Ask the Experts

Q: When Should I Take My Child Back To the Pediatrician?

Your child was diagnosed with ADHD a few years ago, but he’s still struggling. How do you know when he needs another evaluation and/or diagnosis for a hidden comorbidity?

Q: “Our child was diagnosed with ADHD at age 8, but he’s still struggling. Should we insist on another evaluation for a related condition?”

Roughly half of all children with attention deficit disorder (ADHD or ADD) also have a comorbid, or related, condition. That’s why it’s so important for diagnosing clinicians to evaluate children for the following conditions that commonly mimic or occur along ADHD.

  1. Developmental disorders:
    1. Developmental delays
    2. Learning disorders
    3. Autism spectrum disorders
  2. Mental health conditions:
    1. Anxiety disorders (including obsessive compulsive disorder)
    2. Self-esteem problems
    3. Relationship challenges
    4. Mood disorders/dysregulation
    5. Oppositional behaviors
    6. Conduct disorder
    7. Substance abuse
  3. Medical conditions:
    1. Sensory concerns
    2. Tic disorders
    3. Obesity

Initially, many families choose to triage — that is, deal with the biggest problem first. They aim to get the ADHD symptoms under control, and then deal with the comorbidity condition by condition. This approach is sensible and much more palatable to caregivers overwhelmed by the prospect of separating two or three diagnoses that are often intertwined.

For example, you don’t need to know whether autism spectrum condition, anxiety disorder, or ADHD is causing your child’s social difficulties. The answer won’t change the fact that she is struggling socially.  Even if you’re not 100% sure which condition is causing the problem, you know the first-line remedy is behavioral therapy.

[Free Resource: Is It ADHD or a Misdiagnosis?]

What becomes more difficult, as a parent, is deciding whether the treatment plan is working — or further evaluation and treatment is needed. The answer to this question is made only by observing, knowing your own child, and recognizing that:

  • “Something is still going on at school.”
  • “He just doesn’t seem happy.”
  • “The treatment isn’t making a difference.”

The threshold here is low because the likelihood of diagnosing another condition is high. Chances are, your child will need an additional evaluation and/or treatment strategy.

It’s OK to tell your pediatrician, “We started intervening for ADHD, and what we’re doing isn’t helping.”

[When It’s Not Just ADHD: Uncovering Comorbid Conditions]

The solution can mean adding medication alongside behavioral therapy. ADHD medications are safe and effective when used properly, and often decrease comorbid symptoms once ADHD symptoms are well-managed. Many families choose to try it and closely monitor whether things get better or worse.

For other families, the solution may be additional screenings and evaluations. Many can be done by the school district, and they may help your child gain access to more services. As a caregiver, you have the right to ask for a more intensive educational or neurological evaluation as long as the issues are persistent.

This advice came from “ADHD Plus: Diagnosing and Treating Comorbid Conditions in Children,” ADDitude webinar lead by Mark Bertin, M.D. in June 2018 that is now available for free replay here.

Mark Bertin, M.D., is a member of ADDitude’s ADHD Medical Review Panel.