What criteria do doctors use to test for ADD/ADHD?

Discussion in 'General Education' started by Jerseygirlteach, Jun 2, 2015.

  1. Jerseygirlteach

    Jerseygirlteach Groupie

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    I have a question for anyone in the know. I have a student who, in my opinion (and I fully admit I have no medical background whatsoever) is a classic ADD or ADHD kid. A few months ago, I described him in a thread like this:

    I am so frustrated by one of my students. I know that he probably cannot help it, but I'm at the end of my rope with him. He spends about 90% of the day daydreaming or otherwise distracted. He is so distracted that he misses everything going on around him. I'll speak to the entire class about how to do something and I look over and he's looking at the back of the room. I tell him to look forward and a minute later I catch him drawing on his eraser. I take away his eraser and he's playing with his fingers - staring at them. When I ask him if he's heard anything I said or knows what's happening, he admits that he has no idea.

    I've yet to find the lesson or activity that fully engages him. When I reprimand him, I get "Sorry, I was daydreaming." Then he goes right back. I know he's probably ADD, but as far as I know, it's undiagnosed and he's definitely not on meds. I've called mom and she just tells me to yell at him all I want to get him in gear. I don't want to yell at him all the time, but I do want him to focus. When I physically force him to pay attention by moving into his personal space, he actually grasps things relatively quickly compared to what one might expect of him. So, it breaks my heart to think how much he's missing in his dreamworld.


    So, mom tells me that she finally got around to bringing him to the ped and the ped told her that he finds no reason to refer him to a neurologist for testing. I'm confused. The teacher is saying that the kid does not focus for a full minute at a time and there's no reason for testing? What am I missing? If that doesn't warrant testing than what does?
     
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  3. renard

    renard Companion

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    I would suggest that it is always, always valuable to seek an additional medical opinion. I remember once, our pediatrician telling me that my child was a just a brat and needed a heavy hand. It turns out he had autism (moderate to severe, not on the higher end).

    Pediatricians are people like any other - sometimes they bring their own biases and self-formed opinions into situations where it can cloud their judgement. On the other hand, it could very well be that there is no ADD/ADHD. Who knows. But I would never rely on the opinion of one medical professional.

    To answer your actual question, here in Canada at least, the referral goes to the children's rehabilitation hospital and there are a series of standardized testing.
     
  4. a2z

    a2z Virtuoso

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    It could be that these behaviors don't happen over three domains, school, work (or usually activities such as sports or clubs), and social. A big red flag for doctors is when the child has the problems when the inattention interferes with something the child WANTS to do according to what a doctor said in the meeting. The child in question was performing rather well in school considering (but not well due to IQ), but the doctor explained that the child did indeed have ADD because when that child was making plans to play with friends or engaged in activities the child wanted to do the inattention was still present. Other problems can cause inattention during one domain and not others.

    So, it could be that the child's symptoms are only happening in one or two domains according to the reporting of mom and the questions the doctor asked the student.
     
  5. bros

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    With ADHD, the behaviors must occur at school, the home, and outside the home activities (Sports, clubs, etc.). The parent might want to seek a second opinion with a neurologist, as many pediatricians do not feel comfortable with giving a diagnosis of something like ADHD, as pediatricians tend to not feel comfortable with prescribing meds for ADHD.
     
  6. Caesar753

    Caesar753 Multitudinous

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    It could also be that the mom didn't report the behaviors to the doctor in the same way that you reported them to her.
     
  7. EdEd

    EdEd Aficionado

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    All good comments so far. In my experience, doctors tend not to refer to neurologists for ADHD assessment, even if they perhaps should. Maybe this particular doctor has a higher standard of diagnosis (requires more) than a typical doctor I've seen. Those doctors typically rely on a child/parent interview as well as rating scales (e.g., BASC, Connors) across various environments. Something like a card sorting test may be used as more of a direct test of attention and executive functioning, but I've rarely seen it used.

    In the future, it may be helpful to provide a written report that the parent can hand over. Include data, and make formal observations of behavior rather than your interpretations. Even take a watch and time attention span, count the number of redirections given in a particular hour, etc. - make it seem formal and worth considering, but fit it on one page. May help take out the "middle man"
     
  8. waterfall

    waterfall Virtuoso

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    This is what I was thinking too- mom either intentionally or unintentionally downplayed the symptoms to the doctor, or told the doctor that it was only at school and she didn't see any symptoms at home.
     
  9. Jerseygirlteach

    Jerseygirlteach Groupie

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    That's what I'm thinking too - especially since she seems so resistant to the idea when I brought it up to her. Sigh...I would have hoped that if she was going to talk to the doctor about it, a good faith effort would have been made to address the issues that are so severely holding him back.

    Oh well...
     
  10. a2z

    a2z Virtuoso

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    She may have been resistant because she has read up on ADHD and knows that it has to be present in 3 aspects of her child's life. She may have seen the list of traits and knew he didn't fit.

