How to talk to your child’s pediatrician about ADHD and learning differences

If your child is struggling at school or at home, and you think it may be related to ADHD or a learning difference, communication is key. Talking with your child’s pediatrician can be a first step to getting support. But sometimes it’s hard to know what to say to your child’s doctor. 

In this episode of In It, hosts Gretchen Vierstra and Rachel Bozek welcome behavioral pediatrician Dr. Nerissa Bauer. Dr. Bauer offers tips and strategies for talking with your child’s pediatrician about ADHD, anxiety, and more. Tune in to get her advice on questions to ask, materials to bring, and how to make the most of your appointment.

Related resources

• 5 steps to work with your pediatrician when your child is struggling

• How to organize your child’s IEP binder 

• Learning disabilities and ADHD: Resources for patient education

• Take N.O.T.E.: Are you wondering why your child is struggling?

• Check out Dr. Nerissa’s website, Let’s Talk Kids Health 

Episode transcript

Gretchen: From the Understood Podcast Network, this is "In It," a podcast about the ins and outs... 

Rachel: ...the ups and downs,

Gretchen: ...of supporting kids who learn and think differently. I'm Gretchen Vierstra, a former classroom teacher and an editor here at Understood. 

Rachel: And I'm Rachel Bozek, a writer and editor with a family that's definitely in it. Today, we're talking about how to work with pediatricians, so they understand and support you in raising your child who learns and thinks differently. 

Gretchen: In fact, Understood and the American Academy of Pediatrics have developed a resource hub, to help pediatricians start those important conversations with families. 

Rachel: Our guest today is a member of that academy. Dr. Nerissa Bauer is a behavioral pediatrician with a practice in Indianapolis. She also has a company and website called "Let's Talk Kids Health," where she offers interactive virtual courses for families raising kids with ADHD. 

Gretchen: We were delighted that she was able to join us. Well, Dr. Bauer, welcome to "In it." 

Nerissa: Thank you for having me. 

Gretchen: The first thing, let's do is, talk about yourself a little bit. So, where do you sit in that Venn diagram that has pediatricians on one side, and kids with learning and thinking differences on the other? 

Nerissa: Oh! I am somewhat in the middle, I would say. So, as a behavioral pediatrician, I tend to help families with kids who have ADHD, learning disabilities, autism, anxiety. And, I also myself have ADHD. I was just diagnosed a couple of years ago, late diagnosis. And then, I have my own kids with ADHD and anxiety as well. 

Rachel: So, you are really in the middle.

Nerissa: I am in it. Yeah. 

Rachel: You're in the right place. 

Nerissa: Yes. 

Rachel: So, speaking to you with your pediatrician hat on now. If a parent is just starting to notice that their child is struggling in school, what should they do? Is this something they should share with their pediatrician? 

Nerissa: I will always urge families that, first of all, you have to trust your gut. You know your child the best. When you start thinking, "Gosh, something is amiss here," I really encourage parents to first go to their pediatrician. The pediatrician really is the person who's known your child, hopefully, you know, since birth — or at least have that long-standing relationship with you — so they've seen your child grow through those developmental stages. 

And together, they can help listen to your concerns, observe your child, talk with them directly, but then also help orchestrate like what's next? What other data do we need to fully understand how your child is functioning, both at home and school, to really delineate, is this something like ADHD? Is it a learning disability? Is it anxiety or is it a combination of these things, right? 

Or is it just that we need additional support at this time and continue to monitor? But the pediatrician really should always be a family's, you know, first step in helping to partner-decode some of these issues. 

Rachel: That makes a lot of sense. And, this is just a follow-up question related specifically to ADHD, do pediatricians prescribe medication for ADHD? 

Nerissa: They do, they do. Actually, there is a growing trend in the fact that over 50% of general pediatricians are now able to identify and co-manage ADHD in their practices. I will say, though, over the years, the complexity of ADHD has really risen. So, no longer are we only just seeing ADHD, especially after the pandemic. We're seeing kids with coexisting anxiety, depression. That complicates the picture. 

