Who do you start with if you suspect a learning disability?

[journeymom]

MDC has helped me so much, directly and indirectly.  I've posted threads about my wonderful son a couple of times. I'm reading someone else's thread that rings so many bells.

Ds is really struggling in 7th grade and it's time for me to act and get him some help. I can't help him by myself anymore.  Poor kid cannot focus at all in class (or at home, if it's not interesting to him).  The best example is his math class.  It's like he isn't even getting a lesson in school at all.  I'm teaching him the lesson every night, and then I have to sit with him the entire time to help him stay on track, and it takes hours to get through all the problems. 

So who do I start with?  Who does these diagnoses?  Start with his ped?  Start with the school counselor? 

The reason I'm not automatically going to his doctor is because dd went through a similar issue and when I asked her ped doc for a referal to a specialist he replied that he doesn't do referrals like that.  I was imagining that these peds have lists of specialists that they refer their patients to... I was left scratching my head. In the end her ped gave us some adhd questionnaire for us to fill out and he prescribed her with Concerta, which helped for a while but after a few years she decided it was causing her a lot of painful anxiety, so she stopped.  We got her into to see a psychiatrist, who was really helpful with other issues and confirmed that her decision to quit the Concerta was a good one.  I can't help but wonder if the ped referred her on to a specialist (I don't know what kind, as I'm not the expert here!) four years ago, the specialist would have handled it all differently. 

Where do I start? 

Edited for clarity! Oops!

[beanma]

The school should be able to test for ADHD through their counselors/school psychologist. I haven't done this so I can't elaborate, but somebody else here may be able to. You might also post in the special needs forum. There are mamas there whose kids' special need is "just" ADHD, too.

You can seek a private assessment also. You would want a psychologist or a psychiatrist with a specialty in children's educational issues. You might just google your area and "psychologist" or "psychiatrist" and "educational" and "assessment". That turned up several practices in my area. MDC folks in your area may be able to offer some suggestions as well. I know I have seen a few requests like that here on MDC for my area and have also seen it on some local email loops. 

We went the private route for an assessment for our dd because the small private school did not have a counselor, but they wanted us to get an eval. We were able to find a child psychologist who was in-network for our insurance. I really didn't want to do meds and was afraid that a psychiatrist would jump to that right away. Psychologists can go there (via referral) if they think it's necessary, but it's not their first option.

Our dd has some ADHD tendencies, but I really think her anxiety brings them on. She has an over-reactive tendency which presents as almost a panic disorder when confronted with a situation. She is not a huge worrier. Doesn't carry it around with her, but basically freaks out easily, including over homework and then can't focus because she's either freaking out that she doesn't understand the math problem or almost about to freak out. She will drag it out forever, too. It's much worse this year (new school, 5th grade, different style of teacher) and it looks more ADHD. I really don't think she needs meds, though, but she does need some better coping skills for sure. It is interfering with her getting the concepts. We have to go over it again just like you're describing. She does awesome in other classes like science, though, because the teacher there has a better style for her. 

Anyway, hijacked your thread there, I think you should be able to get the school to do an eval or you may be able to talk to the counselor and get a referral from them to a psychiatrist or psychologist whichever you prefer. 

Good luck!

[Linda on the move]

I would double post (or request the moderator move) this in Special Needs.  There are some awesome moms there with kids with ADD/ADHD.

The important thing in requesting the school do an eval is that you need to request in writing, in a real letter with a date and a signature. This is a legal step in the process. They have a certain amount of time to respond.

One of the possibilities could be getting him an IEP that would put him in a smaller math class targetted to kids with IEPs. At our public school, this was a GREAT class with a limit of 12 students and a teacher who was fantastic at breaking things down step by step.

But the first step is the letter.

[Drummer's Wife]

I'd start with the school; they should have a team that can assess him and recommend a plan.  My DS has been evaluated by a SLP, OT, psychologist, and the special education coordinator.  They created (with my help) his current IEP and work with him in the areas he needs extra assistance.

They might suggest following it up with your family doc, but if it's impacting his academics, I'm sure they would want  to find a way to help him at school and when he is studying at home. 

[karne]

Come over to Special Needs!  

We have LD and ADD issues here, with a middle schooler and elem aged kiddo, so I've been there.

FWIW, as you probably know, the school can give impressions, and fill out a Connor's rating scale, but cannot dx.  Absolutely start with them though and request an eval, in writing, if you have not already done so.  Middle school is a very ususal time to start to see evals for kids who may have been able to hold it together, but the demands of the middle school curriculum are beyond the strategies they have been using.

[journeymom]

There are mamas there whose kids' special need is "just" ADHD, too.

You got it right on the nose.  I actually started this thread in special needs and then deleted because it seems like an attention issue isn't, I guess, important enough to be there. 

I really think her anxiety brings them on. She has an over-reactive tendency which presents as almost a panic disorder when confronted with a situation.

I think this is my dd as well.

I found this yesterday. http://www.ldonline.org/adhdbasics/diagnosis  The graph towards the middle is so helpful. It hasn't been clear to me who the different professionals are and what they do.  The medical doctor can't help ds and me with the practicalities, like how to live with this. But maybe a psychologist or a social worker can?

