ADHD Evaluation and Treatment at Kaiser
Parent Q&A
Hi, don’t have a doctor to recommended, but just wanted to let you know you’ll find your young adult’s ADHD med prescription(s) will be switched to the Psychiatry Dept., so you’ll need both a PCP & Psychiatrist. Oakland Kaiser does this anyway.
We just completed the ADHD evaluation process at Kaiser, from the time we self-referred to when we get the results in 2 weeks it will have just been 2.5 months. Because our daughter had a concussion over a year ago we are working with a neuro psychiatrist. The wait times you mention I imagine are just to get the first intake appointment and exclude time to gather evaluations from teachers, etc. and write up the report. Might be quicker to switch to Kaiser if you can and go through them versus waiting that long.
Regarding the therapy versus eval, at the one parent group I attended, the facilitator when asked about the need for medication said that ADHD lives in the prefrontal cortex, so therapy alone won't fix that. The therapy can help with anxiety tools, but in our case with a daughter that most likely has the inattentiveness type, months of therapy have done little help with her emotional regulation issues, especially at night. When she has an emotional response out of proportion to the whatever set her off, it can go on for over an hour and the techniques we were taught in therapy before realizing she probably has ADHD do little to stop that sot of irrational looping/spiraling.
One thing I recommend is to get your child tested convergence insufficiency, a functional vision disorder that can't be detected via a standard vision exam. It's something we never considered because our child loves to read and has tested as above average in reading. Many of the symptoms are the same as ADHD. While kids can have both ADHD and CI, some kids can have just CI. We got an initial diagnosis after a 1.5 hour exam at UC Berkeley's School of Optometry. Here's a link to more info on the link with vision and ADHD: https://www.additudemag.com/adhd-and-vision-problems-understanding-symp…
Archived Q&A and Reviews
Feb 2006
I have read most of the posts and recommendations for pediatric psychiatrists and evaluators for ADD. It looks like most of the psychiatrists and evaluators for ADD are private - out of pocket pay (not under HMO's or insurance) AND they are expensive and they have long waiting lists. The HMO's and MD's covered by insurances tend to have to whip through diagnosing and testing and may miss a lot of significant information.
My question is this: Once you have seen a private physician and if his diagnosis seems correct and his recommended treatment - whether it is medication or not, is indeed helping the child - do you have any problems taking this diagnosis from the private physician to you child's primary care physician or a doctor within your HMO or insurance and saying - look here's what this MD did and this is what he prescribed and it works, we want to continue it. Or do they now send you again through their merry-go-round of lightning speed testing and make you live with their diagnosis or continue to pay high out of pocket fees to the private physician? cindy
I think Kaiser does a nice job of handling ADHD once you find a primary care pediatrician who specializes in the medications. There's usually one pediatrician at each facility who sees the ADD kids and knows about the meds. I don't see why they'd want to re-diagnose your child. If you come in with diabetes they don't do that. I have Kaiser and an EPO plan and we go to non-Kaiser doctors for the rare diseases we seem to have in our family but we use Kaiser for all our ADHD needs with great success. good luck
Bothered by ADD evaluation at Kaiser
April 2005
My eight-year-old son is a very enthusiastic student and tries hard in school but has been struggling with reading since 1st grade (he is in 2nd grade) so it was suggested that he be assessed by the district and evaluated for ADHD.
For the ADD evaluation, we went to Richmond Kaiser and during the 3-hour process, we filled out reams of paperwork, then sat in a room full of parents and heard a lecture from the head of behavioral psychiatry while our son was observed in a room with 12 kids of different ages (all of whom were being evaluated for behavioral problems). The psychiatrist told all the parents that the only treatment option for ADD is drugs and Ritalin has no side effects which I found hard to believe.
Directly after, we reconvened in a psychologist\x92s office with my son. It was awkward to discuss why we were doing the evaluation while he was in the room but we did our best. At one point, my spouse mentioned that our son\x92s gymnastics teacher said he doesn\x92t always follow instructions in his class and he had to give him a few ''time outs''. It was the only example we could think of behavior that might be different from his peers. Otherwise, he is an active little boy who is happy and mostly well-behaved. From preschool through second grade, teachers have said good things about his behavior.
