messy. crazy. amazing. joyful.

We're not all officially ADHD. Dad's unofficial. Our ten-year-old twins have ADHD. Our seven-year old wants to have it because everyone is always talking about it. Our three year old has ADHD--just because she's three. And me, Mom, I think it's contagious. Who can remain untouched in a house where shoes seem to be lost every morning, instructions are routinely thrown aside, and fights erupt over which continent capybaras come from?

Monday, May 24, 2010

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

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.


  1. Reading this all sounds a little overwhelming right now. It is nice that you have been able to get such a comprehensive evaluation. My daughter's diagnosis is ADHD with comorbid Anxiety Disorder but I have never had anyone tell me if it is combinedtype or just Primarly Hyperactivity, I know it is not just primarily Inattentive. Maybe as she gets older and farther into school that will become more clear. I also think my daughter has a mood disorder but has not yet been diagnosed with that.
    Thank you for all the good info.

  2. The funny thing is, even though we have a thorough diagnosis, the treatment is not necessarily exact. My pediatrician said, "You can go to five different psychiatrists and get five different opinions. So we need to just start with the medication that makes the most sense and see if it works. If not, we go on to another. What works is what you stick with."

  3. I am happy for you to have such a thorough evaluation done! And I must admit, a little jealous too! Was this privately done?

    My daughter just turned 10, and her psychiatrist and therapist have FINALLY heard my concerns about her inattention at school. They had pinned in all on anxiety (OCD-which was a real issue for her) but since therapy her OCD has been greatly reduced and yet still it is a battle every morning to find a pair of socks, even if they don't match (she stuffs them into the couch, behind the tv, etc). And homework...*sigh* the worst is when she actually sits and get it done, and somehow misplaces it in the morning even though she knows (and I know!) she put it in her bag the night before.

    Because you mentioned the mood disorder-NOS with your daughter, I thought I'd drop a thought on that. I'm not a doctor, however I do have some university education on the subject.
    One thing to consider (just based on my research) is Childhood Onset (or Pediatric) Bipolar Disorder. Especially if your daughter's hyperactivity seems to come and go which is the case with my daughter. COPBD also often has secondary diagnoses of ADHD and OCD.

    My daughter will get this crazy-hyper giddiness with laugh attacks (hysterics), but look out because if something rubs her the wrong way she can flip the opposite end and become emotionally distraught and aggressive. This might be considered manic or hypomanic, or mixed states of mania/depression.

    Trouble is that diagnosis is somewhat contraversial at this time, as the criteria for mania in children hasn't been established so they are forced to use the DSM-IV but that is based upon symptoms of adults. A good source of information on it is here:

    Our home is: Mom: ADHD/OCD/GAD, Dad: ADHD-hyper/anxiety, son: ADHD+something, daughter: ADHD/OCD+something, and one normal tweenaged daughter with an attitude! lol

    Never a boring day that's for sure!
    Your kids are lucky to have a mom who wants to get all her ducks in a row so they have the best chance they can get in life!

  4. I felt like this was a very thorough exam AND we had evaluations from the school psychologist too. The psychiatrist we visited was referred to us by our pediatrician--but we did tell him we wanted to see a psychiatrist. Our evaluation was covered by our health insurance but I don't know if counseling will be covered. From what I've heard, it seems that ADHD counseling is not covered but because anxiety is in the mix, maybe counseling will be covered.

    The bipolar thing scares me. I know adults with bipolar who have had monumental struggles. Neither evaluation was positive for bipolar, but I did ask about it and I do watch for signs. Do you think your daughter has it?

    Have you ever tried going to another psychiatrist or counselor? I am amazed at all the different opinions we have heard. And some personalities are a better fit. It's a hassle, but I'm glad we found this one to do the evaluation.