Devel peds "skewed" eval — The Bump
Special Needs

Devel peds "skewed" eval

My DS who is 3, has been dx with SPD and expressive and receptive speech delays a little over a year ago. Therapies and all that jazz started. He was seen by devel peds about a year ago for first time. She agreed with SPD and speech. States she didn't have concerns over ASD, but too early to rule out. So we continued to follow up every 3 months or so. So this time, she had moved so the director is now seeing him, great it's who we were supposed to see in first place. So my DS had his appt, of course only time was smack in middle of nap time. so nap was skipped, second he has been sick for 2 days which always throws him off, third new person new facility, and fourth lady was over an hour late for our appt. So with a 3 yr old ready to implode, she walks in and says wow he has a lot of energy. I said he gets like this when he is overly tired, sick, etc, not to mention being stuck in a room for over an hour with mom trying to keep him occupied. She then proceeds to basically say that she thinks he is ADHD.  I'm like really, what are you basing this on? After all the factors I described she labeled him with ADHD and proceeded to attempt to discuss meds. I said wait just a minute, I am NOT medicating my 3 yr old based on some crap assessment. How about assess him on a normal day without all these extra factors. I mean I was ready to bounce myself off the walls and I don't have ADHD. I said how much improvement we have seen with his speech and sensory stuff with therapies and I am not interested in medications. When his sensory system is balanced he is a typical 3 yr old. His teachers all agree. I am so irritated that my kid wasn't really given a good eval by a very well respected devel peds. Ugg, this crap is hard. Makes me question everything I do every single day with regards to my son.  Sorry I just needed to vent and see if other people had experiences like this. She acted totally surprised that I wasn't willing to medicate him. Really?

Re: Devel peds "skewed" eval

  • Princess_LilyPrincess_Lily
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    edited December 2013
    I agree with auntie.
     

    For our dx process, we are currently still in the "waiting period" of evaluations and testing results; the dx journey (for us) has been several months long.

    Our doc said that if DS started to show signs of stress/meltdowns he would stop the session -  he said it would test DS unfairly, putting him at a disadvantage.  He is also planning on going to DS's class to observe him, to get a better concrete answer on his behavior problems.  Children will show signs of other co-morbidities (anxiety, etc.), its not always a simple straight answer sometimes, and its important to find the correct dx so each child can have best environment & supportive tools possible. 

    Frankly, I would be a little skeptical of a dx and medication push from a doc after just 1 appointment. If I were you I would seek a second opinion (from either a dev pedi, or someone else like a psychologist), who can properly evaluate your child.

    Before I met with our doc, I did several phone interviews with registered pediatric doctors covered by my insurance.  I kid you not, there was one doctor who after a simple 2min. question & answer from me, this doc gave an over the phone dx and tried to push medication to "calm him"!
    I polietly but quickly ended the phone conversation, and she must have picked up on my shocked response, but she kept on saying, "Might as well give him the medication now, he will need it at some point anyway."  She was quite curt.

    While not all docs "put the cart before the horse," I wouldn't say that one that does so is a good doctor - unless they are dx'ing a common cold.  

    The AAP does not suggest medicating ADHD children until 6yo+, if they do. Current treatment plans are in place to help children who have signs, but are too young (ie. behavioral therapy) 

    As a background
    At 2.5yo DS was dx'd with a "developmental delay."  His therapists referred to it as SID/SPD; he was also found to have a speech delay too.  Since then, we have been treating with private OT & ST - evaluations every 6mo.  At 4.5yo evaluation, he tested out of having SID/SPD, and while he has problems with pronunciation - he has tested Kindie level (5-6yo) for verbal skills.

    My advice is to base your next pediatric doctor(s) on this experience. Ask yourself what you are looking for in an evaluation for your child, how does the doctor handle meltdowns/difficulties during testing?  What does he/she test for?  Besides ADHD, is he/she qualified to test for other difficulties (ASD, LD's)?  Do you want to medicate in the end, or not?  Is this doc a good match for your family, and does he/she properly communicate with you?

    Don't be in a rush for a dx, but be proactive.
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  • Our dev. Pedi says without a doubt DD will get an ADHD dx when older but she told us 7 is more the age to dx it. I would hightail it out of the office of someone who wanted a 3 year old on meds.
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  • With all do respect, I am not making excuses for my son's behavior. I am simply explaining this is not his typical behavior due to the fact he is sick, no nap, and been waiting in this damn room for almost 2 hours now. Does he have a lot of energy, yes. Do other typically developing 3 year old, yes. Anyone who thinks that  3 year old will just sit and be quiet while waiting in a room for so long, sick, no nap, it ridiculous and unrealistic. 3 year olds have a short attention span and I would question if some 3 year old just sat there for over 2 hours without becoming a  bit irritable. I know my son is not "perfect" and I realize he very well may have a dx of ADHD, I am not negating that fact. However, I find it a bit odd that I would get a dx of this with all of the circumstances. Shouldn't an eval be based on a bit more of a detailed observation, how he typically behaves, not just "out of his comfort zone".  This day was very out of the ordinary for his behavior and it seems as if she didn't take that into consideration at all before throwing out that diagnosis.
  • This director is in the same clinic you've been visiting for a year, right? I imagine she has access to records from your file. I'm surprised at such an early Dx, but I also don't diagnose ADHD/ASD for a living (though I do act on an eval team to assist in the process).

