Q: “How can I get my son diagnosed with ADHD without incurring any medical costs? His school will not give him the diagnosis, even though I have been trying to get him diagnosed since 1st grade, and now he is in 8th grade. His is not a behavior problem. He is a people pleaser, but school is affecting his confidence because his executive function skills are lacking. He puts pressure on himself to be the best at everything he does. He threatened to kill himself last year because of his grades, saying he felt stupid. He did see a therapist for about 6 months after this threat. I just want him to be able to get more help in school so he can gain more confidence in every area of his life, and learn life skills so he can function as an adult.” — FeelingHopeless
Dear FeelingHopeless,
While your hopelessness is understandable, I want to assure you there are good options for your son’s ADHD diagnosis and treatment. Be encouraged.
When bright kids with attention deficit hyperactivity disorder (ADHD or ADD) do ‘well enough’ at school, it can be extra challenging to secure them the academic support they need to develop crucial executive functioning skills. In elementary school, their intelligence often compensates for some of their executive functioning challenges. By the time they enter middle school, though, the greater demands for personal responsibility and independence (seen in new levels of organization, planning, shifting, working memory, and prioritizing), mean they now need direct instruction and extra support from teachers to keep track of assignments, papers, books and schedules.
Unfortunately, schools don’t always provide the services they should. In fact, researcher George DuPaul and his colleagues recently conducted a huge study of this issue and found that one in three students with ADHD receives no school-based services even when they experience significant academic and social impairment. Sadly, your son is not alone.
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As you have personally experienced, it can be a frustrating and convoluted process to obtain a diagnosis of ADHD. There are three main paths to an ADHD diagnosis:
- a private, self-pay evaluation
- a private evaluation paid by insurance
- an evaluation through the public schools
Schools are not allowed to diagnose ADHD because it is considered a health disorder. But they are able to identify concerns about attention, concentration, and memory with psychoeducational testing. If you request an evaluation through the Special Education Department (or through your school), they are mandated under IDEA (Individuals with Disabilities Education Act) law to follow through and assess students for possible learning disabilities, including attentional difficulties. The assessment process usually includes an evaluation of speech and language, academic skills, cognitive functioning, and psychological well-being. If you are not making headway in getting this evaluation, I urge you to contact an educational advocate.
When the evaluation is completed, there is a team meeting to decide what, if any, type(s) of special needs your child may have and whether he is eligible for mandated services (IEP) or an accommodation plan (504). Since many kids with ADHD also struggle with reading, mathematics, or writing, these learning disabilities can be diagnosed by the school and given support services.
Once the report is completed and you’ve had your meeting, arrange to meet with your son’s primary-care provider so he or she can diagnose ADHD if it is highlighted in the evaluation. With this diagnosis in hand, you can now return to the school and ask for appropriate services. Make sure that your son participates in whatever plans are created to help him so he’ll have buy-in and motivation. Your job is to email with the teachers to make sure they are following through and to support your son by implementing the plan at home.
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It seems like your son also needs more guidance developing appropriate coping skills. I’m concerned about the undue pressure he places on himself and his threats for self-harm. Many kids with ADHD struggle with perfectionism as a way to prevent judgment from others. In reality, it leads to greater personal criticism and low self-worth. Helping him discover and value his strengths and talents is a crucial balance to this type of negative self-talk. I strongly encourage you to seek counseling for him, either with the adjustment counselor at his school or through a mental health agency that offers therapy on a no-cost or sliding-fee scale.
You can help with this, too. Each day at dinner or in the car on the way home from school or an activity, ask him to tell you three things he liked about his day. These can be small items such as “They served pizza at lunch” or bigger things like “I got 91 on my math test.” We want to shift his attention away from what isn’t working to what is going well (or at least going ‘okay enough’). Pay more attention to his effort on any project (chores, homework, etc.) instead of focusing on what he does or doesn’t accomplish. This will also reduce his perfectionism and help him value trying as much as succeeding. With patience, practice and useful mental health and school support, I believe that he will be a happier, more satisfied young man.
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The opinions and suggestions presented above are intended for your general knowledge only and are not a substitute for professional medical advice or treatment for specific medical conditions. You should not use this information to diagnose or treat a health problem or disease without consulting with a qualified healthcare provider. Please consult your healthcare provider with any questions or concerns you may have regarding your own or your child’s condition.
Sources
1 DuPaul, G. J., Chronis-Tuscano, A., Danielson, M. L., & Visser, S. N. Predictors of Receipt of School Services in a National Sample of Youth With ADHD. Journal of Attention Disorders (Dec. 2018) https://doi.org/10.1177/1087054718816169