Full neuropsych evaluation advice

I (parent of a child diagnosed with ADHD by Kaiser) would start with your pediatrician and lay out what your wife has observed, and ask for suggestions on next steps. Jumping to a full neuropsych for a 6 year old might be overkill.

He could be both. https://childmind.org/article/twice-exceptional-kids-both-gifted-and-ch…

We had a very very positive experience with Dr. Jessica Lipkind. We liked how much she involved the child in the process, so it wasn't just happening to them, but they were a partner. If your child is in public school, you can request an IEP assessment to begin with, although it's not diagnostic it might give you some insights to decide the next steps for your family. It's very expensive out of pocket, even with private, generous insurance. 

Hi there, very satisfied Summit Center client here. If you can manage the fees, they are excellent. But before that, it might be best to have an initial consult/discussion with Dr. Dan Peters at Summit. We did this when our kid was 8, and then several months later went for the full neuropsych. Dr. Dan could hear your observations, talk through optimal timing/age for an eval, think through why or whether to do one.

We have zero regrets, and later did one with our older kid. In neither case did we get wildly surprising information, but it seriously fine-tuned our understanding and gave us way better grounding in how to move forward thinking about home life and school life. Summit produces very lengthy reports. 

Tips... how it goes and how positive an experience it is for your kid depends a lot on connection to the evaluating clinician. So I would take the time to discuss best fit, than taking whoever has a spot first. Dr. Dan is also going to have the best overview of everyone working in the clinic, if you decide to go with Summit. In our case, the clinician came out and immediately asked our kid if maybe he could assist with solving this little puzzle, because she was having trouble doing it. She did this because we primed her about his interests and communication style. We also prepped him with a mini video she sent of herself in her space, saying hi and showing the room, etc. So, making sure the clinician you choose has, in addition to the millions of forms you are gonna fill out, some specific details about how to best connect 1:1 with your kid, might go a long ways towards his willingness to do the tasks requested. I would also make sure you are scheduling the sessions on low-key days, and maybe including a treat or small fun thing to do after each time. We also planned a prize, a stuffie he was lusting for, for when it was all complete. Bribes don't go very far in our family if the task itself is awful, but it was helpful padding for getting started and he ended up rather enjoying the process--stimulating, novelty, etc.

The thing about pediatricians, in my experience (responding to another responder) is they are going to vary SO widely in their knowledge and responsiveness, how neurodiversity-affirming they are, and how much, for example, their view of ASD is super medicalized. Kaiser also has no interest in twice exceptionality or giftedness. (We did have ADHD and ASD evals with them, but they were in siloed departments and ultimately not very useful.)

In terms of your varying thoughts on diagnoses and how to picture your kid's traits, I also went through stages of wonderings and research. Wondered about giftedness at age 4, ADHD at age 5, and ASD at age 6. Around age 6/7, started researching twice-exceptionality. In early Covid, we were all at home and gathered much more data, which proved super useful when we were able to finally get to Summit in person at age 8.

In the end, we ended up with diagnoses of all of the above! Plus a couple other things. All this learning was new to me, but my instincts were all correct. But...a lot of intense or sensitive qualities can look like any or all of these diagnoses.

It's certainly important to pinpoint why you need to know, and why you need to know now. Is it for school advocacy? Is it because you need different parenting strategies? Etc.

Wishing you the best. 

I want to respond to the part of your question about regrets for testing. I have regrets for NOT testing. Knowing earlier on that one of my kids had ASD and the other ADHD could have vastly improved their lives. I didn’t suspect these outcomes and waived away some tests. I feared labels and too much stress and negative attention. Knowing more about your child will not change who they are nor how you treat them. It could give you tools to help them- and get you and your spouse on the same page. 

Interestingly, your child can be gifted and also have ADHD, check out the "twice exceptional" concept.  Kids that are having these challenges can be so very hard on a parents' relationship. I speak from experience--it can feel very divisive and primal--one parent feels they want to protect or shield the child from being pathologized, the other wants to understand and peel back layers at all cost because they see a difficult future ahead.   Save yourself some time, avoid some traumatic arguments,  and save money on couple's therapy and get your child evaluated.   We did a full neuropsych that I wish we had done much earlier. Now we understand our child and what he needs.  The child feels relieved, too.  We're super lucky to live in an area where many great services are available, and many experts are around that truly are at the forefront of learning differences. 

Some pediatricians may rush to conclusions, as some ASD symptoms can look like ADHD or other learning disabiliaty, especially in children AFAB (ours was misdiagnosed by Kaiser's staff). Considering both the comorbidities, and the spectrum of symptoms for ASD and ADHD both, I don't think parents, or non-specialists can diagnose, even if they may have suspicion.