My son told me later that during the group session one little girl got up and was turning the lights off and on, then a few kids started yelling: \x93we\x92re prisoners, we\x92re trapped here, let us out\x94. He admitted that he did some yelling too. He wouldn't say much about it beyond that.
After the appointment, we and his teachers completed evaluation forms about his behavior. A few weeks later, the psychologist left a phone message that he was negative for ADD/ADHD. However, she had observed some defiant/oppositional behavior. She offered us space in an Oppositional Defiant Disorder Workshop. At that point I was feeling so demoralized, I didn't bother calling back. I have since had a subsequent conversation with her and clarified that there will be a note in his medical record that she observed ''oppositional'' behavior in groups. It's not a diagnosis, just an observation and was supported by what my spouse had said about the gymnastics class. I thought about defending my son, explaining that it had been a bad day and his rowdy behavior was out of character but it seemed pointless.
I am still frustrated by the whole experience and feel like he got a raw deal. Have other parents who have been through an evaluation at Kaiser experienced something similar? frustrated mom
My son has ADD and is being treated for it by Kaiser. I would ask for a referral to a child psychologist or psychiatrist at Kaiser and try to pin down what the problem is. We had a very good experience working with these professionals at kaiser for our son's ADHD. If they think it's not ADD, there is a pretty good chance it isn't, so do follow up.
There is a very popular ADHD class at Kaiser Richmond taught by Rona Renner - see BPN reviews for more info.
Dual prong it… go through Kaiser & IEP through school. If one says inattentive ADHD and the other doesn’t, ask for a second opinion.
Our daughter (now 17) went through this process two years ago, and although it took us more than one try to get all the questionnaires filled out and submitted in a timely way (she's not the only person with symptoms in our family!), Kaiser did come through with a diagnosis and the meds have been fabulous for her. I would encourage you to keep pushing; the fact that the Adderall has been helpful may be something you can point to to support your sense that ADHD is an appropriate diagnosis. When we did it, Kaiser wanted the questionnaire from both parents, a teacher, and our daughter, and made a clinician available more than once to go over their conclusions with us. Does your sympathetic psychiatrist have any advice for how you should proceed? Your pediatrician? People inside Kaiser know how to navigate the maze and I've had my best luck by laying out my needs and worries pretty explicitly, face to face so as not to generate a paper trail that could come back to bite us in the butt. FYI, In our family's experience, the assessment tools for ADHD in adults are really poor; they don't seem to pick up how adults can develop workarounds for the challenges they face (like outsourcing executive function to spouses, or tracking themselves into particular occupations, or constraining themselves with extremely limited routines) so that an assessment based on getting through the day's tasks doesn't pick up necessarily how much the person's independence and freedom is being undermined by their struggles. If you can get a diagnosis now, it might be better to keep pushing rather than wait.
This was about 10 years ago, but our child was diagnosed with ADHD through Kaiser. The parents and several teachers were asked to complete questionnaires which were submitted to Kaiser (we did not see what the teachers had filled out), then an in-person assessment was completed. It sounds strange to me that a person with ADHD could potentially “fail” an ADHD assessment, though I’m not a doctor. I’d be doing everything I could to get the proper diagnosis; in our experience it doesn’t get better over time.
Hi! Wanted to share my experience. Our child is 11 and in sixth grade. Last year in fifth grade, they were having a lot of problems in the classroom, and we went through the Kaiser ADHD process, and they were diagnosed with ADHD. But then we tried a few different medications and nothing had any effect, to the point their pediatrician questioned whether they even had ADHD. I was also not super-impressed with the diagnosis process anyway because it was only about an hour of direct evaluation of our kid (and was remote). We also suspected other things going on, so we decided to bite the bullet and do a neuropsychological evaluation at Summit Center. It is NOT CHEAP, but if you can afford it, I would highly recommend it. The evaluation gave us way more certainty about what was going on - in addition to affirming that my child did have ADHD, it also uncovered things that we would have never known for sure if we stuck with Kaiser (mild ASD, dysgraphia, giftedness, depression/anxiety). After the whole Kaiser process, we really wanted more certainty and a comprehensive understanding of our child so we could better help them. And getting that information, even though it's a lot, is a huge relief.
