Diagnosing ADD/ADHD in Children

Posted by Kate to Is It ADHD? on Apr 19, 2011 at 7:31pm | 0 Comments

The following is a popular discussion that may be of interest to you. Please read through it and see what comments you can contribute.

Tracey: Hi, My daughter, age 9, was seen by a psychologist in December 2005. At that time, she had an overall WISC-IV Full Scale IQ of 131. According to the WJ-111, she had a basic reading skill cluster score and the reading comprehension score cluster in the superior range. I completed a Connors’ Parent Rating Scale Long Form and the hyperactivity T score was 61 and Cognitive Problems/Inattention T score was 56. Essentially, there were no significiant issues relevant to a diagnosis of ADHD.

We had these tests done of our own initiative when my daughter’s first grade teacher began saying she felt my daughter had some reading comprehension issues. I felt it was not a comprehension issue, but rather my daughter was bored and not paying attention. She had no behavioral issues at school. She was beginning to dislike school and often complained about doing worksheets, etc. that were all review to her.

Fast forward to January, 2008. Another round of the same testing was done by a different psychologist. This time her third grade teacher was saying she was seeing signs of ADHD—lack of focus, careless errors, talkativeness, inconsistent performance, moodiness (she described it as “sad” or a “who cares” attitude). This time the psychologist says my daughter is not gifted; her IQ was measured at 109. He diagnosed with her moderate to severe ADHD inattentive. My daughter truly hates school at this point (homework is a nightmare) and resists being challenged at school or at home. She will not apply herself and does just good enough to get by. Though she has few behavioral issues at school (beside talkativeness), she has major issues at home—“lazy”, rude and messy. Everything is now a battle.

Her pediatrician wanted us to put her on 5 mg of Focalin to start and increase the dosage from there if needed. We kept her on in for approximately two months and saw no real improvement. Because we still felt we had no definitive diagnosis, we were reluctant to increase the dosage. She is not on it at all now.

What gives? Do we need a third round of tests from a different psychologist to be able to draw a conclusion? I don’t know if she is gifted and bored or has ADHD. How can I make a determination? I am totally at a loss.

Thank you for your response.

Tracey

Elaine20: My hunch is that she probably is both. Her lower IQ score the second time around may have been due to ADHD symptoms. Your intelligence level is not supposed to change but your IQ score can change. If you are not feeling well one day, having trouble focusing, distracted, etc. your score may come out lower. They have done studies showing that those with untreated ADHD have lower IQ scores by anywhere from 5 to 15 points. Their intelligence is the same but the score does not reflect this.

I am 47 years old and was only diagnosed with ADHD in April. My IQ is 147 and I graduated 10th in my high school. I went on to get a college degree in Accounting. There were times that I “felt” stupid, yet I knew I wasn’t. I didn’t know why that was. My sister, who is a pharmacist, and was valedictorian of her class, felt the same way too, like she was stupid. We both realized that one of the reasons our ADHD symptoms were not apparent to us or to others was due to our intelligence and how we compensated for our symptoms. We were able to do well but not as well as we would have liked. We both felt that we were incapable of going further with our education. We both had trouble with reading comprehension, especially in college when the texts were more difficult.

Now that I am on medication, I realize just how much of a difference it makes. I finally feel smarter and capable of understanding more complex subjects. I would love to become a neuropsychiatrist but at this point in my life, my circumstances and responsibilities (without even taking into account the time and money involved) are not conducive to attending school full time for the 8 years it would require.

My reading comprehension, working memory, organizational skills and ability to prioritize have improved tremendously. I am able to express myself better, and my thoughts are more cohesive and organized. I used to dread writing papers in school (I’d rather have my teeth drilled) but it isn’t as daunting of a task now.
It’s not as easy to recognize ADHD in girls and women who are inattentive and in very intelligent people. The inattentive symptoms can be quite different than those with hyperactivity. Also inattentive girls and women have more internal symptoms (including possible anxiety and depression). They are usually not behavior problems. I was able to function okay relative to many people, but not as well as my IQ would indicate. Now with the medication, I have faster mental processing and I feel more confident. I had anxiety as well and that also helped to mask my ADHD symptoms because I was so concerned about doing well in school. When my anxiety was treated a few years back, my attidtude changed regarding constant worrying. Then I began to show a little more of the ADHD symptoms.