Or we're seeing kids much younger, also having attentional issues that many general pediatricians will then at that point say, "Oh. I'm not sure, so let's go on and refer." But I think that a lot more pediatricians do feel comfortable at least starting the initial workup, having that conversation with families, before deciding whether or not they need to enlist the help of someone like myself or a psychiatrist. 

Rachel: So, if a family kind of goes another route, right? and the child is diagnosed with ADHD before the conversation happens with the pediatrician, what is the process or what's the best way to go about sharing this with the pediatrician? It sounds like it should definitely be shared with the pediatrician, but how does that conversation work or what does it look like? 

Nerissa: Yes, that's a great question. I will often tell parents that I think it's, first of all, important to keep a binder of the most important documents that you are accruing as you're on this journey with your child. I mean, it is not uncommon for parents to, you know, go through testing and then have tutors and therapists and different people on their team. 

And what's most important is making sure everybody's on the same page. And oftentimes when you're talking with either the pediatrician and bringing them up to speed, or a specialist new to the team, it's so helpful to have those documents in a binder along with contact information. 

So that when people ask you, "Who has done this? When was the date of this? Did you try this?" You know, you have that information at your fingertips. And, you know, I can't tell you how much time that helps to save so that we can just, you know, kind of keep moving forward. 

Rachel: We have a resource actually on Understood, called the IEP binder. It sounds like that could be tailored to just like your general binder, right? 

Nerissa: Yes, absolutely. 

Rachel: Yeah. We recommend contacts, all that kind of documentation. And so, is there ever too much information though, right? So, it sounds like you definitely want to tell your doctor about any diagnosis your child may have. But, if a patient shows up with a binder that's filled with everything from, like, you know, the progress reports to, you know, any discipline challenges. Does that information help pediatricians or is there ever a point where it's just too much? 

Nerissa: Well, I would say it's always better to have more information than less. Because the thing is, with any mental health condition, ADHD or otherwise, I tell parents that there is not a singular blood test or an imaging study that helps make the diagnosis, right? 

For us, context is everything. And the conundrum with ADHD is that children and symptoms can appear different depending on the environment. And so, I don't want to make it a burden for the parents to have to figure out like, "Well, does this doctor want to have this or this?" Like, I would rather them just give me everything and then I can kind of sort through really quickly what I think I need. 

Because again, context is everything and just being able to see how symptoms have evolved — depending on who's reporting, who's seeing that child — can make such a difference in helping us understand the full picture of how this child is really doing in these different environments. 

Rachel: So, once a family is working with a specialist, to what extent should parents keep the pediatrician in the loop on things like, if there's a change in medication or even if it starts or stops somewhere along the way, or a new therapist? Or anything else that's kind of in the ADHD zone for the child. Like, it's another kind of "How does this conversation work," but, how does that work? 

Nerissa: That is such a great question. And it can be confusing, especially depending on how many people are on the team. So, what I will often tell parents is, when I first meet with them as the behavioral pediatrician, sometimes they come to me because the general pediatrician does not feel comfortable either identifying or managing the ADHD. 

So, when I know that, I will tell parents to think of me as the pediatrician managing ADHD specifically, whereas I will keep the pediatrician in the loop about what's happening, because they need to know it's part of general health, right? Because brain health is just as important as physical health, OK? We don't want to make that distinction. It's the whole child, right? We're treating the whole child. 

But, knowing who you need to call when certain things arise is so important. And so, that's why it's really important when you're working with a specialist, to really establish that role on the team. OK, so if you're prescribing the medicine, who do I call if I have a concern about a side effect or if I need a refill, right? That conversation needs to happen. And so, typically, the person prescribing the medicine will need to be the person you call, because they're going to be overseeing that. 

Now, if it's not your general pediatrician, absolutely, they'll want to know what's going on in general. Because if your child gets sick and you need to see your doctor for, you know, flu or regular medical care, they're going to want to know everything your child is taking. So, that's why we want to keep everybody in the loop to some degree. 

Rachel: So, we've been talking a lot about ADHD. Do pediatricians diagnose or give parents information about other learning differences, like dyslexia, maybe. Or is it primarily things just like ADHD and anxiety?

