Latest / Play Therapy Parenting: Real Parenting Questions Answered by a Child Therapist / S3E32 - ADHD Diagnosis: What Parents Need to Think Through

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S3E32 - ADHD Diagnosis: What Parents Need to Think Through · Play Therapy Parenting: Real Parenting Questions Answered by a Child Therapist

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  You're listening to the Play Therapy Parenting Podcast
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  with Dr. Brenna Hicks.
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  Hi,
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  I'm Dr. Brenna Hicks,
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  The Kid Counselor.
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  This is the Play Therapy Parenting Podcast where I give you insight,
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  awareness,
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  and enlightenment about your parenting
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  and your relationship with your kids.
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  In today's episode,
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  I'm answering a question from Chantelle.
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  Thank you so much for the question,
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  by the way.
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  And this is about her six year old.
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  And
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  her six year old's actually in play therapy.
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  I'm really thrilled to hear that,
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  Chantelle.
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  I think that that's such a helpful path when a child needs some support.
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  But Chantelle has some questions about whether
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  or not getting an assessment is valuable.
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  And while continuing with the play therapy process,
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  how to address things with the school system.
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  And and kind of the difficulties of working through things and that journey
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  as we're kind of trying to find a more settled state.
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  So let me just hit some highlights from the email and then we'll dive in.
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  My son's issues began in junior kindergarten,
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  which he started at the age of 3.
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  Now he's in 1st grade.
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  He has been working with a play therapist.
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  Challenges go beyond school.
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  It's home,
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  day camp,
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  extracurricular activities,
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  social engagements.
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  He has difficulty regulating his emotions,
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  particularly anger,
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  and seems hyperactive.
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  He's often sent home or kicked out of programs because he's easily distracted,
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  disruptive,
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  and at times aggressive.
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  It doesn't help when kids say things like he's always mad or he's bad.
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  Understandably,
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  that makes him more triggered.
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  We're now at a point where kids in his class try to physically move
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  away from him or are scared and don't want to play with him.
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  I recently took him to a doctor where I described our struggles,
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  and the doctor was very quick to refer us to a specialist to assess him for ADHD.
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  I'm a bit skeptical about that,
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  given that ADHD seems to be the answer
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  everyone has for every child with behavior issues.
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  Yes,
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  100%,
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  that is the issue.
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  I'm happy that you recognize that,
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  Chantelle.
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  How much of this is just normal 6-year-old boy behavior,
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  and when do I know it's time to take the step of getting him assessed?
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  I'm concerned about him being labeled.
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  I don't want him to be limited by a diagnosis.
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  His teacher shared that her own son exhibited similar behaviors at my son's age.
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  They had him assessed and he was prescribed medication,
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  and it changed the game for them.
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  It helped to quote,
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  take off the edge in ways she couldn't imagine,
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  but it did so without changing his personality.
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  This has by no means eliminated my hesitancy
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  regarding ADHD diagnosis and medication.
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  But I live in a constant state of anxiety,
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  waiting for someone to call and tell me that he
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  did something and they need to send him home.
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  Here's some background that I think is helpful.
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  He's very active,
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  high energy.
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  He's very funny and witty.
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  He's very social and expressive once he's comfortable in his environment.
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  Academically,
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  he's doing well.
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  We would like him to make progress in learning to regulate his emotions,
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  and
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  he loves being outside doing anything active.
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  Transitions are typically hard for him,
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  especially if he likes what he's doing.
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  Changing activities can trigger him to become disregulated.
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  We have been working on validating his emotions.
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  You are angry,
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  frustrated,
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  excited,
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  but crayons are not for throwing,
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  etc.
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  Giving him space to calm down.
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  Developmentally appropriate choices,
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  engaging him in lots of physical and mental stimulation.
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  And it's important to us that he understands he's not a bad kid.
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  He just
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  makes decisions that need to be adjusted at times.
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  We enforce
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  to him that his feelings and emotions are valid.
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  It's the behavior that is sometimes problematic.
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  OK.
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  So,
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  Chantelle,
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  thank you so much.
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  And obviously,
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  I only hit highlights.
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  That was a much longer email.
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  But
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  I want to spend a little bit of time talking
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  about this because I think this is so crucial for us
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  as we navigate
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  a very specific
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  system that is more universal.
