Join ADHD Groups!

Click the arrows to expand each group category below

Parents of ADHD Children

ADD Adults

ADHD and Related Conditions

ADHD Professionals

ADHD Resources

Groups by Location

Parents of ADHD Children

What should I expect from a Psychiatric evaluation appt?

My son is 5 1/2 and he is attending transitional kinder. We are blessed to have an outstanding teacher and administration who are incredibly supportive. ADHD has been on our radar for almost 2 years now. His behavior seems to be getting worse. We we finally made arrangements for him to see a child Psychiatrist for a diagnosis. I spent over an hour filling out paperwork in his office. The Dr. met with me for a total of 25 minutes, no more than 15 of them talking about my sons habits, but not in any detail. The only interaction he had with my son was to weigh him, take height, and check his heart. He then said, “he definitely has ADHD.’ He wrote down “concerta” and said that I should research it, but that he was recommending it for him. IS THIS NORMAL? This Doctor is suppose to be the best of the best. We waited for 7 weeks for this appointment. He teaches at USC, and I believe is one of the directors there. I was dumbfounded.  He never spent more than 5 minutes with my son. When I said that I wanted to discuss my notes, and the school psych’s evaluations, he said that I could talk those over with a counselor…he doesn’t deal with that. WHAT? How can can he make an accurate diagnosis if he doesn’t know the whole picture? I was furious! But now I’m wondering if my expectations were too high. What should I expect from the psychiatric evaluation? And if it’s not this, how do I find a good one?
Thank you for the help and direction!

Replies

We went to an educational child psychologist who did 2.5 days of testing with my son, including classroom observations and having his teachers and both of us fill out extensive forms.  It was extremely comprehensive because the psychologist wanted to make sure that there weren’t multiple diagnoses.  I suggest that you see an educational psychologist to get a full assessment as I don’t think a psychiatrist has the time in his/her practice to do this.  If you don’t know where to start to look for one, you can ask at your local large university’s psychology department.

After my son’s diagnosis of ADHD, we went to his primary care doc for a prescription of Concerta, which changed our life for the better!

Posted by MendelZ on Feb 28, 2014 at 3:18am

Yeah, I think your instincts are right there. 

Kids don’t act very “ADHD” in a new situation like a doctor’s office.  They tend to be awed by the new situation and so don’t act like they might in other situations. So the fact that he might not have spent much time with your son is ok.  The rest seems fishy to me.

Most diagnosis is based on detailed reports from parents and teachers.  So they would ask a ton of questions of you, and look at all the forms you and the teachers filled out.

Why was ADHD on your radar since he was 3?  Is it family history?  Because most “ADHD behaviour” is actually quite normal at that age.  It’s when it carries on into ages 7, 8, 9, etc. that it becomes an issue.

I also personally (and no, I’m not a doctor) question whether medication should be the first step ever, never mind at such a young age.  My son was diagnosed at age 9 and we tried (and still do) Omega 3 supplements, 10 hours of sleep, at least an hour of exercise, protein at every meal, etc. plus accommodations in class and at home (e.g. his teacher checks in with him more during work time, I have to break his room down into areas to clean (bed, side table, book shelf, floor) or he gets overwhelmed)).  We’re trying medication now because in the last year his ADHD has gone from mild to moderate, to very severe. 

That he wouldn’t discuss your notes is weird.  When I speak with my son’s doctor (psychiatrist) I can talk and talk and she will give me feedback.  She needs to hear the whole picture and often we’ll switch plans after a full conversation (e.g. I asked to up his meds and she agreed, but after hearing the issues he’s having sleeping and talking at length about this, she (we) decided not to increase and to try working on the sleep first to see if that made a difference).  That tells me that she’s really hearing me and is tailoring treatment to my son specifically.