By the way, we have a neighbor who has an IQ that is over 180 and he has ADHD that is very obvious. your first impression of him is that he isn’t very intelligent. The confusion, disorganization, and lack of social skills give off that impression.

If your daughter is having problems with doing homework, applying herself, hates school, appears to be lazy, messy, etc—those are all classic signs of ADHD. Everything you mentioned points to ADHD. My son and daughter both have inattentive ADHD, as do I and when my son went on medication I saw immediate changes. Once on medication when I asked him to do something he did it immediately. In the past I had to remind him a dozen times and even then, he would still forget to do it. I thought he was lazy and misbehaving. Until I saw the change in him.

If your daughter has already been diagnosed with ADHD by a professional and two teachers have noticed signs, then my guess is that she is both intellegent/gifted and ADHD. Once you find the right medication and the right dosage, I think you will see a big improvement in your daughter.

Elaine

Anni: Hi Tracy: Welcome to the ADDitude forums. Elaine posted a great reply above, and I agree with much of what she noted. I’m just adding a few ADDitude articles that delve a little deeper into diagnosing girls, finding the right medication, and some other non-medical treatment alternatives—good reading that you might find helpful as you navigate this maze with your daughter:

Girls and ADHD: Late Diagnosis, Little Treatment: http://www.additudemag.com/adhd/article/1626.html

Diagnosing ADD ADHD Girls: http://www.additudemag.com/adhd/article/1691.html

Little Miss Diagnosis: Girls with ADHD: http://www.additudemag.com/adhd-web/article/592.html

An Accurate ADHD Diagnosis for Children: http://www.additudemag.com/adhd/article/1591.html

Getting an ADHD Diagnosis: 3 Common Mistakes: http://www.additudemag.com/adhd/article/1876.html

Top 10 Questions about ADHD Medications… Answered!: http://www.additudemag.com/adhd/article/1592.html

Treating ADHD with Behavior Therapy: An Alternative ADHD Treatment: http://www.additudemag.com/adhd/article/651.html

Can Diet Ease ADHD Symptoms? Nutrition As an Alternative Treatment: http://www.additudemag.com/adhd/article/859.html

More about alternative treatments: http://www.additudemag.com/topic/adhd-treatment/alternative-adhd-therapies.html

I hope this helps!

ADD RN: It maybe alittle of both. If gifted any work given that is reviewed can cause her to protest and refuse to do it. When I was in grammar school I tested at the 4th grade at a junior year college level with comprehension. However when they tried to put me in the advance class, I totally protested and refused to do anything because I like the way the slower class teacher taught. They were more animated and worked harder to engage us. It really suprized them to find on a good day my IQ was 169 and on a bad it was 130’s. It all depended on my mood. I have taken many exams and I would usually do very well in them ; however I struggle with advance math. It will get worse as she gets older if they do not find a way to engage her. If she isn’t engaged she will not do her work. This is for both the gifted and ADD child. There is a book about raising gifted child and it maybe to advantage to read it. I would take her to unbiased psychologist and have her examined that way they have no idea about her or her previous testing. If she is an attentive type she may need a stimulant like Ritalin. Also make sure she get pleanty of exercise it seems to help.

stacy28: My son is 16 been on adderral stratter seem make him more agressive and also the aderral. I talk to his doctor he off the stimulant medication. he currently on attend and amoryn he takes both all natural his doctor said fine I told his teachers and the nurse he will no longer will be taken stimulant anymore. and its been doing a wonderful. no outbust just great the website http://www.vaxa.com and other is http://www.amoryn.com you can use deprex or amoryn.

SMM: As with the others, I wholeheartedly agree that your daughter is likely both gifted and ADHD. I tested well within the normal range on group IQ tests, but in the top 2% on individual. I was diagnosed with ADD when I was 16, and the hyperactivity was recognized with I was 23. No medication, though, until after college (unfortunate). Nobody thought, in high school, that a girl getting mostly A-‘s was underperforming! I also displayed a lack of initiative (as I remember it). I was not one of those driven young geniuses you see on tv shows.

