Disagree with Psychiatrist

[bugsmom]

I really need everyones opinion on something because I have been sick for about a week over this...

We had an appointment with Josh's Psych last week...it was suppose to be just a routine check up and we were also going to schedule Josh to be tested for LD's. Well, the last couple of weeks have been rough for Josh. He was having trouble focasing in school again, being way too silly in class, and we were noticing that his frustration level was once again way too high. My first thought when we started to see these behaviors again, was that the Strattera he has been taking is not working. Also, basketball has ended and that daily workout was soooooo good for him. It really kept him focased. Anyway, after he met with the doc she called us in and wanted to know what had been going on. So we told her. So she starts telling us that she wants to change Josh's meds again. I about blew a gasket! This poor kid has been through 8 medication changes in 4 years! I started to protest and she said that we have to keep on trying to find out what is best for him. Well guess what...he's tried them all. There is no other adhd med out there! They either make him a mess emotionally or make him sicker than a dog. We've gone through Adderall, Ritilin, Ritilin LA, Concerta, Strattera, and Risperdal! After we debated for a few mins I then asked her when we were going to start the LD testing. She then says that she didn't feel confortable testing him right now because his adhd is not under control. I LOST IT! I beleive that a lot of Josh's problems stem from him HAVING a learning disabilty. So here I am losing my cool with his Psych because she thinks that his problem is that his adhd is not under control and I think that he really needs to be tested for LD's. We were both totally on a different page. My dh and Josh were practically hiding in the corner! Anyway...it ended bad. She said that she wanted me to come back this week so the two of us could discuss this matter more together. Well guess what...I haven't called. I am just so upset that I swear I've been in a depression. Please don't get me wrong, I think his doc is wonderful. She has been there for us in every way. We have been through the thicket with her and she has always been very professional and really listened to our concerns. I just feel she is so wrong in not wanting to test him right now. I feel like we are losing valuable time and I need to know how to help him. I am so tired of putting this kid through med changes. He gets sick and crabby and it hurts me to my core. I'm just so tired of the struggle...I'm sorry...I really needed to vent here...it been a really rough week. If you were me, would you just go find someone else to do this testing and break away from you doc? I don't know what to do.

Sorry this is so long

[misty]

If you really like this psych, why don't you stay with her & still get the testing done somewhere else?? You could take him to another psych to have the LD testing done, couldn't you? And then after you see the results you could decide whether to switch to the new Dr or let the current Dr know the results & stay with her.

I agree that if theres an LD & you find out there is then it can only be better for him.

I don't understand the bit about getting the ADHD under control first at all! There are no meds for LD so an LD Dx wouldn't change the med problem anyway!!

My daughter has 2 LD's & I do believe (and have seen) that they have caused us MUCH more grief than the ADD EVER has! Getting the right help for her LD's has helped all around...she's happier & she's finally LEARNING & the ADD problems don't seem nearly as severe any more!

I hope that helped a little!

[charliegirl]

Since you have known and respected her for quite some time, I do think you should make the appointment to go in without Josh and discuss all your concerns with her. Write them down so you make sure you cover the points you want to make.

I do know that ADHD can cause an apparent LD due to the memory and processing issues, not to mention just the inattention. I would have sworn that my son has dyscalculia but have been told by people I trust and respect (our Lillian is one of them) that its the processing issues most likely causing the problems.

I also know that ADHD meds will not mask an LD. I think she is hoping that once the ADHD is under control, he won't be having as much trouble in some areas as he is now.

You have a valid concern in that he has tried every med out there and nothing is going to take care of everything. I would wonder also why the learning problems can't be tested for and dealt with while you are trying to find the right med.

I really do think you need to talk. If she has always shown that she cares and knows what she is doing, possibly you can work it out so that he is tested in the areas you consider most pressing. If he has been tested for anything before, maybe she can show you what she sees in those that make her believe its mainly the ADHD causing the problems.

Its so hard to find a psych you can really trust, so don't throw that out

Hang in there. That makes it tuff!

[bugsmom]

Misty and CG...thanks so much for your replies, I have been so upset about this.

After sitting with this for a week I think that my biggest problem is that she gives me the impression that SHE doesn't think he has a learning disability. I beleive that she thinks that everything stems form his ADHD and thats where we disagree. When he was first diagnosed (by another doc), we were told that he had a possible LD, but because he was so young at the time they weren't sure. They re-tested him and the results were still on the fence. In the last year and a half my concerns about this has been more clear...but because Josh exhibits a lot of behavior concerns, it always been pushed to the side. Also, the anxiety factor has been such an issue in the last year that we've had to deal with that also. I just think that a lot of his behaviors come from being so frustrated with school that he will do anything to get out of work.

