New Territory: Results from Neuropsychological Evaluation

"I am so bored with this."

Last week we received a written report on Luke and Isabelle’s neuropsychological evaluations. Today we talked to our doctor about the results and discussed ways we can help the kids. I have learned a lot in the last week about ADHD and related issues that we haven’t delved into until now.

Luke’s clinical diagnosis in a nutshell: He has ADHD-combined type (both hyperactive and inattentive), generalized anxiety, and disruptive behavior disorder-not otherwise specified (DBD-NOS). The DBD-NOS is a term for behavioral symptoms that do not warrant a diagnosis of oppositional defiant disorder but reflect difficulties in controlling aggressive and non-compliant behaviors. On a positive note, his intellectual capacity falls into the superior range and his social behavior among peers shows understanding of social cues.

Izzy’s clinical diagnosis in a nutshell: She has ADHD-combined type (both hyperactive and inattentive), mood disorder-not otherwise specified, and pervasive developmental disorder-not otherwise specified. The mood disorder-not otherwise specified essentially means that she has some level of anxiety and depression but not enough to be diagnosed as generalized anxiety or depression. The pervasive developmental disorder-not otherwise specified means that she has symptoms approaching Asperger’s (which is on the Autism Spectrum) but does not cross the threshold. On a positive note, Izzy shows superior intellect in several areas and a “splinter” intelligence in creative cognition. This means that she is exceptional—off the charts, I guess—in creative intellect. Apparently, these splinter intelligences are great gifts but cause difficulties because the person gets frustrated with areas of weakness.

So now, along with learning about ADHD, I need to learn more about anxiety, DBD, and PDD. One thing I learned this week that I didn’t know before is that ADHD is not on the Autism Spectrum. Symptoms overlap, but ADHD is not part of the spectrum. Here is a good explanation I found online:

Understanding ADHD and Autism Spectrum Disorders

This is from Martin L. Kutscher, MD  http://www.pediatricneurology.com/autism.htm#ADHD

It is probably best to consider ADHD as sometimes sharing the following symptoms with—but not part of—the Autistic Disorders Spectrum: 

·         Poor reading of social clues (“Johnny, you’re such a social klutz. Can’t you see that the other children think that’s weird.”)

·         Poor ability to utilize “self-talk” to work through a problem (“Johnny, what were you thinking?! Did you ever think this through?”)

·         Poor sense of self awareness (Johnny’s true answer to the above question is probably “I don’t have a clue.  I guess I wasn’t actually thinking.”)

·        Do better with predictable routine.

·         Poor generalization of rules (“Johnny, I told you to shake hands with your teachers. Why didn’t you shake hands with the principal?)

Here are the assessments included in their evaluation:

Conner’s Comprehensive Behavior Rating Scale Parent and Teacher Form

Autism Spectrum Rating Scales Parent and Teacher Form

Home Situations Questionnaire

Elementary School Situations Questionnaire

Review of records

Social Attributes Checklist

Teacher Observation Checklist

Cognitive Assessment System

Purdue Pegboard

Autism Diagnostic Observation

PDD Screening Questionnaire

Letter/Number Writing Sample

Wechsler Intelligence Scale for Children IV

Conners’ Continuous Performance Test II

Woodcock Johnson III Tests of Academic Achievement

Peabody Picture Vocabulary Test IV

Expressive Vocabulary Test II

Developmental Test of Visual Motor Integration

Revised Children’s Manifest Anxiety Scale

Reynold’s Children’s Depression Scale

Clinical Interview

And how do I feel about all this? I’ll get into that next time. Baby’s awake.

Riding Is My Ritalin

Riding Is My Ritalin is a great article from Bicycling Magazine that was posted on another ADHD web site. (I can't remember whose.) I feel like I could have written the same thing and called it "Exercise Is My Prozac."It makes me want to get the kids riding bikes more and wishing they had more regular PE classes and recess. They only have PE during one of their five terms. The other terms are music, Spanish, art, and drama. Also, their recess is essentially nonexistent. They have lunch at 12 pm and can go out and play after that—until 12:30 pm. I know the teachers let them out for recess, but not consistently. They have days with no recess, no exercise at all during the school day.