    For DS, it felt like the developmental pedi took 45 minutes with my kid and then made a decision. But looking back (and knowing the process better now for how my county works), he had access to all of our records, had reviewed them, interviewed DS's early intervention team, and then filled in the gaps with his own interview and eval. In my denial phase, I made the excuse that the pedi really didn't get a good picture of DS. DH argued that one for months.

    If you are not convinced, I would call the office and ask for a follow-up. Write down your questions and concerns and talk them through.
    [Deleted User]
  • This deve peds did have records but she admitted herself that she only skimmed thru them right before my appt, because she didn't realize he was coming in for a follow up appt, the scheduler put someone else in his appt slot, so she wasn't prepared. She admitted this to me. Since my son had his dx of SPD, I have become very well versed in it and can tell when my son's sensory system needs input or when something is off. This was what she saw, him needing input and not being able to get it in a confined room. She totally discounted all of the circumstances surrounding his being a little wiggly. Funny because she said to me that he has great concentration but just feels the need to be moving. A little contradictory to me in regards to ADHD in a 3 year old. Many qualities that are SPD can be similar in ADHD and even ASD. I am super proactive with regards to my son and his therapies, etc. I am not blind to anything with him. I just want a fair assessment and I feel he is entitled to this and not be given a misdiagnosis just because he was a busy bee in the office.
  • With all do respect, I am not making excuses for my son's behavior. I am simply explaining this is not his typical behavior due to the fact he is sick, no nap, and been waiting in this damn room for almost 2 hours now. Does he have a lot of energy, yes. Do other typically developing 3 year old, yes. Anyone who thinks that  3 year old will just sit and be quiet while waiting in a room for so long, sick, no nap, it ridiculous and unrealistic. 3 year olds have a short attention span and I would question if some 3 year old just sat there for over 2 hours without becoming a  bit irritable. I know my son is not "perfect" and I realize he very well may have a dx of ADHD, I am not negating that fact. However, I find it a bit odd that I would get a dx of this with all of the circumstances. Shouldn't an eval be based on a bit more of a detailed observation, how he typically behaves, not just "out of his comfort zone".  This day was very out of the ordinary for his behavior and it seems as if she didn't take that into consideration at all before throwing out that diagnosis.

    Just as an FYI, some three year olds can sit and wait patiently. My son spent six hours in a hospital with nothing more than a happy meal toy and waited without whining. What do you think is wrong with him if he can wait?
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  • Fredaline, You are correct.  I am not saying that any 3 year old can't sit still, I am saying a sensory seeking SPD kiddo with all of the factors involved doesn't automatically qualify for a dx of ADHD. My point in my post was that if you have a child who is sensory seeker, which mine is, and you factor in all the issues, I don't know of one SPD kid who would sit still for almost 2 hours without being a little wiggly. For her to say oh he has ADHD based on this was I think a little unfair. Especially when I told her that this is not his normal. I don't need someone to tell me that when he is "off" he acts up or acts ADHD, I live with him, I know this. But when his sensory system is well regulated he doesn't act like this. I think that before jumping to medicate him when this behavior is a rare thing, look at how he usually is, not a rare circumstance. Any child, regardless of special needs could act like this, doesn't make him ADHD and in need of medication. 

     

     

  • Fredaline, You are correct.  I am not saying that any 3 year old can't sit still, I am saying a sensory seeking SPD kiddo with all of the factors involved doesn't automatically qualify for a dx of ADHD. My point in my post was that if you have a child who is sensory seeker, which mine is, and you factor in all the issues, I don't know of one SPD kid who would sit still for almost 2 hours without being a little wiggly. For her to say oh he has ADHD based on this was I think a little unfair. Especially when I told her that this is not his normal. I don't need someone to tell me that when he is "off" he acts up or acts ADHD, I live with him, I know this. But when his sensory system is well regulated he doesn't act like this. I think that before jumping to medicate him when this behavior is a rare thing, look at how he usually is, not a rare circumstance. Any child, regardless of special needs could act like this, doesn't make him ADHD and in need of medication. 

     

     


    Sorry, I just read that "I would question a three year old who sat there for over two hours without becoming irritable" as implying there was something wrong with a child who could sit and wait for that timeframe (and funny enough, I happen to have a sensory seeker who can wait). I wouldn't medicate my child under the circumstances you describe either though. You said your child was previously seeing another doctor in the practice--could it be possible that she read the previous doctors notes, got reports from school, etc and made the dx based on all that vs a wiggly kid who was itching to get out of the doctors office?
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  • KC- Thanks for your response, I wasn't implying there was anything wrong with your child who could sit, not at all, but in many sensory seekers they are impatient and more active, especially when they are "off" sensory wise and when my son is sick he gets "off". Then add on all the other things with having to miss nap, and wait for close to 2 hours and getting fidgety is I feel what made her give him this diagnosis. Believe me that I do not have my head in the clouds about my son, he is not perfect. But when I adopted him from foster care, I made my committment to get him whatever he needed.  I don't feel like he got an accurate dx at 3 yrs old. She actually seemed to discount his sensory processing issues and just want to throw meds at him. She actually was a bit surprised when I said no to meds. I have no doubt that there are many kids needs meds and who knows he at some time may need this too, but I feel like not at 3 yrs old and why jump to this with all the circumstances
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