Health and Psychology

I see a number of people that have been diagnosed with ADD or ADHD. When I ask how the diagnosis was made I hear about questionnaires. Questionnaires are a nice confirming meaure, when other, more objective measures have been done. But as a primary measure for the purpose of providing treatment planning, they aren't a great way to assess attentional difficulties.

Here's how to make the assessment of attentional difficulties in children or adults:

• An adequate history--attentional problems start off early. The problems with attention come in difficulty playing in a sustained manner in the face of adequate parenting. The problems are present at home and continue into a classroom. Teachers are not qualified to make the diagnosis, but can usually help in making a referral to get the child diagnosed. The history should document the pregnancy, birth and delivery of the child as well as the attainment of developmental milestones, any medical problems, injuries and accidents, and a complete history of the symptoms.
• An adequate evaluation--attention difficulties can be caused by a wide variety of difficulties. The differential diagnosis includes petit mal seizures, depression, anxiety, parenting issues, and disorders of executive dysfunction. At a minimum there should be an evaluation using a continuous performance test. These are computer based tests that record response times to a computer generated symbol or tone and record response times in milliseconds. A measure of cognition or intellect will help to differentiate attention problems from disorders of executive functioning. Attention problems show up in working memory and may show up in processing speed. Disorders of executive functioning show up in planning and organizing, starting and stopping tasks and can be present throughout a measure of intellect but impact different subtests differently. Neuropsychological testing or specific tests of executive dysfunction can help to identify problems in the cortex of the brain not just attention problems.
• Teacher or Parent questionnaires-These can be used to monitor the impact of treatment and can serve as a baseline.

Some case examples:

• A parent brought in her son referred by the school because he "obviously couldn't pay attention and didn't listen." He was referred out to a neurologist and subsequently treated for seizures.
• A family was evaluated for attention problems since they believed that all members of the family had attention difficulties. They did show three different types of attention problems on continuous performance testing and cognitive testing. The father was referred out for a blood pressure medication to manage ADD inattentive type with anxiety. The mother was referred out for a non-stimulant medication and an antidepressant for her ADHD. Their son was referred out for a stimulant medication.
• A parent brought in her son because he was obviously hyperactive and the school was requesting an evaluation. Continuous performance testing showed no evidence of attention problems. Our office provided parenting skills training with the mother and father. The teacher questionnaire was used to evaluate the efectiveness of the treatment. Within a month, the child no longer had any symptoms of attention problems or hyperactivity.

If you are interested in an evaluation please feel free to contact our office.