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  In other words,
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  the standard in medical,
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  the standard in insurance,
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  the standard in academic.
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  Is almost always evaluate,
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  diagnose,
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  and medicate.
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  That,
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  that is a standard pervasive approach.
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  And obviously the child-centered play therapy model is different.
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  The child-centered play therapy model is,
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  let's look at all of the components.
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  Let's look at the psychological,
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  the behavioral,
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  the emotional,
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  the social.
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  The relational,
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  so many
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  components,
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  and then if we still think
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  that it warrants an evaluation
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  or a diagnosis,
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  then let's do that afterwards.
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  So for us,
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  it is not that we
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  refuse to diagnose.
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  I'm actually legally able to diagnose.
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  I choose not to,
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  and I've been very upfront about this.
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  A diagnosis goes on a child's permanent mental health record.
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  So at 3 years old.
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  A child that goes and gets a diagnosis of anxiety at 3,
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  which by the way,
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  so many of the diagnoses that children are given,
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  they're not even meant to be pediatric diagnoses.
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  Please do your own research.
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  Please educate yourself.
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  Please be aware.
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  That many of the things that our children are being diagnosed with,
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  they are not even meant to be diagnosed
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  for young children.
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  But this is the model that we're up against.
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  And so,
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  I'm able to diagnose.
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  I choose not to.
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  I don't ever want a child to have a
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  permanent mental health record that's going to follow them
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  into their adult years.
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  And so,
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  that's my decision.
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  There are important components to consider though,
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  because as you mentioned,
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  Chantelle,
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  ADHD is the catch-all diagnosis.
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  I,
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  I make this argument all the time and it's kind of a joke,
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  but I mean it.
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  Every single human on this planet
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  on a certain day of the year could probably meet diagnostic criteria for ADHD.
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  It is not meant to be a,
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  you look at a
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  child or a person at one moment in time
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  and say,
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  yep,
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  you checked 11 of the 13 boxes.
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  OK,
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  you obviously have ADHD,
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  let's diagnose and medicate.
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  We're missing the hole.
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  We need to look at a child holistically
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  and say,
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  OK,
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  what's going on for this kid?
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  What's going on in every environment,
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  in every moment,
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  in every situation,
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  it's not a snapshot.
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  On Tuesday afternoon at 1 p.m.
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  the child was ADHD.
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  We all would meet criteria at any random given time
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  on a random day in the middle of the year.
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  So we have to be really intentional.
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  How are we seeing this in terms of what else is going on for the child?
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  Is this child just dysregulated because they don't have an emotional vocabulary?
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  Is this child reeling because everything in their life in
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  this last year has been completely out of their control
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  and they're just grasping at any measure of control that they can take.
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  Are these signs of dysregulation?
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  Are these signs of anxiety,
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  and often anxiety and power and control go together.
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  So sometimes there's a big crossover there.
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  There's more to the story.
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  So my suggestion to parents is almost always,
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  let's pursue child-centered play therapy.
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  Let's give a child the opportunity
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  to address
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  all of the things that they need to work on.
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  In their truest state,
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  in their most natural state,
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  because as soon as we introduce medication.
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  We've lost causality.
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  Are the meds making the child different?
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  Is play therapy making the child different?
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  Is maturation making the child different?
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  Now causality goes out the window.
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  So we only want to change one thing at a time.
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  And let's let the child process through
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  building an emotional vocabulary,
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  building a worldview,
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  building regulation,
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  building self-esteem,
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  learning how to handle frustration,
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  learning how to problem solve
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  all the things that we know kids gain out of CCPT.
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  Let's go through all that.
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  And if
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  at the end of CCPT we say,
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  you know what,
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  there's still indications that there's more to the story here.
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  We don't see the regulation that we would have hoped for.
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  We don't see the outcomes that we would have thought.
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  Maybe this is worth getting an evaluation.
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  But we're always trying to do less
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  invasive first.
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  So CCPT
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  there are no side effects,
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  there's no chemical changes in the child.
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  They're not forced to take a medication every day,
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  sometimes multiple times a day.
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  The side effects of ADHD meds.
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  are awful
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  most of the time.
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  I,
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  I'm on the front lines of it every day.
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  I see kids on ADHD meds
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  and they're a shell of who they used to be.
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  Are,
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  are they a little bit more in control?