    I hate that you assume a good faith effort was not made just because you didn't get the result you want. You have absolutely no idea what she said in the doctor's office or what this doctors philosophy is on how severe symptoms must be before he tests. Yet you are ready to throw this mom under the bus. You might respect her for the fact that she spent her money and time to take her child to the pediatrician and talk about ADHD like you requested instead of now assuming that she lied to the doctor.

    There are lots of disabilities that cause similar symptoms to ADHD. Executive function problems can be present without a child having ADHD.

    So, if the child did have ADHD and for some reason couldn't medicate the child because of side effects or other medical issues (I've known kids like this), what would you do differently to help him?
     
  11. bros

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    Biofeedback can be useful in people with ADHD. Or, as I did, develop a coping mechanism
     
  12. Jerseygirlteach

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    Wow, that's kind of a strong reaction. I don't think I'm "throwing her under the bus" and I only want to help him. When I suggested to her that he had attention issues, she kinda sorta insinuated that teachers are quick to peg black boys as ADHD. I try really hard not to be offended by that, but that's why I'm saying she's resistant to the idea and why I think she might not have given her doctor all the feedback I gave her.

    Also, as I said, I admittedly have no medical background, but I just randomly researched a few sites and I'm not finding anything about a 3 aspects rule. The most I found was "more than one setting."

    Examples:

    http://www.cdc.gov/ncbddd/adhd/diagnosis.html
    http://www.mayoclinic.org/diseases-conditions/adhd/basics/tests-diagnosis/CON-20023647
    http://www.webmd.com/add-adhd/diagnosing-adhd

    I'll give an example of how he is affected in more than just the classroom setting. At recess, he really wanted to play soccer with the other students. He was very motivated to do so. I told the kids to teach him their rules. He could not focus long enough to understand. They got frustrated with him and, despite several attempts, it never worked out.

    Could it be something other than ADHD? Sure. I would just hope that someone could test him for that in an effort to help him.

    What would I do if his issues couldn't be addressed with medication? Well, I've been working with him on strategies all year. I will continue to do so. It has been very difficult, though.
     
  13. GemStone

    GemStone Habitué

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    Well, statistically speaking, her assertion has merit. Black boys are diagnosed with ADHD at higher rates. They are also referred to special ed more and face harsher discipline throughout school.

    So, he was motivated to play soccer but could not grasp the rules. I have many many children who would have difficulty with that, especially if a bunch of other children were explaining it to them. He could have a processing disorder. Or he didn't want to try to follow the disorganized explanations of young kids and lost interest. I hope a diagram or something was made for him later so he can play with them in the future.
     
  14. 2ndTimeAround

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    Hijack: I have to comment on the facing harsher discipline at school bit. In my experience, it is completely opposite, but I'm sure that is because the two APs that handle discipline referrals are black too and have a bit of a chip on their shoulders. I know it couldn't have been easy for them going into administration when they did way back when, but the leeway they give is crazy. Sometimes it is openly stated that the punishment isn't that harsh because they understand the black boys' struggle when the teacher does not. @@

    However, we can look at statistics for discipline referrals. Proportionally there are more black teens referred than white. Just today I sent four kids to ISS. Three were black and one was white. The black students were actively disrupting class, two of which said as much. They were bored while reviewing for finals and "wanted to get $hit going" one said. I cannot see how a 6'2" 200 lb young man throwing a book across the room and then charging the kid he hit should get away with his behavior. Am I racist because I write him up and send him out of the room?

    At my school black boys cause more disruptions in classes than white boys do, proportionally. White boys do more drugs than black boys do. Black girls start more fights than white girls. White girls cheat more than black girls.

    I don't understand why these trends mean that we should treat students differently than the handbook dictates. Yet I see that insinuation time after time.
     
  15. TeacherNY

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    I'm in the same situation. Not specifically ADHD but one of my students obviously needs meds. I've been told that trying to communicate with his mother is like talking into a black hole. Doesn't get you anywhere. We think she s not telling the doctor the truth about his behaviors. The bus driver is threatening to have him suspended from the bus and what will his brilliant mom do then I wonder!
     
  16. bros

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    Could you get the parent to give you permission to communicate your concerns with the child's doctor?
     
  17. TeacherNY

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    Yes, if the parent would cooperate. You call or send an email regarding this and it takes her 2 weeks to respond. Wehen she responds she tlks about his missing sock (that he decided to flush down the toilet ) and not talk about anything important. Maybe she has ADD herself. Who knows.
     
  18. Jerseygirlteach

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    I'm not trying to argue with you, but I'm interested in your source. I did a quick search and I found here (http://www.help4adhd.org/en/about/statistics):

    By Ethnic Background:

    White (non Hispanic): 4.1 million children have ADHD (8.7%)
    Black or African American: 904,000 children have ADHD (9.8%)
    Hispanic or Latino: 659,000 children have ADHD (5%)

    (indicating only a slightly larger percentage among African Americans).

    These sources state that African Americans are less likely to receive an ADHD diagnosis:

    http://pediatrics.aappublications.org/content/early/2013/06/19/peds.2012-2390.abstract

    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1497740/

    But, my point was that for her to respond to me with "Teachers think black boys have ADHD" is basically saying that my perception is racist which is a pretty serious charge. Almost my entire student population is non-white. I've never suggested a child be tested for ADHD before.
     