Nerissa: I mean, I think to a degree that pediatricians, they know of all these things. A certain pediatrician's comfort level with identifying it may differ, but they are certainly well aware of, you know, differential diagnosis is what we call it. You know, what are some of the possible explanations for why this child is struggling in school and not making the grades or not having the output? So, sometimes it may be detected a little bit later if their comfort level or their awareness of a certain possibility is not quite up there. 

But, you know, I think that's why parents need to feel empowered to continue to talk with their pediatrician about their concerns. And if they're not feeling like they're feeling heard, right? it's OK to seek a second opinion. 

Rachel: So, on that note of perhaps not feeling like they're being heard. I think some families do have some anxiety, you know, about having this kind of conversation with the pediatrician — whether it's about ADHD or anxiety or dyslexia — and maybe they're concerned that the doctor will be dismissive or simply not understand the complexities of what's going on. 

I've definitely heard mixed things from parents trying to have that conversation or concerned about having that conversation. So, do you have any advice for people who find themselves in that boat on just how to have the best interaction possible and make it a productive conversation? 

Nerissa: Yeah. So, you know, I think obviously always preparing for that appointment in advance if you can. Just because the general pediatrician typically will have a briefer visit time with you. And it's not that they don't want to listen. It's just they're really busy, right? And so, we want to make sure that, you know, we make the most use of that time. 

And what I really love about the resources that you guys have on your website is "Take Note." That is a great resource that I refer a lot of families to. So, you know, you want to gather information. You want to talk about it with your child's teacher, "What are you seeing?" Talk to your partner about it. Gather that information, right? And then, you want to also talk with your child. How are they feeling? 

And then, when you present that information to the pediatrician, with data — you know, you've got the report cards, you've got like examples of school work or whatnot, emails with the teacher — and then you can always use those statements of, "I've been noticing. I have been hearing my child tell me these things. We are up until 11:00 doing homework and this is a stress for our family." 

So, you know, trying to come with concrete examples, to really bring that story to life helps your pediatrician really understand the gravity of what's happening. Now, sometimes parents will say, you know, "We've talked to our doctor many, many times and, you know, we still feel like we're not heard. We've tried maybe a couple of things or we've been told to wait. 

Let's wait it out." You know, and I wasn't there, so I can't comment on that, but we really want to help our families know that sometimes you just have to trust your instincts. And if you try to keep going and you're not getting heard, it's OK to seek another opinion. 

Rachel: Sometimes — I mean, I've had this experience with all different kinds of things, not even necessarily this particular conversation where — you're in the office with the pediatrician and you feel like the conversation is going fine and then you leave and you realize you totally did not get what you needed. And it's not their fault either because you're like, "OK, thank you!" And it is kind of like, "Now what? Now what do I do? Because that really didn't satisfy the need of, you know, what I was trying to figure out."

Gretchen: Yeah. I wonder — I have a nuts and bolts question related to this — you know, sometimes I feel like me personally, with my own kids, I used to just have a little Post-it note, right? And I'd be jotting things down and saving it for that one yearly appointment. 

If you are suspecting that maybe your kid has a challenge like ADHD, does it make better sense to say, "No, I want to make an appointment about just this," versus like, "It's part of my yearly checkup?" 

Nerissa: Gretchen, yes. Please, please, please. Your pediatrician, even though you see them annually for your well-child visit if there is any concern that comes up — just like a cold or, you know, if your child skins their knee or, you know, falls on the playground — you need to bring them in. This is just the same. And that's why I wanted to bring it back to, you know, brain health versus physical health. 

Pediatricians treat all of that, the whole child. And I think that's one of the things that parents need to remember is that, you know, if you have this nagging concern about how your child is thinking or learning or behaving, it warrants at least a phone call to the pediatrician office to start that conversation. And I know that the pediatrician would really love it to have dedicated time to focus just on that concern. So, absolutely call your pediatrician office and ask specifically for a separate appointment to discuss this, because we have to have time to peel back all the layers. 