I’m not sure what to recommend to help your daughter. If she can learn to love learining new things just out of curiosity, she’ll be set for life. It would be best if she didn’t feel like she was being directed or encouraged or pushed into things, or if she feels mommy thinks she needs to be “fixed “to be acceptable. Tricky, I know. Maybe displaying intellectual curiosity yourself a love of learning will eventually be seen as normal.

Amy Alison: I also think that she is both ADD and Gifted. I remember going to Kindergarten…I was SO excited to learn and try new things. Instead, the teacher had the idea that sucessful Kindergarten outcome was to have me conform to the standard of everyone around me. I was BORED TO DEATH!!!!!!! I had taught myself to read and write years earlier, yet the teacher insisted that I sit there and “re-learn” to read and write HER way; because I had taught myself independently, she felt that my own curiosity and determination were a threat to her performance as a teacher, I guess. My mother told me a few years ago that the teacher insisted that I sit there with the other kids and practice writing “a” over and over and over…etc. and that I was so bored and frustrated that I’d just do something like reach over and pinch another kid, just to see an interesting reaction. Of course I got quickly labeled as a “bad kid,” and that was a real shame…my self-esteem and self-confidence plummeted quickly, and I became rejected by peers as a “bad” kid. (Yet even though I refused to write “a” over and over and over…at age 33, my own “a” writing is still just fine, lol. )

All the things you said about your daughter could just as well have been written about me…I can relate a whole lot.

I think in Kindergarten or 1st grade they tested me for intelligence, giftedness, ADHD, etc. I was never told what my IQ was, as they thought that knowing could encourage me to feel too proud or whatever, but they did tell me that I’m in the top 1% of the population for intelligence and I went straight into the school’s “Gifted” program. Still, though, school remained a problem for me for years. I was bored, uninterested, and never tried because I felt it was a waste of time. I can completely relate to your daughter’s sad/“what’s the point?” attitude…it’s frustrating to be stuck in that situation and feel powerless to change anything effectively.

No one recognized my somewhat-atypical ADHD attributes, so I was never diagnosed or treated for ADHD, but I certainly had it at that young age. I was probably 30 or 31 before it was recognized, and I didn’t begin treatment for it until last year, at age 32.

I’ve never really lived up to my potential of what I know I could do, if I only knew of how to organize, prioritize, and manage my own mind, and get myself STARTED to do whatever I needed to do. It’s frustrating to me. I’m sure I certainly do not come across as “gifted” or “intelligent,” and sometimes I feel so frustrated with myself even though I know I’m intelligent. I never felt like a competent hosptal RN, because I would be on my way to get a patient her pain medicine and then get a phone call from a doctor…and forget all about the pain medicine for that unfortunate patient. Or, I could not effectively prioritize and complete all the tasks I needed to do…a new patient to admit, another pt needed help to get to the bathroom, someone else needed a blood sugar test before dinner, a patient needed a blood transfusion, etc, all at the same time….I didn’t know WHERE TO BEGIN, and had trouble managing it all simultaneously, with the ADD symptoms that I didn’t even know about… That’s just MY story, but you can see the frustration I’ve felt and can probably imagine the way other staff thought I was just pretty stupid or didn’t even care about the patient in pain!

At this point I am NOW learning all I can about managing the ADD, and also about managing my “giftedness” in order to utilize the parts of me that could benefit myself and others. There’s an AWESOME website, called SENG: Supporting the Emotional Needs of the Gifted…I’d highly recommend it to you. Here’s a link: http://www.sengifted.org/ Please check it out; I’m sure you will find a great deal of help there!!!!!!!

It’s very uplifting to see a parent so actively involved in trying to understand and help guide a child as you are. It will pay off, believe me! My mom has ALWAYS been my biggest support throughout my life…and words cannot even begin to describe the gratitude I feel for her for always believing in me and fighting for me throughout those awful school years. Now we know more than all the “experts” knew then, so I’d encourage you to keep fighting for her, and validating her experience…you will help her maximize her learning/curiosity potential and there are now better resources to help guide you. Please let us know how things go for her (and you).

Nivlong: Sign me up for the “both” bandwagon! I wasn’t diagnosed with ADHD until 24 where I was given ritalin to help in college. I’m now 31 and looking to get back into treatment because of changes at work (promotion) and home (new baby!). Things are going well and I want to keep it that way!

