Building Personal Resilience: A Guide to Positive Living
Chapter 4
– Attention Deficit Disorder: Disease of the New Millennium
ADHD Assessment: Testing and Diagnosis
Children and adults are being increasingly referred for assessment and treatment of Attention Deficit/Hyperactivity Disorder (ADHD). Individuals with ADHD commonly have difficulties with attention, hyperactivity, and impulsivity. Problems with organization and memory may also be present, together with moodiness, irritability, difficulties getting along with others, and getting things accomplished.
Those with ADHD experience these problems more frequently and more intensely than might others and their lives can therefore be more troubled. A child’s behaviour for example can test the abilities and patience of a parent and teachers and create failure in school even if the child has good intelligence and potential. Similarly, adults with ADHD often have difficulties at work and in their relationship with others and they can be difficult to live with.
True ADHD is something that we are born with; it is not something that we can ‘catch’ nor something that we can simply easily let go of by merely willing it. Emotional and behavioural problems that are due to anxiety or depression or trauma can show many of the same characteristics of ADHD. A differential diagnosis by a trained professional can do a comprehensive assessment to determine the difference.
ADHD Help Ottawa
If you recognize that you or your child has experienced the symptoms of ADHD since early in life, and you recognize that these symptoms are causing significant difficulties at home, and at school or in the work place, referral to a mental health professional is certainly appropriate.
A psychologist can help. By using specialized assessment and treatment methods ADHD can be properly diagnosed and worked with , and the families and friends and teachers who are involved or affected can also come to know how they in turn can best assist.
If a diagnosis of ADHD is made, a number of treatment strategies will be offered by the professional, based on the particular difficulties of the individual. As noted in this chapter, some individuals receiving this diagnosis are primarily inattentive while others are primarily hyperactive and impulsive. Still others show significant problems with attention, hyperactivity and impulsiveness. Therefore, it is not surprising to find that individuals with ADHD may differ in terms of the problems that are most prominent in their adjustment.
Medication, usually stimulant medication, is often recommended. Many factors need to be taken into account to determine if the prescription of medication is in the individual’s best interest. Only a medical doctor is trained and legally permitted to prescribe and monitor medication. Therefore, social workers and clinical psychologists who diagnose ADHD refer children and adults to psychiatrists if they feel that medication may be useful to the individual.
Parents are also taught to apply behaviour management programs designed by the professional to cope with the child’s problems at home while teachers are helped to design programs to address the child’s problems in the school setting. Children whose impulsive behaviours lead to conflicts with peers are often helped to achieve better interpersonal relationships through social skills training groups. Adults who are diagnosed as suffering from ADHD can also benefit from the use of medication.
How to Access Professional Help
Therapists can also teach the adult with ADHD time management and self-organizational skills. The teaching of anger management and communication skills may also be appropriate for some adults. Most large urban communities have support groups for parents and adults who suffer from ADHD (i.e. C.H.A.D.D. – a support group for parents, which can be easily accessed). It is important to recognize, however, that involvement in a support group cannot replace professional assessment and treatment.
You can obtain a referral to a health professional practicing in this field through your family doctor, your child’s teacher, an Employee Assistance Counsellor, or through your state or provincial professional associations for doctors, psychologists or social workers. If an “official” diagnosis is required to access special services within the school system, assessment by a psychiatrist or clinical psychologist would ensure the most comprehensive treatment following assessment. Similarly, services provided by different health professionals are not always reimbursed by insurance companies or may be reimbursed to varying degrees. As appropriate, in-depth assessment and treatment of ADHD is a relatively time consuming process, the wise consumer will take the time to make sure that they will be able to obtain full, comprehensive service prior to taking this important step for themselves or their child.
In this chapter
Dr. Smyth’s chapter clarifies the issues, the diagnosis, and also the treatment approaches that are most effective. No longer do individuals with ADHD have to hear that they are lazy, bad, insensitive, incapable, or hopeless. We now know more about this condition and both children and adults and all those who care deeply about them and want to help can look forward to a future that is far more bright and hopeful.
About the Author
Dr. Frances Smyth has been a psychologist in our group since 1985 and she has served as a business partner since 1992 when the five women partners of Gilmour Psychological Services® formalized their partnership. Dr. Smyth retired in 2018.
Table of Contents
Introduction
During the past two decades, parents and educators have been referring increasing numbers of children to mental health professionals for assessment and treatment of Attention Deficit /Hyperactivity Disorder as there has been a growing recognition that this disorder can, if untreated, lead to adjustment difficulties both at home and school.
What is an Attention Deficit/Hyperactivity Disorder (ADHD)?
Individuals suffering from ADHD tend to have difficulties with attention, hyperactivity and impulsivity. Problems with organization and memory are also common features of this disorder. It is important to recognize that we all experience difficulties in these areas at times but that those who have ADHD experience these problems more frequently and more intensely than does the average person.
It is also important to know that some people are hyperactive while others have the traits described but are not hyperactive. ADHD is a biologically based disorder, which is present throughout the individual's life. You cannot "catch" ADHD, you are born with it. The following description of "John" is typical of children who are diagnosed as suffering from an Attention Deficit /Hyperactivity Disorder.