I really do have a good relationship with this doc...otherwise I don't think I could have been so bold with her. I don't want to lose her as his doc because Josh really likes her and opens up very well with her. My concern is that she is really sweeping my desire to get this testing done under the rug. We were suppose to begin testing in December and she put it off because Josh had a short bout with his anxiety again and she thought it was the wrong time. Now she wants to change his meds again and wants to put it off again. Like Misty said...it doesn't have anything to do with getting the ADHD under control.

I don't know...I'm just spent. I'm so tired of the medication merry-go-round. Concerta was the best med we used and it worked out well for a good long time, it just stopped working. Then when we upped the dose he got so sick. I'm just so tired of it all. I would like to just detox him from everything, put him on alternitive methods and homeschool him. I just have no more fight left in me at the moment. Sorry...its been a hard week.

Thanks for your suggestions...it means a lot!

[charliegirl]

By all means, talk to her. Explain how you are feeling now and that you need to have the testing done. I think her concern is that it will still be on the fence and that further testing at this point will still be inconclusive, but something needs to be done now.

My memory stinks so I have to ask even though I know you've told us before. Does he have an IEP? Possibly he could get one for Other Health Impaired even without further testing. She could probably help you with that. You can then address the issues in the IEP and get some accomodations that way. Whether its all the ADHD or an LD, if he needs help, he should be getting it.

I really feel for you. I know what its like to be spinning your wheels. She has to know that you are at the point where you are considering chucking it all or going elsewhere for the testing if something isn't done to get him the help he needs. If you can talk to her calmly and have your points all set up so you can make them rationally, you may have better luck with her. When you are trying to deal with her and only have a few minutes after she has seen Josh, you are agitated and possibly not getting your points across to her.

If after your talk you still aren't satisfied that you are both on the same page, you can always look for someone else to test him.

He is very blessed to have you for a mom. Many would have given up by now. (((HUGS)))

[katiekat]

Bugsmom, Although I don't have any suggestions for you I want you to know I understand how you feel and it IS so frustrating. We are going through the same thing with Sean but at school. In my heart of hearts I am positive that Sean has an LD(s). But they just keep insisting that it's his behavior. As a parent you know your child better than anyone. They make me feel like I WANT him to have a LD,which of course I dont I just want it to be identified sooner rather then later.
I would meet with her and let her know how you feel especially since Josh has a good relationship with her-we all know how hard it is to find that! ;D

[crazyhouse]

I'm sorry you have had a bad week! It's understandable that you had to blow your top and hopefully your Dr understands. I feel like I have been on the merry go round of bad behavior. The meds is probably much worse. I had a question has Josh gained weight at all in the last few weeks or 3 months? We are just putting Jake on that med and the dose has a lot to do with how much you wiegh. Then the other thing can your Dr test for LD's because my sons Dr told us right up front that she could not test for LD's, and that we had to go thru the school for all that. I hope it helps I'm sorry I don't have more ideas.

I definately think misty and CG have some good ideas

[lillian]

Bugsmom,

Are you sure that your son doesn't have an older brother in Texas, who was put up for adoption about six years ago??? I swear, our kids are related!!!

Let's see, we've tried Strattera, Concerta, Adderall, Ritalin LA, Ritalin, Tenex (worked great for a year-and-a-half, then my son began sleeping in school), and, most recently, Daytrana (my son acted like I did back in my wild teenage days when I took Black Beauties--speeding his brains out). What worked the best for him, by far, was neurofeedback, but I don't recommend it for a child under ten. As far as meds are concerned, I just say, "No. Sorry, doc, they haven't worked."

I am always asking myself why meds don't work. Does he REALLY have ADD? Is it anxiety, instead? Is it PTSD? Or is it the dyslexia? I've been asking myself these questions for five years, and I'm not sure I am any closer to an answer. I will say that the behavior has improved dramatically over the years, though. We have tried a controlled diet, vitamin/mineral supplements, allergy shots, and neurofeedback, as alternative treatments. I think all of them were helpful, with neurofeedback being the most helpful.

