ADHD Roadmap for Your Child in Turkey

Say that at the parent-teacher meeting the teacher said, "a bit absent-minded, you might have him looked at." On the way home five words spin in your head at once: psychiatry, RAM (the Guidance and Research Center), BEP (the Individualized Education Program), report, medication. Which comes first, which after whom, what is each for?

Each of these words is a separate door, and the doors have an order. When the order is broken, months are lost: going to RAM without a diagnosis, taking the report for a school decision, not noticing that the medication report has expired. This post is the narrated version of the one-page Turkey guide page. At each step I write what happens, where people get stuck and what it is for. Institutional practice can vary from province to province and from school to school, so what is binding is always what the institution you are attached to says.

First observation, then the appointment

The teacher's sentence is a clue, not a diagnosis. Not every active or absent-minded child has ADHD. What is looked for in the evaluation is behavior clearly above what is expected for the age, seen in at least two settings, spread over months and truly affecting life. I wrote in detail about which behavior falls in which area in the post on ADHD symptoms in children.

The most useful thing you can do before the appointment is to keep notes for a few weeks. Don't write "has no attention." Write "gets up every ten minutes during homework, a single page takes an hour." Collect old report cards and teacher comments in one place as well. Sentences that have repeated for years on the report card, such as "absent-minded" or "not using his potential", are real data for the doctor.

The common mistake here splits in two. Some parents wait, thinking "it will pass as they grow up." Others try to draw a diagnosis out of a single bad week. Both are wrong, because moving, a change of school or tension at home can produce similar symptoms. The quiet child who looks out of the window, on the other hand, often never becomes a subject of complaint, especially among girls. This is why the child who causes no trouble in class does not get referred.

The right door: child and adolescent psychiatry

The evaluation of ADHD in children is done by a child and adolescent mental health and diseases specialist. Neurology is not the door for this, because the diagnosis is not made with imaging or a blood test. A psychologist can apply tests and strengthen the file, but the diagnosis and the medication are decided by the doctor. I explained this distinction step by step in the post on which doctor to see for ADHD.

You take the appointment from the hospital's appointment system; ask when booking whether a referral is needed. Since appointments can fall weeks ahead, take the date on the day you decide and write it in your calendar. If the appointment is far off, don't let the time in between go to waste: keep taking notes and ask the school for a written observation.

Between a state hospital, a university or a private practice, the diagnostic criteria do not change. What makes the difference is the time given to the interview and the history you bring. And one small detail: don't list the child's problems at length in front of the child. If possible, hand over part of it in writing, or watch for a separate moment.

Evaluation: there is no single test

Those who go expecting "it will be understood with a test" are disappointed. No single blood test, imaging or attention test makes the diagnosis. The doctor brings together the developmental history you tell, the interview with the child, and the rating scales filled in by the parent and the teacher. A child who sits calmly in the doctor's office is not therefore without ADHD, because symptoms can appear fewer in a new and interesting setting.

Take it calmly when information is requested from school. This is not the doctor interrogating you, it is a requirement of the criteria: whether the symptoms are also seen in a second setting is checked. It is enough to tell the teacher, "the doctor wants your observation too." Don't be surprised if an intelligence test or a hearing exam is requested either. These are not to prove ADHD but to tell apart other conditions that look similar.

It often takes one to several interviews. That no diagnosis is made at the first appointment does not show that something is going wrong. I told the process in more detail in the post on how ADHD is diagnosed in children.

With the diagnosis in hand: the school side starts with RAM

Once the diagnosis is made, the second process starts, and the first abbreviation you hear is RAM. The point that gets confused most is this: you do not go to RAM to ask "is there ADHD." RAM is a center attached to the Ministry of National Education and its job is educational assessment. So, with the diagnosis in hand, you go to determine what that diagnosis will turn into at school.

The application is made in two ways: through the school with the Educational Assessment Request Form, or by the parent's own direct appointment. Appointments are given through the RAMDEVU system. Since the documents required can vary from center to center, the most solid way is to call RAM before the appointment and get the list. Going with a missing document can extend the process by another month. The details are in the post on how to get a RAM report.

