Evaluation Process to Diagnose Learning & Behavioral Issues

I have talked about why kids should be evaluated if they have learning or behavioral issues and who is involved in this evaluation in the past few posts. Today I want to talk about what to expect during an evaluation. Not all kids need every test available. It depends on what their specific concerns are as to what will be tested, but a proper diagnosis can’t be made without standardized testing and a complete evaluation.

What types of things are evaluated?

Evaluation Process to Diagnose Learning & Behavioral IssuesThe evaluation includes several types of assessments because there are many things that can cause learning or behavioral issues.

There are no specific laboratory or imaging tests available to determine a diagnosis on a routine basis. It’s important to do a thorough standardized evaluation to get the right diagnosis.

Contributing issues include but are not limited to: ADHD, anemia, anxiety, bullying or abuse, chronic illness, depression, hearing or vision problems, learning disabilities, malnutrition, oppositional defiant disorder, sensory integration disorder, and sleep deprivation.

Symptom overlap

Having one diagnosis does not mean you can’t have a second. Actually many of these issues go hand-in-hand and co-exist.

ADHD, anxiety, neurodiversity, learning disorders
There is a lot of overlap of symptoms of many similar conditions.

Standardized questions

A big part of the diagnosis lays in the symptoms noted at home and school, so there are a lot of questions about how your child fares at each.

Both parents and teachers and any other significant adults should fill out standardized questionnaires as recommended by the clinician doing the evaluation for many behavioral issues. Older kids (and adults) can do self assessments.

It’s important to answer each question as honestly as possible to avoid misrepresentation of symptoms, which can lead to an improper diagnosis.

History

Reviewing the child’s story can give clues. This includes the current concerns of parents and teachers in addition to historical facts and events.

If there were developmental delays in motor skills or language development, further evaluation in those areas might be insightful.

It’s important to review the family history, since many of these issues run in families.

Sleep patterns are often insightful since sleep deprivation can decrease executive functioning and mimic many conditions.

Other issues, like a history of anemia or elevated lead levels should be discussed.

Exam findings

A physical exam should be done to help identify any physical symptoms that can contribute to learning or behavioral problems, such as large tonsils leading to sleep apnea.

Behavior evaluation

Some clinicians will go to your child’s classroom to observe behaviors. This is sometimes provided through the school district but might also involve a private therapist.

Neuropsychological testing

Neuropsychological testing might be recommended. It can assess learning disorders and attention issues, identify strengths and weaknesses, and help determine what interventions will work best for your student. Understood.org has information about neuropsychological testing.

Vision and Hearing

If your child has not had a vision and hearing screen done previously or there are concerns, it is recommended to do those screens. When a child cannot see the white board or hear the instructions, learning and behavior are both impacted.

Evaluation Process

As you can see, there are many things to consider when evaluating learning and behavioral concerns. A proper diagnosis usually takes more than one visit. More than one person should be involved in the screenings in many cases. Do not attempt to shortchange this process. Without a proper assessment, the wrong treatment might be advised, leading to poor outcome.

The next few blogs will discuss treatment options for ADHD, including dietary changes, supplements, alternative and additional treatments and medications.


Looking for more?

Many parents benefit from support groups to learn from others who have gone through or are currently going through similar situations, fears, failures, and successes. Find one in your area that might help you go through the process with others who share your concerns. If you know of a support group that deserves mention, please share!

ADHD

CHADD is the nationwide support group that offers a lot online and has many local chapters, such as ADHDKC. I am a volunteer board member of ADHDKC and have been impressed with the impact they have made in our community in the short time they have existed (established in 2012). I encourage parents to attend their free informational meetings. The speakers have all been fantastic and there are many more great topics coming up!

Anxiety

Many parents are surprised to learn how much anxiety can affect behavior and learning. To look for local support groups, check out the tool on Psychology Today.

Autism

The Autism Society has an extensive list of resources.

