When is ADHD not ADHD?

[handmademitlove]

My DD (diagnosed with ASD) shows many symptoms of ADHD, particularly hyperactivity - little sleep, constant fidgeting, talking very fast etc. Also poor executive function and time management.

QB test suggests this is not ADHD. I know that symptoms of ASD / ADHD can overlap but no-one I have spoken to thinks that the level of hyperactivity / poor organisiation / memory issues is explained by ASD.

We are a bit stumped as to what to do next. Obviously we are supporting with these issues but as she transitions to adulthood we need to enable her to manage all this herself, without us scaffolding in the background.

Any suggestions of what to do next?

Has she had an OT sensory needs assessment?

My DD, who has been referred for ASD and ADHD assessments, has sensory difficulties; the most disruptive are tactile ones, she has extreme reactions to particular clothing, she also can't go to sleep in her bed at the moment because of the bumps in the sheet and because her duvet 'hurts' her legs.

But she is also very sensory seeking in terms of touch, touches things to see what they feel like, very tactile with people.

I've been looking into sensory processing quite a lot because of this and excess movement, fidgeting etc (which my DD exhibits) can also be a way of obtaining sensory input.

However, I don't know the differences between excess movement, etc because of ADHD and because of sensory seeking. I have arranged a (private) OT assessment and this is one of the things I intend to ask!

She does have sensory issues - she was diagnosed with sensory processing disorder before the ASD diagnosis. She hasn't seen OT in around 5 years - getting a re-referral is complicated!
Might have to investigate private OT in our area...

My daughter is on the asd pathway and will definitely get diagnosed but for us her sensory processing disorder is the hardest to deal with.
She constantly talks,fidgets,no time management,constant accidents as she bounces everywhere constantly.
Her OT said it's definitely not ADHD after I questioned the hyperactivity

Hi Handmade
An ADHD diagnosis shouldn't just be made on the QB test alone as my understanding is that isn't always accurate. A detailed Connors questionnaire also needs to be filled out by yourself and the school which is scored and helps to inform any potential diagnosis. My son also has strong sensory seeking behaviours and finds it hard to stay still, fidgety, slightly impulsive and weak executive skills. He was assessed by CAMHS who felt everything could be explained by ASD and sensory processing issues but I was unconvinced. We ended up getting a private ADHD diagnosis relatively quickly although it was costly. It can be hard to distinguish between the conditions sometimes as so many features of ASD which often includes sensory behaviours overlap with ADHD.

@Pheath yes this is the problem!

School questionnaire was not helpful - having seen their responses... Yes, she does have all her equipment as needed (as I go through a checklist every morning) .... Yes, she hands homework in on time (because I go through it with her every night)... But I get that they have to report as they see it. Unfortunately I never got the opportunity to discuss this with CAMHS - they simply discharged on the basis of the qbtest results....

She told me when she did the qb test she challenged herself not to move her head just to see if she could 🤦 a little knowledge is a dangerous thing!
But CAMHS are hopeless (I only got qb test results through a SAR) so options are to go private for ADHD assessment or look at an OT or Ed Psych assessment to get a better handle on what is going on. Not sure which would be best at the moment.

If you are looking for a possible ADHD diagnosis to trial medications I'd personally go for a private ADHD assessment face to face if you can, many are now done via zoom. An OT or EP assessment will throw light but probably won't speculate on a diagnosis as that's not in their remit. We had OT, SALT and EP assessments as part of the EHCP process and they were incredibly useful in that respect and made helpful recommendations. It took some time however, both finding assessors, long wait for appts and then many weeks until reports written.

Our CAMHS was also very poor and got the impression they just wanted to bat us off.

Has she been assessed by an OT and and Educational Psychologist? They don't care what the diagnosis is. They assess your child and advise what their strengths and challenges are and then advise what support will help your child thrive.

It might be worth going private to get that level of advice sooner rather than later.

Also worth bearing in mind that many people will need support / scaffolding throughout their lives. This is not a bad thing. But it is helpful to recognise and accept this so the support and scaffolding can be found. Otherwise failure and disappointment and low self esteem could be a pattern through adult life. This is where having a great partner, fabulous work place, gym membership, as well as a neurodiversity coach and therapist can be helpful. This is all scaffolding albeit some people may not describe it as such.

I'm an adhder and having a work place needs assessment at work to enable me to be the best I can be at my job (I'm very senior in a professional services environment).

My child did exactly the same in the QB test (so much so they did it twice to check). He was in the 1St percentile for not moving! But he was quite inattentive. The QB is what sparked them also testing for autism.

They had enough info from us, a bit from school plus 2 SALT reports2 years apart that mentioned listening and attention difficulties.

The QB should never be used on its own as we were told 'all results tell us something, even if it's not what we're looking for'

@Pigriver it is frustrating that they will not assess - we feel that if they actually assessed her and said no, that would be more informative. This is still a halfway house really! Need to find a good ed psych locally. Had a recommendation but he only does assessment work for ASD.

Thanks everyone for your support! Will keep going and see where we get to next.

QB test is not hugely reliable, the real assessment is a clinical assessment by a psychiatrist (or psychologist), it is then backed up by Conners questionnaires.

@eatdrinkandbemerry OTs are not qualified to assess ADHD, trust your instinct

QB test is actually quite reliable, but this definitely cannot be only diagnostic tool and you must know how to interpret it. Its not just the overall scores that count. And there must be information coming from other sources, school and home. Then again whatever questionnaires or interview they conduct, people tend to overreport or underreport things. They are also not hugely reliable. Thats why there is also needed information about performance. Problably some autists have been mistakenly diagnosed as adhders or failed to diagnose adhd in autistic people. I would not trust a psych who gives adhd diagnosis just easily with 1-2 meetings.

I personally find QB tests fairly accurate and helpful in diagnosing ADHD. To teach the criteria in the Dsm5 it would be very unusual for a child to have Adhd but "pass" a QB test

@eatdrinkandbemerry I