He loves to write his name over and over again, to count his toys, and make up new rules to games. He's a blast to be around, and his enthusiasm for life is exactly what I need when I've had a bad day. I love him dearly, and I make a point of being there for him as much as I can. So, today I went with H and his mom for a neuro-psych evaluation that his school mandated. The school believes that he has ADHD, and they needed someone with the appropriate credentials to give their diagnosis a stamp of approval -- and that is exactly what this evaluation was.
Over the years, I've spoken against ADHD, ADD, and the medications that typically go along with it. In "ADD, ADHD, Neuro-stimulants, and the Gifted Brain," I discussed the physical and mental repercussions of prescribing stimulants such as Adderall and Ritalin to such young children and analyzed the significant increase in diagnoses over the last decade. I've known for all too long that many of these diagnoses come from psychologists and neurologist who "specialize" in placing such labels on children after spending very little time with the child simply to appease a school district that doesn't know how to handle a child who's neuro-divergent - or just a little more enthusiastic about learning than their peers! Despite this, the evaluation that he received today shocked me. I'm not even sure it should be called an evaluation, and I'm most certain that this neurologist had no right to claim that H has any sort of neurological disorder based on the full TEN minutes she spent with us. Yes, ten minutes.
I've always wanted to sit in on a neuropsych evaluation "for ADHD" to see what it's really like. Albeit, I'm sure that there are some doctors out there that are truly passionate about their work, love children, and live up to the Hippocratic oath, but this one sure didn't fall into that category.
I was skeptical from the beginning. We walked in the doors and quickly rushed H to the bathroom after a long car ride. His mom greeted the receptionist, but the receptionist could barely be bothered to muster a meager "hello." The receptionist handed her a single paper which asked for basic information including name, address, child's name, and date of birth. While I'm not a particular fan of the paperwork that doctors hand out, I definitely understand their purpose. On this particular occasion, we expected a mountain of paperwork containing various symptom rating scales, a request for a full medical history, and some open ended questions about H. We were given no such paperwork at any point during our visit. No release forms or HIPPA forms. Nothing.
The waiting room was uninviting -- neatly lined up chairs, a few children's books that hadn't been replaced since the 70s, and dull colors. The only redeeming quality of this waiting room was the TV awkwardly hung on the wall playing children's cartoons. We sat and waited. After ten minutes, another child and his mom left the back room. We watched as the doctor sat at her desk and paced around the office. We continued to wait, and H watched his cartoons. He was seconds away from napping in the car, and he might've taken a short nap in the waiting room if the seating allowed for it.
Forty minutes later, the doctor walks out and calls us back. No "Hi, How are you?" No friendly greeting of any sort. We walk the ten short steps to her office and take a seat. I silently wonder if I should close the door because she didn't. The room is nothing special -- two adult sized chairs, a desk, a medical table, and an open Sterlite containing a stethoscope, a flashlight, and a reflex hammer. No toys, pictures, inviting activities, books, or even colorful walls. There wasn't even a chair appropriate for a four year old child to sit comfortably on. There's three of us and two chairs, but there's no offer to grab a third chair. We awkwardly arrange ourselves and wait for her to begin.
She asks our names, so we introduce ourselves. She asks H his age. He proudly sticks out four fingers and declares his age. She proceeds to ask a few menial questions. Was he pre-mature? No. Does he have any siblings? Yes. Does he play with them? Yes. H sits quietly in his chair. We told him that he was going to go play with a new doctor. He likes to play with his teacher at school. This was going to be just like that. This time never came.
Without forewarning, she throws a card onto the table and asks him to name the object in the picture. They're simple and almost insulting. Apple. Cat. Key. Ball. He plays along. Which one of these pictures is a pet? He stabs the picture of the cat. She goes through six of these cards and, no surprise, he nails each one.
She places a few worn out foam cubes on the table of varying colors. How many red cubes are there? "1....2....3....4...There are four red cubes," H answers. How many green cubes are there? "1...2...3...There are three green cubes." She starts to put the cubes away, but he wants to count the yellow and blue cubes too. "No. We're not counting those cubes," she snatches the cubes away. H wants to know why he can't count the other cubes. When he takes a test at school, they want him to count all of the groups. He plops his head on the desk. Defeated.