Dyslexia 

Dyslexia Help is designed to help dyslexics, parents, and professionals find the resources they need, from scholarly articles and reviewed books to online forums and support groups.

Learning Disabilities 

Learning Disabilities Association of America offers support groups as well as information to help understand learning disabilities, negotiating the special education process, and helping your child and yourself.

Tourette’s Syndrome and Tic Disorders 

Tourette’s Syndrome Association is a great resource for people with tic disorders.

General Support Group List 

For a list of many support groups in Kansas: Support Groups in Kansas .

School information

Choosing schools for kids with ADHD and learning differences isn’t always possible, but look to the linked articles on ways to decide what might work best for your child. When choosing colleges, look specifically for programs they offer for students who learn differently and plan ahead to get your teen ready for this challenge.

Midwest ADHD Conference – April 2018

Check out the Midwest ADHD Conference coming to the KC area in April, 2018. I’m involved in the planning stages and it will be a FANTASTIC conference for parents, adults with ADHD, and educators/teachers.

Midwest ADHD Conference
The Midwest ADHD Conference will be held in April 2018, in Overland Park, Kansas.


Share Quest for Health

 


 

Who’s Who In Learning & Behavior Evaluation & Management?

I tried to convey why it’s so important to get a proper diagnosis of learning and behavioral problems in my last blog, Labels – Why should my child be diagnosed? Today I’d like to explain what is done during the evaluation and who’s involved in testing and treatment. Primary care physicians are a great place to start with questions about how to evaluate and treat various concerns. After that where should you go?

Start with the pediatrician

learning and behavior evaluation and managementParents are sometimes surprised to learn that I treat ADHD, anxiety, and many other behavioral disorders. I see many kids every day with these issues. I enjoy watching as they learn to manage their behaviors and improve their executive functioning over the years. Even kids who really struggle in the early years can grow into confident and accomplished adults.

I often say that kids with ADHD are talented, smart and can do wonderful things. They have unique gifts.

There are some pediatricians who don’t treat these issues, but I find there’s a huge need. In many cases since I’ve followed a child for years, I know them well and can help better than a specialist who doesn’t have that history.

Despite plenty of experience, I do use specialists often.

Many learning and behavior problems have similar symptoms, so it might take several professionals to help evaluate the situation.

Of course the professionals at school are imperative to being part of the team. And there are times when the diagnosis isn’t clear or a child doesn’t respond to the treatment well, other specialists are very helpful to assess the issues.

Cautions…

There are of course many tests and treatments available that have not been proven to help. Future blogs will cover testing and treatments, but until then, just a few cautions.

There are tests available, such as EEG for ADHD, that are not shown to be beneficial and can increase cost without adding to the diagnostic evaluation.

There are many treatments that haven’t been shown to be effective but still advertise good results for a fee.

If it sounds too good to be true, it probably is. Discuss tests you are considering with your child’s doctor, especially if there is a large price tag attached.

 


Who’s who?

The alphabet soup of credentials confuses many parents. I’ve tried to compile a list of experts in various fields who might need to be involved in your child’s assessment and care as well as explain what types of things they can do to help in the process of evaluating and treating learning and behavior issues.

Parents

Parents (or primary caregivers) are critical to giving insight into how children learn and behave. They should be interviewed and fill out standardized questionnaires to help with the diagnosis. Their feedback on how each treatment is working is helpful in fine tuning treatment plans.

Teachers & Other School Professionals

Teachers are imperative in helping assess the issues and concerns since they can compare any one child to a room of their peers and they know how your child handles various situations and what their typical behaviors are.

Many schools will have a school counselor or psychologist evaluate and help treat students.

Teachers with advanced background in learning disabilities are used to help address specific concerns.

It’s recommended that each teacher fill out standardized questionnaires to help with the initial evaluation of focus and behavior disorders and again to assess responses to treatments.

Schools may put students on IEP or 504 Plans to help with their education. For more on these see IEP & 504 Plan. 