Growing up, I lived up to my parents high expectations, did a variety of activities (music lessons, private tutoring, and later theatre, martial arts, jazz, ballroom), and was even enrolled in gifted education classes. Their support and interest in me definitely help me succeed (4.2 high school GPA with the help of the advance placement classes where a 4 = 5 points).

So love, support, and structure can all help, even without medication (since I was undiagnosed back then). I do wish I’d had found out sooner, but it’s hard for people to imagine that “gifted” kids could have a mental disability. It’s hard enough now, as an adult, for some people to accept the diagnosis (I supposedly just have “issues”)!

Also - I wasn’t told the results of my IQ test, either! They just stuck me in the gifted program in fifth grade.

dthodtho: Hello. My daughter is 10 years old and was diagnosed ADHD at 7. Within the last year, she has been diagnosed with Anxiety, which is not a surprise as I am ADHD with Anxiety. I am becoming concerned re the medication (number and dosage) and believe that we will likely change from a stimulant (concerta). I noticed that you mentioned treatments from vaxa.com. Would appreciate your (and anyone else’s) feedback. I am not familar with the suppliments or website and am always very cautious about non-FDA regulated supplements. Do you know of any testing/ studies that are available? My daughter also suffers from mild asthma, so that is a concern, as well. Thanks.

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stacy28 said: My son is 16 been on adderral stratter seem make him more agressive and also the aderral. I talk to his doctor he off the stimulant medication. he currently on attend and amoryn he takes both all natural his doctor said fine I told his teachers and the nurse he will no longer will be taken stimulant anymore. and its been doing a wonderful. no outbust just great the website http://www.vaxa.com and other is http://www.amoryn.com you can use deprex or amoryn.

MamaPants: BOTH! I’m a mom of two, and a (about to be) former teacher, and a highly gifted person myself. Both our daughter are superior range testers, too. Here’s my advice. 1. You may want to get another IQ score done, especially if they didn’t give you the scores all broken down. One of my daughters’ scores are wildly different across domains - almost 150 in reading etc., and closer to 110 in math related stuff. We were able to finally see why she continues to excel in math - she has such a high ability to comprehend the directions! You may see with your daughter’s breakdown scores that she needs more support in one area over another. 2. IQ scores are not the be-all-end-all and will change. After a horrible 6th grade, by IQ dropped by almost 20 points, which it recovered the next year with challenging teachers and a better curriculum. So, while it’s a window into the brain, it’s hard to predict if the curtains are going to be open or the shade is going to be up. 3. Supplement! There are on-line gifted programs at many universities. Northwestern University runs the Center for Talent Development (not sure of exact name- it changed recently) and Duke has online courses. Often these courses allow kids to interact and meet other gifted kids in a safe forum, without having to move, go to camp for 6 weeks across the country, etc. Although those are options. 4. A Section 504 plan. Your daughter has a medical diagnosis of ADHD and decreased performance in school. While a highly gifted child is not going to qualify for “special ed” there are probably loads of classroom accommodations that the teachers could and should be making for her. A 504 plan makes sure that kids with medical issues (and ADHD is a medical issue) get the support they need. Get one and watch the school like a hawk to make sure it’s followed. You may want to bring your psychologist to the meeting to make sure they understand what your daughter needs because it seems that ADHD in highly gifted people presents differently than ADHD with LD symptoms. 5. Other gifted folks. Just recently, I was at a seminar about career happiness and the leader said we should think about the people we want to be around - did we want to be around people with the same interests, or these people, or those people, or do you want everyone around you to have a PhD? It was wildly validating to realize that it was okay to choose “everyone has PhD!” I was always told to be well-rounded, which isn’t bad, but sometimes “everyone else” gets me down. (I’m leaving teaching to get my PhD) Your daughter may be having just as much trouble with other classmates as she is with the teachers. Help her find other gifted kids to be friends with - they’ll probably be quirky too and her differences will seem less of an issue. Introduce her to other highly gifted adults - they’ll probably recognize themselves in her and be able to help with advice and support. Good luck! Let us know how it goes. @Amy - thanks for the SENG link. I’ll be checking it out later today.

eabeam: However, challenging and engaging teaching should be the first intervention!
http://askdreric-schoolpsychologist.blogspot.com/