Asking your pediatrician for a refferal is a good start, though wherever you go, expect a long wait for an evaluation: all the providers we called had 6 months or more wait time. We end up going to Kristin Gross in Berkeley, and can recommend her. I'm not sure what her availability is like though.

hello, we suspected that our son had ADHD at that age and we did a limited study for ADHD which showed he had it and the behavioral pediatrician provided some accomodation recommendations for the school. We recently did the full exam as required for acccomodations in HS. We learned a lot about his style of learning which was very useful. The full study around $6K which our insurance paid 90% after I requested an in network deficiency exception in advance of the testing. To have accomodations, the tests must be less than 3 yr old though keep that in mind. 

I recommend you start by meeting with a behavioral pediatrician. 

Knowledge is power. However, a full neuropysch assessment is very expensive and many schools won't accept them as they like to do their own. I learned the HARD way. So if you are concerned and he attends public school, you could start with a full educational evaluation; if you disagree, you can then ask them to pay for a full neuropsych evaluation with someone independent. The school district is obligated by law to do so if you request one and they have 60 days to do so. It is a good start particularly if you think it is affecting his performance at school. If you need a sample of an email/letter to send to the school, I would suggest reaching out to DREP, https://dredf.org/. They are based on Berkeley and have templates you can use to request an educational evaluation. 

I don’t know what is the right age, but we had our son do a neuropsych when he was 10. FWIW, I regret not doing it sooner. He was identified as twice-exceptional— gifted/advanced learner AND with ADHD. It explained so much! I was very concerned about pathologizing and a potential negative impact on him from getting a “diagnosis” and it has been just the opposite. Hugely helpful to him and us to better understand how he thinks and learns. We used Summit and they seemed thorough and thoughtful and also didn’t push us into anything. (And very pricey!) Hope this helps.

Autistic adult with very likely 2 autistic kids here, just piping up to say there's a huge overlap between being gifted and ADHD or autistic. All of those qualities are differences in your brain wiring that change how you interface with the world <3

We ended up doing evals at Cortica in Marin. I was reluctant to set foot in a place that offers the hugely problematic behavioral therapy that's usually the first line of "treatment" for autistic kids, but we had a generally pleasant experience with the doctor who did our kids' evals, and got what we needed. I expect we will never set foot there again.

I also looked at Summit, because I wanted something neurodiversity-affirming and non-pathologizing, but like all places that aren't "medical providers" they are VERY expensive (like upwards of $5000 per kid) and we just couldn't swing it. Cortica offers autism and ADHD evals, I don't know if they also do IQ testing (which has its own problematic "stuff" but that's a longer conversation). And everything was covered by our insurance so was less than $100.

You don't give much info about why your wife thinks your kid is autistic or an ADHDer while you think they're gifted--are they struggling with school? Are there other challenges?

Thanks. I should have mentioned we did an ADHD evaluation with Kaiser, which was unsatisfactory, and they retracted it.  

Thanks everyone! Really good tips here. Our son definitely adds challenges that put strain on our life. It also makes a lot of sense that the evaluation depends hugely on the evaluator, and maybe we should talk to Dr. Dan so he can recommend the right evaluator.

The reason I want to do the evaluation is so we can understand our son better, and find him the right school or approaches at home. I feel I understand him pretty well, but it would be good to have it confirmed.

As for ADHD or ASD, I’m not worried about the  labels. I’m worried about how my son would benefit from it. And this is true regardless of whether he matches the criteria or not. It’s like when your child shy, and you label them as shy, and then you and others treat them like a shy person. If that’s helpful, then great. But if it’s not, and especially if it’s damaging, then where’s the rationale to use the label?

I noticed no one mentioned the UC Psych Dept. They did a very thorough job for our child. And because it is CAL students they get the 2e issues -- the student who did the eval in high school was familiar with the kind of modifications that are needed for a college 504 plan (It needs to be redone at that age for most colleges). The first testing we did was in 2nd grade for visual motor issues, and then a full eval in 4th grade. The full evaluation included quite a few subtests that found the specific processing areas that were a problem (and also the ones that were strong.) The detailed testing was very helpful to share with the teachers and to plan modifications, even though because of the giftedness they were always above grade level and so never qualified for services through BUSD (I'm not sure if this is the rule in other districts). We paid out of pocket for various remediation. Even now, as a young adult, the testing has been helpful for self-understanding and career development.