Therapists (not mental health)

Physical Therapists, Occupational Therapists, Audiologists, and Speech Therapists can be school based or private, but they are helpful in addressing specific motor skills, sensory issues, hearing issues, or speech/language concerns.

They do not prescribe medication, but work within their area to improve certain skills that affect learning and behavior.

Check with your insurance to see what is covered in your plan. Ask the school if they offer any of these services.

Mental health specialists

Psychologists (clinical psychologists, cognitive psychologists, educational psychologists and neuropsychologists) and clinical social workers offer testing as well as therapy for many disorders.

Some therapists specialize in testing, others in treating. Some do both. You will have to ask what their qualifications are and what role they play in diagnosis and management.

Clinical therapists can do parent training to help parents manage behaviors at home, especially for younger children.

Therapists cannot prescribe medications, but some people find that the therapy provides enough benefit that medication is not needed or that the therapy in addition to medicine helps better than either treatment alone.

Cognitive behavioral therapy is the preferred first line treatment for certain disorders, such as ADHD in young children and anxiety.

Therapists often provide social skills training, which is needed for many children with behavioral and learning issues who don’t learn social skills as easily as their peers.

You should check your insurance list of providers to see who is covered. It also might be worth pricing some who do not take your insurance but will give you a bill to submit yourself. If a person is out of network your cost might be about the same as a person who is harder to get in to see but on your plan.

Physicians

Physicians (pediatrician, family physician, developmental pediatrician, neurologist, and psychiatrist) can make a diagnosis and prescribe medications for treatment of certain diagnoses, such as ADHD or anxiety.

Not all have experience with each of these issues so you must ask what their experience is.

It can take quite a while to get into specialists and they can be expensive, so starting with your primary care physician often is easier and very helpful to rule out medical issues and to do the evaluation and treatment if they are comfortable.

Many psychiatrists do not accept insurance and they are typically difficult to get in to see.

Physicians (including psychiatrists) generally do not do therapy. They focus on the medication benefits and side effects. Therapy along with medication often improves outcome, so multiple specialists working together can be beneficial.

Physician-extenders

Nurse practitioners and physician assistants can work with physicians to diagnose disorders and prescribe medications to treat them. In some states they can work independently.

They do not offer psychotherapy, so it is often beneficial to work with more than one person to get the best outcome.

Benefits include that they are generally easier to get in to see and they are relatively inexpensive compared to physicians. Not all are comfortable with treating these issues. Ask about training and experience.

Working as a team

The types of professionals who work with any given child to assist in diagnosis and treatment vary depending on the issues at hand. The most important thing is that they work as a team and communicate with one another.

This communication is often done through parents and written reports. It’s important that all members of the team have access to what the others are doing.


Looking for more?

Many parents benefit from support groups to learn from others who have gone through or are currently going through similar situations, fears, failures, and successes. Find one in your area that might help you go through the process with others who share your concerns. If you know of a support group that deserves mention, please share!

ADHD

CHADD is the nationwide support group that offers a lot online and has many local chapters, such as ADHDKC. I am a volunteer board member of ADHDKC and have been impressed with the impact they have made in our community in the short time they have existed (established in 2012). I encourage parents to attend their free informational meetings. The speakers have all been fantastic and there are many more great topics coming up!

Anxiety

Many parents are surprised to learn how much anxiety can affect behavior and learning. To look for local support groups, check out the tool on Psychology Today.

Autism

The Autism Society has an extensive list of resources.

Dyslexia 

Dyslexia Help is designed to help dyslexics, parents, and professionals find the resources they need, from scholarly articles and reviewed books to online forums and support groups.

Learning Disabilities 

Learning Disabilities Association of America offers support groups as well as information to help understand learning disabilities, negotiating the special education process, and helping your child and yourself.

Tourette’s Syndrome and Tic Disorders 

Tourette’s Syndrome Association is a great resource for people with tic disorders.