The board decision turns into two things at school. The first is the BEP, that is, the Individualized Education Program. The BEP development unit at the school prepares it, and you are a member of that unit. In ADHD the BEP generally changes not the curriculum but the way it runs: seating arrangement, giving instructions in writing, extra time, breaking homework into pieces. Ask for the goals to be measurable. "Will be more attentive" is not a goal; "will complete a three-step instruction when it is given in writing" is a goal. Check that the person responsible is written next to each item. A goal with no one responsible is often not carried out. The whole framework is in the post what is a BEP.

The second, if it is in the decision, is the support education room. The child stays in their own classroom all day and goes to the room only in the planned lessons to work one-to-one or in a small group. An ADHD diagnosis does not create this right on its own; what decides is the board's decision. Ask in writing in which lessons, how many hours a week, on which day and with which teacher.

The weakest link of the chain is usually the last one. The form leaves the school, the decision comes from RAM, the implementation happens in the classroom. While the decision sits in the file, nothing may change in the classroom. So keep a copy of the board decision and talk to the teacher separately. Go to the meeting with two requests at most and, at the end, make clear who will do what. I wrote how to do it in the post on talking to the teacher.

Three reports, three separate doors

This is where heads get most confused, because three separate things are being talked about as a "report."

ÇÖZGER is the health side. It is issued for those under 18, and instead of a disability rate it states the level of special need. The diagnosis itself does not bring an automatic level; what is looked at is how much support the child needs in daily life. Which hospitals are authorized can vary from province to province, so ask beforehand. In the post what is ÇÖZGER there is the flow of the application and the right to object. When the child turns 18 the rights do not continue automatically; the assessment is done again under the adult regulation.

The RAM decision is the education side. The document I just described.

The medication use report is the reimbursement side. Using medication is a decision you make together with the doctor. If medication is started, in order for the cost to be covered by SGK, a report is needed in addition to the red prescription. The report is issued by a child and adolescent psychiatry specialist and entered into e-Nabız (the national health records system). The duration is not fixed; the expiry date on the report is what counts. Write in your calendar not that date but a month before it. When the report expires, the medication does not go away but becomes paid, and no one will tell you this. Get the report before the prescription. The details are in the post on how the ADHD medication report is issued.

Trying to settle all three at the same appointment means going to three separate institutions. Going knowing the order saves a few weeks.

Exam accommodations: last in line but started early

Exam accommodations run through two channels. For in-school exams there are adaptations written into the BEP: a quiet setting, arranging the exam time, how the questions are spread across the page. For central exams, the request is submitted through ÖSYM's application system, based on a health board report, and for those under 18 ÇÖZGER is taken as the basis.

Who benefits from which accommodation, how much the extra time will be and the application calendar are written in each exam's guide for that year, and they change. For this reason I am not writing numbers here. The process does not move fast: the report requires a chain of appointments. A job started two weeks before the exam usually does not make it. For the general framework look at the post on exam accommodations and rights.

Extra time alone does not solve everything. It makes exam day easier but does not touch the struggle during the preparation period. The two need to be thought about separately.

What I take from it

To my mind the most important steps of this road are the first two: someone stopping to look, and going to the right door. I got my diagnosis at twenty-two. In those years no one was ill-intentioned, but no one asked the right question either. So if you have suspected something in your child, I am on the side of asking rather than waiting, and of seeing the diagnosis as a framework rather than a label.

The remaining steps are a chain of paperwork. Demanding but learnable. If it were me, I would keep a single file: the doctor's report, the RAM board decision, a copy of the BEP, the expiry date of the medication report, the appointments, and with whom I spoke about what and when. I would end every meeting with a written sentence. It is a great relief not to have to explain everything from the beginning next term, to a new teacher or at a new school.

The information here is a general framework. For diagnosis and medication decisions, get written confirmation from the doctor who sees your child, and for documents from the RAM, school and hospital you are attached to.