Rachel: OK. So, as we get towards the end of our conversation, I wonder if we can bring it back to the beginning for a moment. Is there anything that you think your family or pediatrician could have done when you were a kid so that you could have gotten an ADHD diagnosis earlier?

Nerissa: Yeah. I mean, I think it's multifold. I mean, I think just being asked, you know, "How is school going?" and not just kind of at the surface level, right? I mean, I would just imagine that my parents would have said, "Oh, she's doing fine. Her grades are A's and B's, you know. She's not failing anything, right?" And so, then it just is "OK, check, check, check," right? 

So, I think when parents have a specific concern about attention and learning to not just say, you know, "I wonder if this is ADHD." I really want us to think about what are you seeing, what examples can you provide? And let's go from there. Because I think even when I'm interviewing my own patients, I will ask the child themselves first. 

I'll have that conversation with the child too, not just the parent. But ask them like, you know, "How is school going? What is an example of a class that's going really well for you and why? And then let's talk about the fact that not everybody can be good at everything. And so, what are some of the more challenging subjects or classes that you have and why is that?" You know, and I'll try to probe and push kids to say, well, you know, sometimes they'll say, "I don't like writing." 

Well, what is it about it? Is it that your hand gets tired? Is it that when you're asked to write something, you get overwhelmed, you don't know where to start? Or when you're starting to write, you don't like the editing part? You know, like, what is it about that? You know, so if we can really dig a little bit deeper and not say at the superficial level, I think that gives us a little bit more insight into how that child is thinking and feeling when they're struggling in school, right? 

I think giving voice and really inviting them to think a little bit deeper about what it is about that, that they're struggling. First of all, validates that experience for them, but then also helps them be able to give voice to that. 

Rachel: I love that very specific questioning. It's good. 

Nerissa: Yeah. Because we know ADHD is a challenge of motivation and interest. And so, that's part of the thing that I like to teach parents in general, it's not a deficit of attention, even though that's part of the name, right? But it's that we have a hard time regulating that attention and focus, that interest, that motivation. It waxes and wanes. And that's part of the problem, like, it's so stressful for kids and families to understand, you know? "You're just being lazy." I hear that a lot.

Rachel: So, is there anything else that you'd like to add that we haven't covered already in this conversation? 

Nerissa: Well, with that invitation, I will just say that I honestly, again, just want to impress that ADHD is not necessarily good or bad. And I try to teach that to families, you know, all the time. I want them to recognize and not be afraid of ADHD. I think so much of what I've seen is that kids come to me when they finally come to see me, they've had a hard time. 

You know, they've struggled. They've gotten messages that, you know, "Why can't you do this? Why are you always forgetting this?" They're internalizing a lot of that and they're feeling like they're just not good enough. And I'm here to tell you that, regardless of the diagnosis, we need to invite kids and educate them alongside their parents. 

We have to talk with them, not just to the parent, because they're in the room. They're hearing things, are observing things. And I always wish, you know, that when we're talking with kids that we fully turn our attention to them, show them that we care, and then really help them sort of learn to love who they are, their whole self. 

You know, I tell kids all the time, "We can't give you a brain transplant. You know, ADHD affects our brains, but the brain is what makes us who we are. And we just have to learn that, how your brain is working so that way we can work with it, right? We can work with it and we can thrive." So, we want to give them that message that having ADHD can be an incredible opportunity and a gift. But it's so important in those early stages of how we talk about it to really set a positive tone. 

Rachel: That's a great way to end this conversation. Thank you. 

Nerissa: Thank you so much for having me on. 

Rachel: You can find links to our pediatricians hub, which includes a conversation starter toolkit in our show notes for this episode. 

Rachel: You've been listening to "In It" from the Understood Podcast Network. 

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Rachel: If you want to learn more about the topics we covered today, check out our show notes. We include more resources as well as links to anything we mentioned in the episode. 

Rachel: Understood.org is a resource dedicated to helping people who learn and think differently, discover their potential and thrive. Learn more at understood.org/mission. 

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Rachel: And thanks for always being "in it" with us.