General Support Group List 

For a list of many support groups in Kansas: Support Groups in Kansas .

School information

Choosing schools for kids with ADHD and learning differences isn’t always possible, but look to the linked articles on ways to decide what might work best for your child. When choosing colleges, look specifically for programs they offer for students who learn differently and plan ahead to get your teen ready for this challenge.

Midwest ADHD Conference – April 2018

Check out the Midwest ADHD Conference coming to the KC area in April, 2018. I’m involved in the planning stages and it will be a FANTASTIC conference for parents, adults with ADHD, and educators/teachers.

Midwest ADHD Conference
The Midwest ADHD Conference will be held in April 2018, in Overland Park, Kansas.


Share Quest for Health

 

Labels – Why should my child be diagnosed?

This is the first in a series of posts about learning and behavior I will do over the next several weeks. Parents are often afraid of labels when it comes to getting an appropriate assessment of learning  or behavior issues.

I see a lot of children with various behavioral and learning issues. Teachers and parents often first think of ADHD with any problem, but that isn’t always the problem, or at least the primary one. It’s simply one of the most common diagnoses. Since it’s so common, I will focus on this topic often, but it can mimic other problems and it often coexists with other issues.

I firmly believe that kids with learning and behavioral problems cannot just “work harder” to fix the problem.

We would never ask a child in a wheelchair to “just try harder” to walk up stairs. We shouldn’t expect someone who has trouble focusing to be able to “just try harder” either.

When I’m sleep deprived, I cannot focus as well. I cannot read and comprehend what would typically be easily understood and retained. I lose track of things. I lose my temper more easily or get upset about the little things that usually wouldn’t phase me. I must put extra effort into everything, which is even more exhausting.

I liken this to how some people feel most of the time.

How can we possibly expect them to just try harder without professional assessment and treatment?

What about labeling?
ADHD kid messing around
Kids with ADHD get distracted easily and have trouble staying on task.

One reason parents don’t want to have their child diagnosed with ADHD or any other learning or behavioral problem is that they fear a label.

What’s a label?

It’s not a diagnosis, but the way we’re perceived. Think about how many judgements and labels you make in a day.

I try really hard to not judge because it’s not my place, but those thoughts sneak into my mind all the time:

  • That person is rude.
  • That’s my shy (hyper, loud, smart, active, loving, etc) child.
  • That outfit is inappropriate.
  • That group of giggling girls is too loud and out of control.

I don’t say anything with these thoughts most of the time because it’s not my place.

I often mentally rebuke myself for having them, but I still have the thoughts.

The truth is that we all make judgements all the time. And when a child acts out a lot, he is judged and labeled.

If a child never seems to be organized, she is judged and labeled.

If a child falls behind academically, he is judged and labeled.

If a child bothers other kids in class with movements or talking, he is judged and labeled.

It happens with or without a diagnosis. The label is there.

With proper management, your child might lose the negative labels and be able to succeed!

Aren’t behaviors and focus problems from bad parenting?

Probably in part due to this stigma, parents worry about how the diagnosis will reflect on the child and family. If a child has an infectious disease or  a chronic condition such as asthma, there is much less hesitation to assess, diagnose, and treat the illness.

If this is just due to bad parenting, how does medicine help?

Diagnosing isn’t always easy.

One of the problems with diagnosing many learning and behavioral disorders is they’re difficult to test for since there is a continuum of symptoms of normal and atypical and there are so many variables (such as sleep) that can affect both learning and behavior.

There are diagnostic tools that should be used to assess the issues at hand. Your child shouldn’t be diagnosed without a standardized assessment. There are many available, depending on the concerns (ADHD, anxiety, dyslexia) and the age of the child, and sometimes kids need more than one type of assessment. Some of these can be done at your physician’s office. Others can be done with a professional who offers that type of assessment.

There is no proof that electroencephalography (EEG) or neuroimaging is helpful to establish the diagnosis of ADHD.

