Dear Therapist

My daughter is 6 1/2. Last year the school brought to our attention that she is displaying possible signs of ADD and they recommended an evaluation. Our pediatrician suggested that since preferred reputable specialists don’t take my insurance, and it’s a very costly evaluation, and being that my daughter is still very young, we can wait until after first grade when we’ll have more information on which to evaluate her. Additionally, he said it is not recommended to start medication at this young age.

However, I am concerned that if she needs help why not be proactive and get her the help now. She has a very healthy self-esteem and I don't want she should lose it if she does poorly in her school work.

When is the right time to evaluate for ADD?

Is there a benefit of having a diagnosis if I won't be medicating her until we have exhausted all other options? 

What’s the benefit of having a diagnosis if I won't be medicating her until we have exhausted all other options?

Who would be suggesting other options, the doctor or do I have to search for them myself?

Response

There are a number of questions that should be addressed.  Which member of the school’s faculty contacted you?  Was that person reporting first-hand information, or was he simply relaying information obtained from another source?  What are the “possible signs of ADD” that concern him?  Do you observe similar signs at home?  Is your pediatrician very familiar with mental health issues and local specialists, or is he only assuming that there are no competent practitioners who accept your insurance?  Is he qualified to determine the appropriateness of ADHD medication?

There can be various reasons for many of the symptoms associated with ADHD.  For example, symptoms like trouble focusing and distraction in school can be due to ADHD, or they can be indicative of high intelligence, which can cause the child to be easily bored.  Kids who grasp concepts more quickly than others often lose interest when the lesson becomes repetitive for them.  Regardless, it’s important to identify the problem, rather than focusing on a label, like ADHD.

It’s important for you to meet with the people who interact with your daughter on a daily basis to get a clear sense of their specific concerns.  Once you understand the potential problem, possible causes can be discussed.  If you determine that a professional should be consulted, an ADHD specialist can help identify causes and possible corrective action.  There are some very good specialists who accept insurance.  A mental health referral agency like Relief can help to guide you in choosing the right professional for your daughter.  A proper evaluation should give you a sense as to whether there is a clinical cause for concern or, if not, what corrective action can be considered.  Depending on the issues and causes, solutions can range from medication to therapy to classroom modifications or accommodations.

Once alerted to a possible diagnosis, parents sometimes become overly vigilant in identifying behaviors and assigning labels to them.  Although your daughter may have problematic symptoms, be careful not to attribute typical behaviors (like normal disinterest in homework or the occasional careless mistake) to a disorder.  Remember to focus on the problem—not the label—in order to ascertain whether it requires intervention, and if so which specific intervention is appropriate.

-Yehuda Lieberman, LCSW

  psychotherapist in private practice

  author of Self-Esteem: A Primer

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