This article makes a lot of sense to me because I’ve found that exercise is critical for me. It helps me sleep, digest, feel more happy and energetic. Last year just before Christmas, I was not exercising at all. I didn’t like my gym, and I couldn’t find anyone to run with me in the dark, cold mornings. (What? That doesn’t sound like fun?) I was a piece of work, crying over everything and feeling stressed and CRANKY. That works really well for my family…

In January I started exercising again at a gym that I really like and that, along with some other stuff, helped me do a 180 turn around. I just felt like the troubles of life could roll off me like water on a duck’s back. My very, very favorite thing is exercising outside in a beautiful place. Nature kind of rejuvenates me somehow. My next favorite is at least getting outside anywhere and exercising. And then if all I can do is exercise inside, that’s still pretty good. I know not everyone is so rejuvenated by exercising, but I wonder if it does have at least some of these positive side effects for everyone. And I wonder how I can get my kids to like aerobic exercise as much as computer games. Wouldn’t that be nice? If they were constantly asking me if they could go outside and ride their bikes and fighting over who got to go first? They do at least like riding. And they love the trampoline. So that’s a start. Maybe I’ll tell them the doctor insists that they exercise for at least a half hour a day before they play computer games or watch tv. Would that be naughty?

First Impressions after Neuropsychological Testing

The Love/Hate Twins

Back from our multiple-day neuropsychological testing with Dr. Adam Schwebach. Though we will not receive all the written results, diagnoses, and advice for another week, I can say at this point that I am glad we did it. The kids felt comfortable with “Adam” and thought the testing activities were “fun.” After each day’s testing, Dr. Schwebach talked to me about his thoughts and preliminary findings and answered any questions (as always, quite a few) that I had.

He thinks that both Luke and Isabelle do have ADHD. He didn’t feel that either of them have Asperger’s. While Izzy does have some symptoms of depression and anxiety, he feels this is due to the stress caused by her ADHD. If we can cope better with the ADHD, these symptoms may improve. He was also concerned about her reversals in writing. She often writes letters (not entire words) in reverse, especially “s” and “g.” We may have her assessed for motor skill development. He thinks that she is more intelligent than her schoolwork shows because ADHD hinders her problem solving and emotional responses. She does fine academically, but it would be nice if she enjoyed school more and experienced less frustration.

 On the other hand, Luke may have some anxiety that should be addressed separately. This was a surprise to me since I worried more that Izzy had anxiety issues. Luke understands social interactions but cannot control his emotional reactions. He knows that what he is doing is unusual or that he is overreacting, but he cannot stop doing it. Though both kids are using Intuniv, Dr. Schwebach said he would like to try them on stimulants in addition. (Both grandmothers are groaning here.) The Intuniv is a norepinephrine drug, and he feels they may benefit from a drug that stimulates their dopamine production. We did tell him about our Vyvanse nightmares, so we will try other drugs, maybe Concerta, Adderall, etc.

I’m looking forward to getting the results. Dr. Schwebach will include suggestions on behavioral therapies to implement at home and at school and how to work with the school to best help the kids. That sounded great to me. I can think of some teachers that could use a little ADHD education…

Dr. Schwebach also gave me the book, “Raising Resilient Children” by Robert Brooks and Sam Goldstein. I will give it a read and see what I think. (Aren’t I skeptical even though we had a good experience?) Dr. Schwebach is an associate of Sam Goldstein, who is quite a well known psychiatrist, speaker, and writer. ADHD is one of his special interests. He has a web site with some good resource links. If you are interested check out http://www.samgoldstein.com/ Why didn’t we go to Dr. Goldstein? I didn’t want to wait six months! And I think Dr. Schwebach was good. Sometimes the “famous” people are too busy writing books, giving speeches, and teaching at universities anyway right? So there are my first impressions. I will write more when I get our results.