So I took ds in to see his pediatrician this morning, for another reason, but brought up this issue as well. So I've got copies of the Vanderbilt Assessment Scale for dh and me, and for 4 teachers.  I'm also going to try to contact the school counselor and request a separate assessment.  

I say 'try' to contact the counselor because when I called a few weeks ago to talk to her I learned that they prefer there to be a parent-student-teacher meeting.  I really couldn't figure out how to explain that this just wasn't what I was expecting and didn't sound like a solution.  I finally figured out (yesterday) that what I need is help for me, so that I can better help my son.  I don't think the history teacher can help with specialized education needs.  I dunno. 

Thanks, All. Your responses are so helpful!  I'm going to ask to have this thread moved. 

[Peony]

In larger areas there are often clinics that will eval for LDs. I'm not talking about Sylvian type of places but centers with a team of health care and educational professionals. We live in a very rural area with minimal resources and we traveled across the state to such a clinic that could dx DD1. I knew she had LDs from a very young age but had no resources to turn to. Just start googling in your area or other areas to see what you come up with. Pedis IMO are often worthless in this area. 

[Emmeline II]

The Connor's scale is for differentiating hyperactive children from typical children so if his primary issues are innatentiveness and impulsiveness it's not going to raise any ADHD flags.

There are psychologists and psychiatrists that specialize in educational testing, this is probably your fastest route privately but it seems to be more expensive than going to a place like this, though clinics like that can take awhile to get into. Though ds was initially diagnosed by a psychiatrist he gets his therapy elsewhere.

If your hasn't seen an optomitrist in awhile I'd do that as well; not related to ADHD in particular, but I was having a particularly difficult time in 7th grade math and found out after borrowing someone's glasses that I could not see the board--you'd think eye sight that bad would be obvious, but .

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Wrightslaw.com is your new favorite website and the IDEA legislation is your new nighttime reading.

http://www.webmd.com/add-adhd/guide/adhd-causes

Under IDEA/IEP, if your child has a disability that adversely affects educational performance, your child is entitled to an education that is designed to meet the child's unique needs and from which your child receives educational benefit.

A 504 is helping your child get the same education that everyone else is getting--more for a student that needs accommodations to help them learn (like sitting next to the teacher) or for behavior, and that they are not punished for things that they cannot control due to the ADHD (like needing to work standing up or not sit inside a group).

[A IEP or 504 is not an escalation or punishments for the teacher/school. It's more about getting all appropriate parties involved and on the same page. The student, parent/legal guardian, teachers, principals, Pupil Services administrators, support staff (i.e. nurse, counselor, psychologist, language/speech pathologist) as well as the student's physician or therapist may be involved in the placement process including the 504 meeting.]

Eligibility under IDEA for Other Health Impaired Children

Key Differences Between Section 504, the ADA, and the IDEA.

(http://www.wrightslaw.com/info/sec504.summ.rights.htm)

Key Differences Between Section 504 and IDEA

(http://www.wrightslaw.com/howey/504.idea.htm)

Is a Child with ADD/ADHD Eligible for Special Education? - Wrightslaw

Wrightslaw - IEP FAQ

Do IEPs Cover Executive-Function Problems? | ADDitude - Attention ...

Don't forget Executive Dysfunction Goals in the IEP ...

Google Search: IEP executive dysfunction goals -- http://www.google.com/webhp?rls=ig#r...fp=GfJSJdxUFlI

Helping Parents Secure ADHD School Accommodations: IEP & 504 Plans for ADD Children | ADDitude - ADHD & LD Adults and Children

Section 504 Online Introductory Tutorial

Section 504 - Civil Rights Law, Protection from Discrimination ...

Wrightslaw

Parents as Experts

Special Education Law and Advocacy

http://www.adhdnews.com/testforum/test886.htm

Crisis Management, Step-by-Step - Wrightslaw

CHADD Live | Home Page

CDC - ADHD, Symptoms and Diagnosis - NCBDDD

Wrightslaw: From Emotions to Advocacy, 2nd Edition (book)
 

ADHD- Middle and High School, search
http://www.google.com/search?q=ADHD+middle+school&ie=utf-8&oe=utf-8&aq=t&rls=org.mozilla:en-US:official&client=firefox-a

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ATTENTION DEFICIT DISORDERS EVALUATION SCALE
 

 

ADHD Connors Test

 

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About: ADHD Hyperfocus | ADDitude - Attention Deficit Information ...

http://www.additudemag.com/adhd/article/1572-2.html

http://www.addinschool.com/elementary/socialskills.htm

Coach Your Child in Friendship Skills
http://add.about.com/

ADHD-Vision
http://www.add-adhd.org/

 

[journeymom]

Would you say that executive dysfunction is the same as adhd?  Or, is adhd under the umbrella of executive dysfunctions, along with other disorders?  Can one have an executive dysfunction but not adhd (or vice versa)?   

Optometrist: ds's visit to the ped included the eye exam and he passed fine. 

[Linda on the move]

Originally Posted by journeymom 

Optometrist: ds's visit to the ped included the eye exam and he passed fine. 

