ADHD meds and choices

[justTess]

My 15 yr old son was recently diagnosed with ADHD using 3 surveys.  I really wanted him to be tested using WISC since he is also gifted (140 OLsaT 3 years ago).  It seems like our current psychiatrist allows us to decide our own course with medication to see what would work best.  He is currently on 25 mg Vyvance and the last month he has said it made a world of difference with his attention in school.  His grades are like a rollar coaster, either failing for incomplete or missing or outstanding 95+.  

My question is

1) Is it a good idea for my son to take the meds whenever he feels like it?  He wants to take it on days he wants to focus on the instruction and other days he doesn't want to take the medication because he says it makes his personality boring. (I say more obnoxious and annoying).

2) If he takes meds daily, wouldn't it be more possible to see more consistent grades? organization habits?

[Rachna Varia, PhD]

Hello-It sounds like there is still a lot of confusion about when your son should medications and how helpful it actually is.  Given that I am not a medical doctor, I cannot comment on the medications directly.  I can, however, state that it is very important to get a thorough evaluation to determine what type of ADHD it is (there are many different subtypes, which may inform treatment) as well as if there is another learning issue involved.  The incidence of other learning problems with children who have ADHD is quite high and that is why a full psychoeducational assessment is required.  At our practice, we never base a diagnosis of ADD on a self report measure, because it can be so subjective.  It is important to get a baseline IQ, understanding visual and auditory memory, visual motor integration, executive functioning (organization, planning) as well as how the symptoms create an educational impact on reading, writing, and math.  I would consult with your MD and ask for more direction about the medication protocal as well aas seek out a psychologist to complete a more thorough assessment.  Dr. Varia

[Rachna Varia, PhD]

I just spoke with one of my former colleagues in Austin - Dr. Jim Misko and he recommended  Dr. Richard Fulbright in Dallas [phone].  Dr. Misko Misko said that if he doesn't work with adolescents, he should know who does  I hope that helps. -Dr. Varia

[justTess]

We're in the Dallas, TX area.  

I'm hoping to find some sort of diagnostic testing which will aid in helping my son understand his difficulties and enable him to decide what choices he has to compensate in particular areas which seems to be his hypersensitivity to light and sound.

[Rachna Varia, PhD]

Yes, it is true that the testing might not be covered by insurance, because they believe it to be more "educational" than "medical."  Where do you live? Perhaps, I can recommed someone in that area.  Thorough testing is a must to really understand how a child/adolescent child's brain works.  At MindWorks, out testing is usually 5-7 hours and includes consultation with teachers, parents, or any others who might have a perspective on the problem. It is also important to document ADHD clearly (if that is what it is), to determine if might be eligible for speicial accomodations, such as extended time on standardized testing.  In this situation, they would definitely need the scores/interperpreation from the WISC/WJ-III (Tests of Achivement), CPT (A computerized test of attention that measures vigilance, reaction time), visual motor integration (organization), and reading rate fluency (Nelson Denny Reading Test).  

It is really a problem that complicated diagnoses are made from checklists.  Can you imagine if a diagnosis of cancer was made from a checklist rather than extensive bloodwork?

We're working hard to have other professionals and people understand how important a thorough work up is.  I'll post a blog on it.  Dr. Varia

[justTess]

thank you for your advice.  

That is one of the problems I have been experiencing for 6 months.  We have seen 2 psychologist who just met with for an hour which led to an "inconclusive" diagnosis.  None of them do the type of testing that you have mentioned.  We finally found a psychiatrist who would see an adolescent and has only offered the self report surveys.  When I asked about something more indepth like the WISC, he tells me since my son is not failing any subjects, it would be hard for insurance companies to pick up the tab for such.

How do I find the right kind of psychologist who uses more indepth diagnostic type testing?  

Is there a specific name or specialty I am looking for?

Thank you in advance.  The whole process is a bit time consuming and fustrating.