As for timing, I don't have any solid info - but my gut feeling is you would definitely want something by high school, when academics get harder and the need for accommodations will be greater. At this point, my child does not need formal accommodations, but I suspect they will in the next few years, and I'm glad the school is on notice about it. Even just having their teachers aware of it is helpful IMO - I have seen a little more flexibility toward them already, even though we do not have a 504 plan yet.
I'm so sorry it has been so hard to get a diagnosis! I really feel this, both as a kid who was tested and found to "be borderline but not actually have ADHD" at age 11, and as someone who was later diagnosed as an adult, recently at 40+. I am not sure if this will be helpful feedback, since I am an adult, but I was diagnosed through Kaiser earlier this year, and I found the process much improved from when I previously asked for an evaluation there. I think I am familiar with the written questionnaire that you might have done a few years back. I also filled something similar out when I first started seeking a diagnosis, and did not submit it, because I found it problematic and was worried I wouldn't end up with a diagnosis, even though I was certain I had ADHD. When I went back for testing recently, the process was verbal, rather than written, and done via Zoom. I found the evaluator and psychiatrist that I worked with to both be sympathetic and lovely. My non-network therapist has also said that she had heard that Kaiser seemed to be doing a better job recently of diagnosing ADHD, especially in women and girls.
Have you discussed the potential for ADHD with the therapist? What is their opinion? If they are in agreement with you, there's probably a good chance the evaluation will result in a diagnosis. I also want to send some reassurance: I believe if your daughter was already diagnosed with social anxiety and has a regular therapist, I don't think a non-diagnosis of ADHD would also lose you her previous diagnosis and existing therapist. You should be able to easily confirm this with them via email if you want to make sure before you start the ADHD evaluation.
I would advise to go ahead and go forward with the evaluation at Kaiser, make sure you tell the evaluator about your concerns and previous experience, and if the results are not what you know your daughter needs, ask for a second opinion. If anyone refuses you a second opinion, make sure it is noted in her charts that you asked for one. Then do your best to get an out of network evaluator that has a good reputation for diagnosing ADHD in girls. Ultimately, I hope those steps aren't necessary and the process is easier than it was the last time you tried!
Any chance you would consider taking a functional medicine approach to your daughter’s spacey behavior? We are having success using a naturopath rather than stimulants.
Hi! I have a very similar situation with my 10 year old daughter. It took me about 2 years of advocating with Kaiser to finally get a diagnosis. They evaluated her twice and both times they saw the concerns on parents rating and also noted the symptoms in their interactions with her, but because she does not stick out at school, school ratings were not elevated and they would not give us the diagnosis. I ended up going through Kaiser to get myself identified (I knew I had ADHD for a long time, but never pursued official diagnosis). Once I was diagnosed I went through their online class for parents of children with ADHD and then was able to advocate through the provider who gave the class for my daughter to come in for an in office assessment. She did the computerized assessment and did well (because it's novel and she attends to novel activities). They noted mild impulsivity on there. Then we had an extensive talk with the psychiatrist where I clearly outlined all of the executive function concerns, the impact on her self-esteem, as well as my own diagnosis and similarities to her in school. The doctor was still on the fence, but finally decided t give her the Dx of ADHD-unspecified type. It is frustrating that there is not as much attention or awareness to the ways ADHD can present differently in girls. I am happy to chat with you anytime, but I encourage you to keep advocating for her because it seems like they need a lot of persuading if the student is not disruptive or struggling in school. Good luck!
Hi - We just avoided getting the diagnosis at Kaiser entirely. I assumed it would be a nightmare, and your experience so far suggests I was probably right. Our son was 5 when we figured out he was probably ADHD. I don't think Kaiser would even consider testing until he was 6, and of course trying to get an appointment with a specialist was an exercise in absurdity. We went to a neuropsychologist who did the testing and diagnosis and passed it along to our Kaiser pediatrician. So far, everything's been going okay. We're in the process of trying to find the right medication now. If I'm remembering rightly, the neuropsycholgist's testing and diagnoses cost about $5k, which obviously not everybody has lying around. I believe another option would be to go through your daughter's school district. My understanding is that they are required by law to provide support--which should include testing. This website should either have some information or you can email the organization for help. https://familyresourcenavigators.org/. I asked them a couple of questions when we were negotiating the IEP/504 situation at our son's school (OUSD), and they were super nice.
Good luck!!