Now, when you have LD's thrown into the picture, the issues become even more complicated. For a child to test with LD's when the child is your son's age, the child must be very low. LD's become more and more apparent as the child ages, and the gaps between what the child can do in comparison to other children his age and at the same academic level can do becomes wider. Honestly, when a child is really young, the child hasn't been in the academic environment long enough to test much in the way of academic achievement, and if the child has strong verbal and oral comprehension skills, then the child's difficulties reading, writing, doing math calculations, etc., are often brushed off to developmental issues, not LD's. Parents are told to "give the child time."

With the child who is comorbid ADD/LD, the child's LD can be blamed on attention. The child could read, if the child would pay attention. The child could do math calculations, if the child did not continually make "careless errors" due to rushing through and not trying hard enough. The child is resisting and "won't even try" to write. If your child is comorbid ADD/LD, you might as well go ahead and prepare to hear this for the rest of your child's academic future. I still hear it, but I counter with, "If my child could read, my child would pay attention," "Reversing signs in mathematics is not careless to a child with dyslexia," and "He is resisting writing because writing is a visual portrayal of what he does not know, and he would rather you not see that." If your child has LD's, they will become clearer, as your child ages, and it will be your responsibility, unfortunately, to make sure they are seen for what they are and not blamed continually on attention.

However, attention issues can greatly influence how a child deals with LD's. Remediation is not going to work, if your child cannot focus enough on the remediation techniques being used. And testing a child for LD's is extremely difficult, when the child cannot concentrate on the tests being given. It will take someone who will spread the tests out over a series of days, and who has a lot of expertise testing a child with ADD to get valid results. Neuropsychs often are the best to use in this situation because of the severity of issues they deal with day-to-day. The psych you have now doesn't sound like she feels capable of doing the testing, and that's important for you to know. She may be a great doctor, but testing children may not be her expertise. At least she told you, before you wasted your money on the testing. When I told the dyslexia expert who tested my son that I was worried about the testing results because of all the hyper and avoidance techniques he used during testing, she burst out laughing and said, "Don't worry. There's nothing that he can pull on me that another child hasn't tried. If he wants to stand on his head during the testing, he can. I've tested a child that way before."

[notellin]

I would find a neuro-psyche for complete testing. Perhaps her diagnosis is wrong or incomplete, which would explain the meds not working. I would not feel compelled to get her agreement or buy in. You don't even need to tell her. You are the parent and you are in charge. Follow your instincts.

[bugsmom]

First of all, thank you all for your great suggestions and responses. It feels so good to talk to people who actually have been through this. No one around me really understands my frustration and it means so much to hear from all of you.

First of all Josh's psych is not the one that is even doing the testing. All his testing is going to be done by a neuro-psych that is in the same office. The office we go to has all services under one roof, the psych, neuro, and psychogist. His psychiatrist was going to set up all the testing so that we wouldn't have to wait 3 months like someone off the street would have to. I am so looking forward to getting this testing done you just wouldn't believe. We have never had the neuro testing done before, just testing by the psych and psycholgist.

Second, I truly believe that Josh has a learning disability, if I didn't I know I wouldn't have made such a stink. I know he has ADHD for sure, but I believe he also has an LD down to my core. He pretty much sailed thru 2nd and 3rd grade without a problem. His meds were working great and he did well, still immature, but good. 4th grade came along and that's when I started seeing the struggle. First he had a horrible teacher (I almost got him fired!), then the anxiety started BAD. We spent the whole year changing meds over and over again, when inside I thought something else was going on. But you see everyone was re-acting to the behavior and not really looking at the struggle.

This year he has a wonderful teacher that will do anything to help him succeed. Even with her backing he still get very frustrated and just turns off if something is difficult. Then the goofing around starts, then he gets in trouble. It's a crazy circle. When he feels confident in something, he's fine, if not forget it. Then the anxiety kicks in...oh Lordy!

Crazyhouse...to answer your question, Josh has not put any weight on in the last couple months. He actually lost weight due to the Basketball season. I know that Strattera is very weight based but Josh was on the lowest does possible. He's very touchy with meds and we couldn't up him up to where he was suppose to be. But the med was working wonderfully for him, even at the wrong dose, he loved it when he started taking it. Now...we're back to square one.

CG...Josh doesn't have an IEP in place. He goes to a small private school that has been wonderful without one. They have made every accomidation that we asked for. They do have a resouce room for LD's but I he has made it clear that he doesn't want to go. We would be doing outside tutoring on our own.

Lillian...thank you soooo much for your wisdom. It helps so much when I think I'm wrong. I read your input and I see my son. Thanks for your advice and suggestions.

Thank you everyone! Sorry this was sooooo long!!!