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  Are they a little bit more flat?
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  Are they a little less all over the place?
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  Sure,
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  but they're not even who they used to be.
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  We have to be really careful
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  about looking at how do we give a child an opportunity
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  to sort
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  through things
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  without altering who they are.
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  And
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  in my opinion,
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  that's CCPT.
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  So,
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  Chantelle,
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  let's get back to your question.
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  Is it worth,
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  after your child's already been in play therapy for a while and we're still not
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  at a point where we want to be yet,
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  is it worth getting an evaluation?
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  Here's my thoughts on that.
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  An evaluation
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  is just an evaluation.
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  It provides insight.
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  It provides answers.
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  It provides information.
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  And you get to decide what you do with it.
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  So you can get an evaluation and regardless of the results.
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  You can just file it away in.
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  A drawer somewhere and ignore it.
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  Or you can present it to the school,
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  or you can
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  pursue
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  medication.
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  Or you can pursue a 504 or an IEP or whatever
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  it is within the school that gives your child accommodation.
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  Or you can pursue other services as a result.
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  You are completely in control.
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  The,
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  the evaluation and the assessment in and of itself
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  changes nothing
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  other than
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  you have someone's opinion of what might be going on.
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  If you get it back and it says,
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  yeah,
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  this is all just psychological and this is all
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  behavioral and it's all emotional and we don't see any
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  physiological or chemical reason for this,
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  so
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  you just need to keep play therapy.
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  Then you decide what you want to do with that.
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  If it comes back and says,
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  he's on the spectrum,
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  and he has ADHD,
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  and he has
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  something else.
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  OCD or,
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  you know,
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  whatever.
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  OK,
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  so you get all of this litany of diagnoses,
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  you decide what you want to do with that.
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  The school doesn't need to know.
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  You don't need to pursue anything other than you got information.
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  And even if you choose to do nothing with the results now,
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  you could do something with the results down the road.
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  You can file it away for now and then make a different decision 6 or 12 months from now.
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  So I think that
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  an evaluation and an assessment
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  is a tool to provide potential why.
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  But you get to decide whether you want to pursue
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  anything further beyond the information that you were given.
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  And you can choose to
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  never speak about it again,
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  or you can choose to
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  garner his whole childhood around that.
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  So while I'm very much,
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  let's just do CCPT
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  and see if we even need an evaluation
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  at some point down the road.
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  Because
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  CCPT
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  almost always addresses everything a child is dealing with.
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  So most kids at the end of CCPT,
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  no one would ever consider pursuing a diagnosis at that point.
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  But if you're at a point where you're like,
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  look,
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  we've been in play therapy for a while and we're still having some issues,
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  it doesn't hurt anything
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  to have an evaluation or an assessment.
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  Hold on to the information until you want to do something with it,
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  or maybe you never want to do anything with it.
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  Maybe you burn it
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  and you say,
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  I think this is nonsense.
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  I'm,
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  I'm just going to pretend it never happened.
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  Maybe you tell the school,
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  maybe you tell the pediatrician,
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  maybe you do whatever,
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  but there's no harm in having the why.
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  And then making an educated decision as a result.
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  So that would be my suggestion to you,
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  Chantelle.
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  I've encouraged a lot of parents to do that,
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  and they've been able to do that with a lot of success and a lot of comfort
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  because I think a lot of the unknown is what happens if
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  I do this?
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  What does that mean?
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  Well,
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  you get to decide what that means.
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  And there's a lot of control
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  over the outcome for that.
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  So I hope that that encourages you and for those
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  of you that are maybe in that same situation,
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  you know,
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  like you,
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  you're curious about whether or not your child is struggling with something.
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  An evaluation is just a tool for information,
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  and that's all that it needs to be unless you choose to do more with it.
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  So I hope that that encourages you and supports you.
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  If y'all want to reach out to me,
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  I'd love to hear from you,
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  Brenna at the kidcounselor.com.
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  I love y'all.
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  Keep loving your kids.
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  We'll talk again soon.
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  Have a great week.
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  Bye.
• 13:29
  Thank you for listening to
• 13:30
  the Play Therapy Parenting Podcast with Dr. Brenna Hicks.
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  For more episodes and just subscribe to our newsletter,
• 13:37
  please go to www.playtherapyparenting.com.