Where do you fit in? Are you basically demanding of your child or do you encourage decision-making? Are you overindulgent with your child or are you able to say “No”? Do you demand perfection of your child or do you set realistic standards?
Case Study Example
Please note that we protect the confidentiality of our clients, so our case example is fictitious.
A psychologist working in his community saw John, aged nine, at the request of his parents. Although his parents had some concerns about his adjustment at home and in the community, it was his problems in the school setting, which had led them to seek professional assistance. While John's teachers had always commented that they felt he was of at least average ability, his teachers since Kindergarten had identified him as a problem child. He had been observed to be a restless child who had difficulty remaining seated during group activities. He also appeared to have a very short attention span and was easily distracted. As a result, he was inclined to begin playing with toys or looking out the window when his teachers were giving lessons. John learned to read and spell without much difficulty during his primary school years. However, his tendency to encounter difficulty focusing his attention and concentrating meant that his teachers found that he never completed written work unless he was constantly reminded to stay on task.
Since more written work was required as he grew older, John began to fall behind academically. His parents found that completion of homework was a daily struggle and the assignment of a project like a book report, to be completed at home, led to stress for the whole family. John's teachers and parents found that he had other problems, which also got in the way of his achieving academically. He was likely to forget relevant books and materials which were needed to complete work at home or at school. He also seemed to have difficulty organizing himself when a task required several steps or phases for proper completion.
While John's academic performance had been the primary reason for his parent's seeking help for John, they readily acknowledged that they became very frustrated with him at home. His parents needed to monitor him constantly during the mornings if there was to be any hope of his washing, dressing, eating breakfast and getting his lunch and school books ready to leave the house in time for the school bus. Although John had friends, his parents noticed that he tended to get into conflicts with other children more frequently than had been the case for his older siblings. He frequently behaved in a manner that irritated his peers. (i.e. he had trouble waiting his turn, he tended to interrupt other people etc.) . He was also inclined to be moody and easily irritated.
Characteristics of ADHD Remain in Adult Life
Originally, Attention Deficit /Hyperactivity Disorder was viewed as a condition which children would "outgrow" as they reached adolescence. However, recent research has indicated that at least 50% of children diagnosed with this condition will continue to display these characteristics (and therefore to continue to have some adjustment problems) in their adult life. While it is very probable that the hyperactive behaviour seen in childhood will disappear, other problems will remain.
Since the characteristics of individuals with ADHD lead to difficulties with academic and social adjustment, it is not surprising to find that individuals with ADHD tend to develop low self-esteem and other emotional difficulties. Therefore, diagnosis and treatment early in life are important to promote healthy development in children who suffer from this disorder. Although the prevention of difficulties through early diagnosis is not possible for adults who have never been identified as ADHD, they can be helped to achieve a better adjustment in the present through diagnosis and treatment. Better late than never!
Factors of ADHD
How does a person recognize that they or their child may have ADHD? The following list indicates factors that are associated with ADHD.
- Relatives, parents, or siblings who have been diagnosed with ADHD
- Parents with depression, alcoholism or antisocial behaviour.
- Low maternal education and financial status
- Single parent
- Pregnancy complications and problems at time of delivery
- Alcohol consumption during pregnancy
It is important to note that these factors are not causes of ADHD, but are more commonly found in the history of individuals diagnosed with ADHD. The next list describes the characteristics of ADHD and ways in which these characteristics are demonstrated in the behaviour of those with this condition.
Other Causes of Behaviours Suggestive of ADHD
Although this chapter has emphasized the importance of early diagnosis and intervention to promote healthy development of people with ADHD, it is important to rule out other possible causes of the type of problems you or your child may be experiencing before initiating contact with a mental health professional.
It is particularly important to remember that ADHD is a disorder that is present at birth and is not something that we "catch” or develop at some point in our lives. If you have never observed the problems described in yourself or your child until recently, but now find that many of these problems are present, it is very possible that ADHD is not the cause of these problems.
Symptoms looking like those found in individuals with ADHD can be the result of any of the following factors:
- Difficulty with school assignments
- Anxiety or depression
- Use of some medications (anti-convulsants and asthma medication)
- Lack of motivation to succeed in school
Needless to say, anxiety and depression can be the result of different stressors in a child's life. For example, children whose parents are in the process of separation may be anxious and depressed and will therefore show symptoms like those of classmates diagnosed as ADHD. Similarly, adults may show symptoms of ADHD if they have certain medical conditions or if they have various psychiatric disorders. They too may show symptoms of ADHD as a result of stressful experiences.
If you recognize that you or your child have not shown symptoms of ADHD until recently, and you are aware that one of the factors listed above may well account for the present symptoms, referral for assessment of these problems as opposed to assessment of ADHD would be more appropriate. If the symptoms are likely to be a reaction to stressors in your life or your child's life referral to a professional is probably not necessary although there are steps you can take to help yourself or your child to cope with these symptoms.