She places some letter cards on the table and asks him to name the letter. Singular. But she places other letters on the table too. It's clear that she wants one answer, but even I'm not too sure which letter he's supposed to identify. H decidedly names the letters in the order that they were placed. Good job, kid. She looks satisfied. His head is still on the desk. He's bored. He's tired, but mostly he's just staring at her like she's a crazy lady. Maybe she is. She makes a living evaluating children, but she sure doesn't seem to like children. In fact, she seems rather annoyed to be in the presence of a child. His eyes are barely open, and he answers all but two correctly. I'm also confident that he's just poking fun at her questions. He doesn't want to play this game. He's not a trick pony.
That's it. She's done with him. She taps his knees with the reflex hammer. She flashes a light at his eyes and hands. She doesn't tell him to look at it, and I'm not sure she's paying much attention either. She's just going through the motions. She asks his mom another question or two, and then we're done. We walk out the door, and return the car. The whole process took less than ten minutes. She didn't talk to him or ask him questions. She barely treated him like a person. He's four. That doesn't make him less than human. That doesn't mean he doesn't deserve respect. He was standing right in front of her, and she barely looked at him the entire time.
His mom and I spent the car ride back venting about the experience. She took the day off from work to spend with H to ensure his day went smoothly. We spent nearly two hours in the car to go to this evaluation. Ten minutes consumed an entire day and didn't provide any worthwhile results. I felt as if we lied to H. We told him that he was going to meet a nice new doctor that was going to play with him. That didn't happen. We put him in a situation with an adult that didn't show him an ounce of respect. We deprived him of a nap. He doesn't nap often, so he must not be feeling too well. We pulled him away from his toys and his favorite little brother and impeded on a relaxing day off to spend ten minutes with a so-called professional that conducted an evaluation H could've administered himself.
This experience wasn't at all what we expected, and H deserves so much more. The report that this doctor writes will impact his entire educational career simply because she has an MD tacked onto her name. This particular assessment was a targeted ADHD evaluation, so it wasn't supposed to include a comprehensive IQ test or a battery of achievement tests, but I still expected the doctor to spend enough time with H to assess whether or not any of his behaviors or habits were of concern. If this assessment had been a personal decision, I most certainly would have shelled out the extra cash for a fully comprehensive neuropsychological evaluation that included a full battery of tests, but it wasn't my decision. The school district requested it, and they chose the doctor. Regardless, a doctor should still do their due diligence when diagnosing a child with any disability. A targeted approach won't provide anyone with a full picture of the child, but it should -- at the very least -- be thorough enough to provide some understanding of the child.
Before an initial appointment, you should receive several behavior checklists and questionnaires to fill out about your child. You should be allowed to fill these forms out at home with adequate time to carefully think about your answers and articulate your thoughts. Upon arriving for the evaluation, the psychologist or neurologist should spend time interviewing you[the parent]. The doctor should open up a conversation about your child's behavior in different settings, your child's medical history, developmental milestones, family issues, and more. Since the doctor doesn't see your child every day, the parent interview is an important part of the process to help him/her understand your child better.
After meeting with you, the doctor will spend time with your child. The doctor should spend time with the child with you in the room and without you in the room. The doctor should start by ensuring that the child knows why they're at the doctor today and follow that up with several questions to help your child feel comfortable. When working with young children, any assessment should seem like fun. The assessment should consist of activities that allow the doctor to see how your child engages with the tasks presented. These tasks may consist of a combination of questions, games, and puzzles.
If you aren't satisfied with the service you receive from a doctor before, during, or after a neuro-psychological evaluation, consider seeing a different doctor. You and your child deserve the best care out there. In this particular case, H's mom doesn't feel that another assessment is necessary because she didn't feel it was necessary in the first place. The doctor did put her stamp of approval on the school's "diagnosis," but it doesn't seem like it will harm him at this time. No one wants to medicate him, and he will stay in a mainstream classroom. He gets to keep his IEP which is like a golden ticket in the world of public education. The state of NJ doesn't require IEPs for gifted, but if a child already has and IEP, it can include services for giftedness. He has a phenomenal preschool teacher this year that works with H closely and differentiates to suite the different learning needs of all of her students. We'll see what next year brings.