So many excuses to wait…

There are many reasons for parents to be hesitant to begin an evaluation when their kids are showing signs of a learning or behavioral problem.

  • Some think it’s just a phase.
  • Many wonder if another few months of maturity will help the child.
  • Some think the child is just misbehaving and stricter rules or harsher punishments will help.
  • Others think the child is just looking for attention and giving more praise will help.
  • Some parents think it is because of the other children around — you know, “Little Johnny is always messing around in class so my Angel Baby gets in trouble talking to him.”
  • We should try something else. (Linked blog is from a parent who shares her story.)
Why not wait?

While I’m all for looking for things on your own that can help a child’s behavior and optimize their learning (to be covered in a future post), I also think that avoiding the issue too long can lead to secondary problems:

  • academic failures
  • poor self-esteem
  • depression
  • drug/alcohol abuse
  • accidental injuries due to impulsivity and hyperactivity
  • strain on family life
  • social issues with peers

Working with the school and seeking professional help outside of school can help your child succeed.

If a parent is not wanting to start medication, there are other things that can be done that might help the child succeed once the specific issues are identified.

Not treating ADHD and learning differences has consequences.

The children suffer from poor self-esteem because they constantly are reminded that their behavior is bad or they fail to perform at their academic potential.

They have a harder time doing tasks at school because they lose focus. They get distracted and miss important information.

Children get in trouble for talking inappropriately, acting out or for invading other’s personal space.

Social skills lag behind those of peers and they often have a hard time interpreting how others react to their behaviors.

Their impulsivity can get them into dangerous situations, causing more injuries.

Older kids might suffer from depression and anxiety from years of “failures”.

Teens often try to self-medicate with drugs or alcohol.

Why are you hesitant?

If you still worry about labeling your child with a diagnosis, think about what the root of your worry really is.

Remember that the diagnosis is only a word. It doesn’t define the best treatments for your child, but it opens the doors to allow investigation of treatments that might help your child. In the end most parents want healthy, happy kids who will become productive members of society.

How can you best help them get there?

Looking for more?

Many parents benefit from support groups to learn from others who have gone through or are currently going through similar situations, fears, failures, and successes. Find one in your area that might help you go through the process with others who share your concerns. If you know of a support group that deserves mention, please share!

ADHD

CHADD is the nationwide support group that offers a lot online and has many local chapters, such as ADHDKC. I am a volunteer board member of ADHDKC and have been impressed with the impact they have made in our community in the short time they have existed (established in 2012). I encourage parents to attend their free informational meetings. The speakers have all been fantastic and there are many more great topics coming up!

Anxiety

Many parents are surprised to learn how much anxiety can affect behavior and learning. To look for local support groups, check out the tool on Psychology Today.

Autism

The Autism Society has an extensive list of resources.

Dyslexia 

Dyslexia Help is designed to help dyslexics, parents, and professionals find the resources they need, from scholarly articles and reviewed books to online forums and support groups.

Learning Disabilities 

Learning Disabilities Association of America offers support groups as well as information to help understand learning disabilities, negotiating the special education process, and helping your child and yourself.

Tourette’s Syndrome and Tic Disorders 

Tourette’s Syndrome Association is a great resource for people with tic disorders.

General Support Group List 

For a list of many support groups in Kansas: Support Groups in Kansas .

School information

Choosing schools for kids with ADHD and learning differences isn’t always possible, but look to the linked articles on ways to decide what might work best for your child. When choosing colleges, look specifically for programs they offer for students who learn differently and plan ahead to get your teen ready for this challenge.

Midwest ADHD Conference – April 2018

Check out the Midwest ADHD Conference coming to the KC area in April, 2018. I’m involved in the planning stages and it will be a FANTASTIC conference for parents, adults with ADHD, and educators/teachers.

Midwest ADHD Conference
The Midwest ADHD Conference will be held in April 2018, in Overland Park, Kansas.


Share Quest for Health