Before I found this doctor though, we visited two others I was *not* impressed with.  The first diagnosed him and seemed very good.  Unfortunately she was only filling in for someone else and when we went back to see that someone else, we were told my son was too mild to require anything else from her and she would see us in a few years.  (?!?)  We managed ok on our own for a bit after that (he really was mild/moderate), but this year he got worse and I went searching for a new doctor (paediatrician because that’s who we’re supposed to see here).  The next one asked me very little about my son, did the physical, and asked me (I’m not kidding) at least 10 times if I’d had his eyes checked.  Then as we were leaving he gave me some handouts on using timeouts appropriately and suggested we could try medication at the next visit.  I didn’t trust him at all and wouldn’t have taken my dog to him, never mind my son to try medications that have numerous side effects!

My recommendation (and actually the recommendation of the first paediatrician (the good one, the one who diagnosed him)) is to learn as much as you can about ADHD.  Russel Barkley’s book is very good.  He has many talks online as well.  If you can get into any seminars or parent groups (taught by psychologists), these can be very good.  Just learn as much as you can so you know how to parent your son, but also so you know what you should be seeing in your doctor.

And try the sleep, protein, Omega 3, exercise, etc. and accommodations in class to see if that is enough, because it might be for now.

Posted by Rai0414 on Feb 28, 2014 at 3:38am

Oh, and it might be that medication really *is* the best thing for your son… that’s not what I’m saying.  Just that I’m not sure, like you, how on earth that doctor could know that based on how little he seems to know of your son…

Posted by Rai0414 on Feb 28, 2014 at 3:40am

A psychologist is who med with my dd for months & then did 3 hrs of psychological testing. The psychologist then made the recommendation to the psychiatrist of a diagnosis of ADHD.

Posted by hal6242 on Feb 28, 2014 at 4:47am

Thank you for your response.

There was a distinct difference between our son in preschool at age 3 then other 3 year olds. We “hoped” he grow out of it. I began reading and studying about ADHD by the time he was 4. He couldn’t sit in his seat and complete simple tasks like the rest of the class and he was extremely impulsive. He’s always been kind and not mean spirited, but his aggressive play often ends up hurting someone by accident.
He is extremely bright and has an incredible memory, so school comes easily, but socially he is a mess. It is noticeable to all who interact with him for any amount of time. He talks constantly, and when he’s not talking he’s humming loudly or banging something. He is not responsive to adults giving him direction—even other parents, and it comes off as disrespectful. He runs off constantly. He wants to do his own thing, and will do whatever it takes to ensure he can do what he wants to do. Recently he has shown some signs of depression—saying he’s loser, he doesn’t belong in the family, etc..These things have NEVER been said to him in our family. He comes from a loving home. We are constantly working discipline strategies, and we’re running out of resources.
I am very scheduled and monitor is diet. He has always been a great sleeper. He goes to bed at 7:30pm-6:30. I ensure lots of protein, and limit, processed foods and artificial coloring. He takes 2 multi-vitamins, and 2 Omega 3’s per/day.
I feel like I’m doing about everything I know how how to do and it’s just not enough.
WIth all of the above negative things I’ve said about him, he is loving and bright, and generally happy.
I just want to find more support through good doctors and more direction…such a frustrating journey that so few seem to understand!

Posted by GandJ on Feb 28, 2014 at 4:51am

My son was evaluated by an educational psychologist that specialized in ADHD. It was an independent evaluation. It wasn’t done by the school district. I would get further assessments done so that you can feel good about the diagnosis and be sure nothing else is going on. During my son’s eval. The psychologist spent 4 hours with him doing a variety of testing and observing. I wouldn’t feel good about medicating for ADHD without a more thorough exam if I were you. Psychiatrists are better at prescribing and managing medication rather than diagnosing these types of things if you ask me.