The screening where the have the kid stand in the hallway and read an eye chart isn't a real eye exam. It's quite possible to have vision issues that don't show up on those. (I did as a child)

Pretty much all insurance covers a real eye exam for kids every year, and many states have free coverage for this for kids who lack private insurance. Although I suspect that his issue is more complex, this is a VERY easy (and cheap) thing to rule in or out. 

[journeymom]

Originally Posted by Linda on the move 

The screening where the have the kid stand in the hallway and read an eye chart isn't a real eye exam. It's quite possible to have vision issues that don't show up on those. (I did as a child)

Pretty much all insurance covers a real eye exam for kids every year, and many states have free coverage for this for kids who lack private insurance. Although I suspect that his issue is more complex, this is a VERY easy (and cheap) thing to rule in or out. 

Absolutely right.  Ds had two eye exams. One was the eye chart (in a frame-work box thing on a table, he looked into, instead of the chart on the wall), and the doc also examined his eyes, lights off, with the hand-held ocular device thing that sits in all exam rooms.

You're so right to differentiate the different exams.  He wasn't examined with the big eye-glass thing that optometrists use, but I'm satisfied for now. 

[Emmeline II]

Originally Posted by journeymom 

Would you say that executive dysfunction is the same as adhd?  Or, is adhd under the umbrella of executive dysfunctions, along with other disorders?  Can one have an executive dysfunction but not adhd (or vice versa)?  

Executive dysfunction is a significant part of ADHD, but it doesn't equal ADHD.

What is Executive Function? - National Center for Learning Disabilities

[raksmama]

Hugs to you jouneymom!

It could be so many things and I think teachers are always quick to jump to the ADHD diagnose too quickly. I agree with the others who all said see an educational psychologist, but that being said they (educational psychologists) are not all alike. The first time my son got tested when he was in 4th grade we did not like the psychologist at all and felt he did not "get" our son. Nevertheless his recommendation to go on an IEP was a very good one and it did help our son. When he was in 7th grade we had a reassessment by someone who we chose ourselves (the first one had been from the school). We had to pay for it but it was still worth it.

[karne]

Originally Posted by journeymom 

Would you say that executive dysfunction is the same as adhd?  Or, is adhd under the umbrella of executive dysfunctions, along with other disorders?  Can one have an executive dysfunction but not adhd (or vice versa)?   

Optometrist: ds's visit to the ped included the eye exam and he passed fine. 

Yes, it's very common to see executive function issues w/add and adhd.  But, this is where an eval is really helpful because what looks like executive function may be something else entirely, or impacted in a significant way by another issue such as slow processing speed, poor working memory, etc.  

Feeling overwhelmed, even physically tired, an be seen when a kid is working really, really hard just to maintain themselves through the day.

[journeymom]

It could be so many things and I think teachers are always quick to jump to the ADHD diagnose too quickly.

Ds's teacher a couple years ago mentioned  (to a group of moms, we were standing around chatting ) that they're advised not to suggest any disorders or syndromes or other alphabet soup issues.  None of his teachers have ever said anything to me that sounds like a diagnosis, other than they consistently point out how disorganized he is.  I'm the one who 'diagnosed' him with adhd (95% sure), I've just been ignoring it.  Poor guy can't suffer like this anymore. 

I my next step will be to look into local educational psychologists.

[raksmama]

Could very well be you are right about adhd, but I am just saying that someone with a non verbal learning disability or sensory processing disorder can also be disorganized.  The same goes If someone has  problems with their eyes (like my son, he has 20/20 vision but problems tracking) or is having extreme allergies. The list goes on and on.....

Originally Posted by journeymom 

Ds's teacher a couple years ago mentioned  (to a group of moms, we were standing around chatting ) that they're advised not to suggest any disorders or syndromes or other alphabet soup issues.  None of his teachers have ever said anything to me that sounds like a diagnosis, other than they consistently point out how disorganized he is.  I'm the one who 'diagnosed' him with adhd (95% sure), I've just been ignoring it.  Poor guy can't suffer like this anymore. 

I my next step will be to look into local educational psychologists.

Edited by raksmama - 10/15/11 at 10:52am

[joensally]

ADHD is an EF issue.  There is a great article here:

http://www.dradamcox.com/articles/index.html

ADHD & Executive Control

I really like the book Smart but Scattered.

http://books.google.ca/books?id=J5MA8e5YHmQC&printsec=frontcover&dq=smart+but+scattered&hl=en&ei=WGeaTo-vBsWwiQKekeHyCg&sa=X&oi=book_result&ct=result&resnum=1&ved=0CDEQ6AEwAA#v=onepage&q&f=false

As for the eye test.  There's a condition called strabismus/convergence insufficiency, the behavioural manifestations of which closely mirror those of ADHD.  http://www.visionhelp.com/vh_add_05.html  (this is a random link via google, not making any comment about the website - just looking for the study).  DS has it, and passed a full eye exam.  It was a developmental optometrist, and later confirmed by an opthamologist, that identified it as a problem.

I would google "learning disabilities + my town" and see what comes up.  I wouldn't go to anyone without good credentials (ie specialized tutoring services which offer screening tests).