Coping Strategies to Deal With ADHD
Even if you feel that the symptoms you or your child are experiencing are probably caused by ADHD, these steps will also prove helpful in coping dealing with the symptoms. These steps involve the three "Ss": structure, schedules and support
Structure
Structure refers to a set of external controls we put in place to compensate for the lack of internal controls. In other words, if we cannot easily organize ourselves, remember what we should be doing, and keep ourselves on task, we can set up structures to help us to do so. Lists, reminders, appointment books, filing systems are all methods of creating structure for us when we are not able to do it for ourselves.
Schedules
Schedules are a method of creating structure for ourselves, which are worthy of special mention. In times of stress it is helpful to schedule regular appointments or activities at specific times during the week. Therefore, attendance at these appointments or performance of these necessary activities becomes automatic and are no longer things we struggle to remember to do or get frustrated with ourselves if we forget to do!
Support
If we are inattentive and forgetful as a result of emotional stress, it is important to have the opportunity to express our feelings and get suggestions for coping with our problems. At the present time there are many support groups available for children and adults who are coping with stressful life events such as divorce. It is important for adults to schedule time to talk about stressors and transitions with their children and to offer their children the chance to express feelings and problem solve
Seeking Professional Help
If you recognize that you or your child has experienced the symptoms of ADHD since early in life, and you recognize that these symptoms are causing significant difficulties at home, and at school or in the work place, referral to a mental health professional is certainly appropriate.
Perhaps you wonder what to expect when you meet with a professional. To a certain extent, the assessment will differ depending on the professional you meet. Psychiatrists, clinical psychologists and social workers do assessment and treatment of ADHD. Each of these professionals will attempt to gain an understanding of the history of the problem and will likely have the child's parents and teachers complete standardized questionnaires. These questionnaires are designed to identify the presence of behaviours symptomatic of ADHD and also allow the professional to determine if the behaviours occur more frequently for this child than is normally the case for a child of their age and sex.
A clinical psychologist will use the history and questionnaires to diagnose ADHD but will likely also perform tests of intellectual functioning and memory which will indicate if the child has more difficulty with attention, concentration, planning and memory than is normal for his or her age. The psychologist may also administer tests designed to assess emotional adjustment (i.e. tests assessing anxiety, depression etc.) to determine whether the child is experiencing ADHD like symptoms as a result of emotional problems.
When adults are assessed, spouses or close friends who know the individual well, complete questionnaires. If possible, the parents of adults may be asked to complete questionnaires concerning their recollection of their children's behaviour during childhood. Clinical psychologists will probably administer tests of intellectual functioning and memory and may also administer tests of emotional adjustment.
If a diagnosis of ADHD is made, a number of treatment strategies will be offered by the professional, based on the particular difficulties of the individual. As noted at the beginning of this chapter, some individuals receiving this diagnosis are primarily inattentive while others are primarily hyperactive and impulsive. Still others show significant problems with attention, hyperactivity and impulsiveness. Therefore, it is not surprising to find that individuals with ADHD may differ in terms of the problems that are most prominent in their adjustment.
Medication, usually stimulant medication, is often recommended. Many factors need to be taken into account to determine if the prescription of medication is in the individual's best interest. Only a medical doctor is trained and legally permitted to prescribe and monitor medication. Therefore, social workers and clinical psychologists who diagnose ADHD refer children and adults to psychiatrists if they feel that medication may be useful to the individual.
Parents are also taught to apply behaviour management programs designed by the professional to cope with the child's problems at home while teachers are helped to design programs to address the child's problems in the school setting. Children whose impulsive behaviours lead to conflicts with peers are often helped to achieve better interpersonal relationships through social skills training groups. Adults who are diagnosed as suffering from ADHD can also benefit from the use of medication.
Therapists can also teach the adult with ADHD time management and self-organizational skills. The teaching of anger management and communication skills may also be appropriate for some adults. Most large urban communities have support groups for parents and adults who suffer from ADHD (i.e. C.H.A.D.D. – a support group for parents, which can be easily accessed). It is important to recognize, however, that involvement in a support group cannot replace professional assessment and treatment.
How to Access Professional Help
As explained in the previous section of this chapter, various professionals offer assessment and treatment for ADHD. You can obtain a referral to a health professional practicing in this field through your family doctor, your child's teacher, an Employee Assistance Counselor, or through your state or provincial professional associations for doctors, psychologists or social workers. However, it is important to be aware that in some states and provinces, only doctors and clinical psychologists are legally permitted to diagnose disorders such as ADHD.
If an "official" diagnosis is required to access special services within the school system, assessment by a psychiatrist or clinical psychologist would ensure the most comprehensive treatment following assessment. Similarly, services provided by different health professionals are not always reimbursed by insurance companies or may be reimbursed to varying degrees. As appropriate, in-depth assessment and treatment of ADHD is a relatively time consuming process, the wise consumer will take the time to make sure that they will be able to obtain full, comprehensive service prior to taking this important step for themselves or their child.
Chapters
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