child meets the criteria for ADHD. Learning disability may also need to be ruled out if the problem behaviors are present at school.


There are three types of ADHD, inattentive type (without hyperactivity) hyperactive-impulsive type and combined type, found when the child meets the criteria for both inattentive and hyperactive-impulsive type. By the way, this process does require that the professional visit with the child!

If referred to a psychiatrist, the child should be evaluated and diagnosed before medication is prescribed. There shouldn't be a "diagnostic trial" of medication, as even children without ADHD improve their attention on medication. The diagnosis should be established first, then medication provided."

I hope your questions have been answered.


Best wishes,


Kate