Okay I guess I complicated thing. It's his non mental health doctors/nurses that give me trouble about his diagnosis and mine "because lamictal isn't an ADHD/AS drug", "he's to social to have AS" and "what is bipolar 1 with psychosis?" "are you sure he does have that"... So I started to wonder the difference between with or without psychosis.

A= primary pdoc that he sees monthly
Z= re-evaluation pdoc
T= child's therapist that he sees 2x a month

He's been with A for 2 ish years. Children grow, behaviors change, therapy helps, so the children re-evaluate every 2-3 years. So the re-evaluation can not be done by the Child's A. I guess it's kinda a review of A's work also.

The Z gets all A's notes and T's note along with the 2 packets about his functionality (can he do this?, 1-5 do you strongly agree - strongly disagree that he does X (ie. daily tantrums, refuses to shower), family medical history and questions about his home life (ie. how many times has he been hit, slapped, spanked w. an object, punched, strangled or other wise harmed in the last month, Is he exposed to illegal drugs including pot, prescription abuse, cocaine with in the last month...)

While 2 family members fill out the separate packets (= 2 packets) with the same questions. The child takes a 3+ hour test. All that information is collected and reviewed by Z. Z suggests Dx and possible med changes if needed, this letter is also sent directly to the home as well as given to A.

Between the parent's, child's T and child's Pdoc a decision is made with the least restrictive diagnosis possible. Miguel's primary pdoc told us not to be surprised when we get his re-evaluation letter and it says bipolar, given his history, our history and his medication reactions. I think she's already seen the letter. His primary doctor does have to change Miguel's dx. (currently officially adhd) because of his reactions to the adhd meds and how he has done with lamictal. However she will not put in his file that Miguel as bipolar because his ocd behavior and mood swings can fall under AS.

Once Miguel phases out of the child's department or moves we will likely be staring at a bipolar dx the new pdoc according to Miguel's T and Pdoc. He will have a re-evaluation in 3 years unless he is in IOP, or child crisis then when entering he will get re-evaluated.

Umm... I hope that's a bit more understandable. He see's 1 pdoc, and 1 T but he's re-evaluated every 2-3 years. His pdoc try's to keep kids on 1 or 2 meds because kids have a harder time taking meds. Miguel's lamictal is dissoluble and he's 11.