Posted by JS on Feb 28, 2014 at 5:12am

Always trust your instincts as a mother.  You truly do know best and if it feels like something isn’t quite right, seek another opinion.
You said that you filled out paperwork, were his teachers asked to complete any surveys?  ADHD cannot be diagnosed unless it is seen in more than one setting.  It is common for doctors to reply on surveys when making a diagnosis, but I have never heard of them only taking information from one source (parents and not school).
It is quite likely that the diagnosis is correct, but it is important for you to feel confident in the diagnosis and have a professional who actually knows your son and takes the time to answer your questions.  This is not the first time I have heard of doctors saying they don’t have time to do actual therapy or several sessions, but surely when giving the diagnosis I would think there should be time for you to ask questions and get a clear idea of the options.
It sounds like he didn’t actually give you a prescription for Concerta, is he expecting you to return or to see your family doctor or paediatrician for the medication?
I work with many parents with children who were recently diagnosed because many doctors are unwilling to take more time beyond diagnosing and then monitoring medication.  There are many options, but it is important for you to have a professional who can answer your questions and help you uncover the best strategies for home and school so that your son is able to meet his full potential.
Give yourself a pat on the back for being such a great advocate for your son!  Many people are happy to have a diagnosis and a prescription and just hope for the best.  It is great that you are being proactive and getting as much information to help your son and yourself as you can!
I would be happy to answer questions you still have.
Wishing you all the best on this journey….

Carrie Silverberg BA(Psyc), RECE
ADHD Consultant and Coach
http://www.adhd-strategies.com
.(JavaScript must be enabled to view this email address)

Posted by ADHD-strategies.com on Feb 28, 2014 at 5:50am

Unfortunately, what many people do not realize is that when you select to see a psychiatrist (vs a psychologist or other) for your first visit, what you most often (but not always) run into is the psychiatrist doing what psychiatrists do (write prescriptions). 

That is just the sad reality of mental health care in the US.  There ARE some great psychiatrists who will even DO some “psychotherapy” but they are the exception not the rule. 

The sad and unfortunate fact about choosing to go the other route, see someone who is much better at diagnosing mental health issues (a psychologist or other) is that after lots of time is spent making sure the diagnosis is correct, if you wish to get any meds for it you now must go find a psychiatrist, make an appointment, wait for that appointment, then get the 25-min Wham Bam Thank Ya Mam…

Posted by BC on Mar 01, 2014 at 8:30am

Thank you for all of your feedback, I really appreciate it.

Does anyone have a suggestion on how to find a good psychologist or adhd specialist? After this experience, I want to ensure that the next person we meet with is a good fit. I’m just not sure where to look. I live in Southern California btwn Los Angeles and Orange County.

Posted by GandJ on Mar 02, 2014 at 9:14pm

Something to look into RE: Omega-3 supplements.  Often the recommended dose on the packaging is way lower than what is actually “recommended” for ADHD (and it’s really hard to find that info online these days too).  My internet searches done about a year and a half ago were much more “informative” than ones I’ve done lately trying to establish what is considered best practices.

In most of the studies that originally supported their effectiveness for ADHD the doses given were HUGE mega-doses (like > 9 grams), and they were also using formulations with a higher than “normal” ratio of EPA to DHA.  EPA is the Omega-3 that’s considered the “active ingredient” for ADHD. 

Online I’ve found that for children Dr. Hallowell suggests ~2000 mg (2 grams) of Omega-3 (combined amounts of all Omega-3s contained in the supplement).  Our own pediatric psychiatrist recommends ~3000 mg (3 grams).  The FDA currently considers 3500 mg to be the max “safe dose” for kids.

Dr. Hallowell recommends two brands for Omega-3s (high EPA/DHA plus low levels of mercury)—OmegaBrite and Dr. Barry Sears’ formulation.  Our pediatric psychiatrist recommends OmegaBrite (purchased from People’s Pharmacy or directly from OmegaBrite) and the addition of 2000 mg of “the cheapest Vit C there is” to increase absorption of the Omega-3s.  (I reminded him at the next visit that the Vit C should not be taken at the same time as any stimulants as the acidity interferes with proper absorption of the stimulant).

Posted by BC on Mar 02, 2014 at 10:47pm

Reply to this thread

You must be logged in to reply. To log in, click here.
Not a member? Join ADDConnect today. It's free and easy!

Not a member yet? Join here »


Important! User-Generated Content

The opinions expressed on ADDConnect are solely those of the user, who may or may not have medical training. These opinions do not represent the opinions of ADDConnect or ADDitude magazine. For more information, see our terms and conditions.