Health and Psychology

I do a lot of psychological and neuropsychological testing.  I'm often asked to do screenings instead of psychological evaluation.  In many cases that's adequate.  But in other cases it leads to an inadequate and incorrect diagnosis.  

Schools, psychiatrists, general medical doctors, and pediatricians do a lot of screening measures.  These are often checklists, questionnaires, and other self-report measures that people complete themselves or on behalf of someone else.   These are great as an initial step in trying to figure out how to appropriately diagnose and treat someone.  The problem comes when these are used as stand alone evaluations, and the person is not responding to the "appropriate" treatment.  The problem is often that these measures are inadequate and another condition is causing the problems.

Because I see people that are either not diagnosed or not responding to treatment, the first thing I do is start an evaluation with a history, laboratory reports, review of any testing that has actually been done, and a review of any checklists that have been completed.  Often I can compile enough information to document what is going on and then do a specific test to rule in or out a condition.  In other cases I have to do a battery of tests to make that determination.

Let me provide two cases:

Johnny is not focusing or paying attention in school.  The teacher suggests an evaluation and treatment for ADHD.  A pediatrician sends home a Connor's checklist for the parent and teacher to complete.  It comes back positive for ADHD and a medication is prescribed.  Two weeks later, the child is now more irritaable, not sleeping, losing weight, crying often, and still not paying attention.  Rather than revisit the evaluation, the doctor either adds a new medication, or increases the dose of the original.   Behavior problems continue and eventually the child gets an adequate evaluation.

The first thing I'm going to do with Johnny is to take a history.  This will include information on the pregnancy, birth and delivery.  I'm going to take a history of attention difficulties and when they started.  I'm going to attempt to confirm the ADHD diagnosis with a continuous performance test-either a Connor's CPT or a TOVA CPT.  These are computer based tests that measure reaction times.  If that comes out positive I'm going to review the diet and the response to medication.  I'll give information back to the prescribing doctor about more effective methods to help Johnny attend in school.  I may also suggest things like preferential seatig, a study space free of distractions, extra time on assignemnts and tests, a more organized space to study, and a plan for managing homework.  

If it comes out negative then I'm going to do more testing.  The Wechsler Intelligence Scale for Children 5th Edition will allow me to look at cognitive functioning in several domains.  If that shows significant scatter I may do some more testing or I may refer out for a neurological work-up.  

So in several cases as mistaken ADHD diagnoses what came up on testing?

• Parietal lobe disorders from birth trauma or head injury.
• Depression
• Seizure disorders
• Malnutrition
• Sleep disorders
• Medical conditions
• Genetic disorders