  19. bros

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    The behaviors also need to last 6 months or more continuously
     
  20. EdEd

    EdEd Aficionado

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    Given that African Americans only make up 12.2% of the population, this indicates a much higher rate of diagnosis.

    I'd counter with the fact that this, by itself, doesn't mean diagnoses are invalid - different populations can have different incidence rates (consider sickle cell). However, my experiences and study in the area indicate it probably is.
     
  21. Jerseygirlteach

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    No. It looks like the percentages are percent of the population group, not of ADHD diagnoses as a whole.

    Here is the link. It doesn't seem to be working in the other post:

    http://www.help4adhd.org/en/about/statistics
     
  22. YoungTeacherGuy

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    I'm Latino and so are most of the students at my site. However, I can't imagine giving less harsh or more harsh punishment based on the students' ethnic background.

    There are times, though, when a student's home life comes into consideration (for example, so-and-so is acting out because he was just removed from his home and placed in foster care).

    Additionally, most of my students (over 95%) receive free/reduced lunch. Should they be disciplined any differently because they come from poverty? No way! :2cents:

    When people pull the race card, it really hits a nerve.
     
  23. EdEd

    EdEd Aficionado

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    I stand corrected.
     
  24. waterfall

    waterfall Virtuoso

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    Sorry, to hijack, but thank you for saying this! I wish my admin agreed with you. They are so often very lenient with our kids because they have rougher home lives. I know that impacts their behavior at school, but I don't think we're doing them any favors by letting them get away with so much. I worry about what a lot of our kids will do when they're older having grown up with no consequences.

    Also, my :2cents: about more boys being identified with ADHD is that this is more a problem with girls being under diagnosed, not boys being over diagnosed. IME girls with ADHD are more "daydreamy"/unfocused and less hyperactive/disruptive. The "daydreamy" behavior is stereotyped as the girl being "ditzy" or "spacey" rather than seen as a legitimate disorder. When is the last time you heard someone refer to a boy as ditzy (I can't think of a time I ever have)? I've had several girls over the years that I suspect had ADHD but the concerns were laughed off by others as, "Oh, Susie's just a space cadet!"
     
  25. EdEd

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    Responding to the poverty issue, I think discipline should be first and foremost effective. Another way to phrase it is that equal is not necessarily fair. Sometimes kids need different things.

    Kids from impoverished backgrounds may actually need different discipline, and that may not be unfair. That said, I probably wouldn't base discipline on simply median family income, but if I knew a child was going through a particular situation, my disciplinary responsive may change - depending on the situation, it may get more firm, less firm, or have nothing to do with firmness.

    Few people will argue that kids should grow up with no consequences, but few can make a solid case that tit for tat consequences with kids with ADHD is a good idea. There are simply too many behaviors that occur, and your punishment rate would be so high that you'd have all kinds of other side effects.
     
  26. bros

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    Boys are more commonly diagnosed with ADHD Predominantly Hyperactive, which most people think of as "ADHD" - girls are more commonly diagnosed with ADHD Predominantly Inattentive, which is a bit harder for people to associate with ADHD, as there is more daydreaming and less hyperactivity.
     
  27. 3Sons

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    There's a few reasons Teachers can't diagnose ADD by themselves, and only one of them is because of lack of medical certifications. Another is because a diagnosis requires that the behavior is observed in more than one environment.

    It's possible that he's simply not the same elsewhere. Maybe he just tunes out school. Or the parent isn't seeing, for whatever reason, what you are.

    I would resist the temptation to think of the parent as being dishonest or whatever. Just reiterate what you see, and stress the need for you to find a better way of dealing with it than yelling (there are lots of reasons, including it possibly disturbing other kids).
     
  28. bros

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    Thing that people think of as ADHD could also be giftedness - the student could simply see the work as beyond them and are just bored and acting out. Although ADHD and giftedness like to occur together.
     
  29. comaba

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  30. czacza

    czacza Multitudinous

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    A kid may see it that way or use being bored as an excuse. Truly gifted kids are rarely bored and professional educators who are aware know the difference.
     
  31. anna9868

    anna9868 Habitué

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    just curious, czacza, how do you understand the difference between gifted kids and truly gifted kids?
     
  32. bros

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    There's also twice-exceptional. Which some do not consider to be truly gifted.
     
  33. czacza

    czacza Multitudinous

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    By truly gifted, I am referring to kids who meet the criteria for gifted-ness. There are learners who are highly intelligent or who have great skills in a specific content area, but who are not considered 'gifted'.
     
  34. 3Sons

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    The National Association of Gifted Children would define it thus:

    I agree, though, that a number of children in gifted programs are there due to a somewhat greater intelligence combined with above-average levels of obedience, particularly in lower grades. Kids with ADD usually will not be in such programs, regardless of whether they are also gifted.
     
  35. 4815162342

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    We weren't even allowed to suggest that kids get tested for anything. We could give our input if the parents brought it up first.
     

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