Home
>
Parenting
>
What Makes a Good Evaluation for Attention Deficit Hyperactivity Disorder?

What Makes a Good Evaluation for Attention Deficit Hyperactivity Disorder?

So you have just returned home from your third meeting with your child's teacher. She tells you that your child is not getting his work done, he cannot sit still, and he is simply not going to have any success in school unless something changes. She suggests that you talk to someone to see if he has ADHD. What do you do next?

This can certainly be a difficult time in any family, so we would not want you to be uninformed as you take the next important steps. Here are the things that we recommend if you have a child that ought to be looked at for possible Attention Deficit Hyperactivity Disorder.

First, there should be an "adequate" physical exam by the child's pediatrician or family practice doctor. This doesn't have to be an extensive, expensive exam, but should be able to rule out possible problems like Mononucleosis, Thyroid problems, lead poisoning (if it is common in your area), and potential attention problems caused by medications, such as allergy medications. Then, with a clean bill of health, we move on to step two.

Second, get an evaluation for attention deficit hyperactivity disorder. Usually a psychologist or other mental health professional will do this evaluation for ADD ADHD. But please, only get counseling or therapy from professionals who have a lot of experience treating attention deficit hyperactivity disorder. Therapists who do not have a lot of experience with ADD ADHD will just take your money and then probably blame you, the parents, for the child's disorder. Find experts on attention deficit hyperactivity disorder in your area. Ask around at your local CHADD chapter. Call you local Psychiatric Hospital and ask for the Child or Adolescent Unit. Then ask for the "Charge Nurse." Ask the Charge Nurse who the best psychiatrists and therapists in your town are. They know.

The Evaluation

When you get an evaluation for attention deficit hyperactivity disorder, there should be a good parent interview. It's absolutely essential that somebody sits down with the parents and spends 45 minutes to an hour with them. The psychologist or therapist needs to find out what's going on now, why did the parents pick up the phone and call now instead of last week, and so on. A good developmental history on the child must also be taken. Important questions are:

How did mom do during pregnancy?
Were there any problems at all during pregnancy?
Was there any exposure to drugs or alcohol prior to birth?
When did he learn to walk or crawl?
How about speech development, any problems?
Did he have very many ear infections?
Have there been any head injuries, high fevers, or seizures?

Head injuries and seizures can look just like attention deficit hyperactivity disorder, but aren't. They may require different treatment options.

Then a good family history is great. The family trees of Attention Deficit Disorder kids are often very similar. Look at one and you may say, "Gee, there's no wonder this kid has it," because most of the time, about 80 percent of the time, you can trace the impact of this gene as it runs through families causing things like depression, obsessive-compulsiveness, alcoholism, attention disorders or learning disabilities throughout the family.

The clinician must also know:

Is child depressed?
Does he have anxiety problems?
Is he hallucinating?
Is he delusional?
Is it a head injury?
Is it a seizure disorder?

Parent rating scales are very good and should be given. The ADHD scales we like are by Ned Owens out of Texas. Keith Connors has a fine tool that you have probably seen if you are involved with attention deficit hyperactivity disorder children at all. It is very important for the parents to fill out these behavior rating scales. Ideally the teachers will fill them out also. You want the teacher's input because they see 30, 32, or 35 kids every single day, year in and year out, and they know what is normal behavior and what is not.

Note: One of the things we have noticed is that lately we are having more trouble with the teacher rating scales because the teachers ten years ago, eight years ago, five years ago used to rate the kids pretty reliably compared with the "normal" kids in the class, the non-ADD kids in the class. But what we are seeing lately is very often the teachers are comparing the child that we want rated against the "worst kid" in the class, who might be totally off the wall. And so the rating scale comes back reporting that the child we want rated isn't much of a problem at all. We have to give directions to the teachers to rate them versus "normal kids," not against the "worst kids" in the class.

Also, an in-depth clinical interview with the child is important. This interview is needed to determine the child's reality testing, his degree of maturity, his degree of verbal skills, and so on. Ask the child if he's hallucinating. Sometimes he is, but he hasn't told anyone. Ask the child if he's anxious. Some kids have tremendous fears, but have not shared them with anyone. There is a lot going on with kids that their parents are not aware of.

Psychological Testing for Attention Deficit Hyperactivity Disorder - ADHD

Psychological testing as part of an evaluation for Attention Deficit Hyperactivity Disorder can be helpful. We used to give tests such as the WISC-R, an IQ test, the Wide Range Achievement Test (WRAT), and the Bender-Gestalt test, which is a visual motor integration test. Bored already? Well, they are boring things. But they can be helpful. There are certain patterns that one might expect on these tests if the subject had attention deficit hyperactivity disorder of some type. But it's art, not science at that point. The patterns are not "diagnostic" for Attention Deficit Hyperactivity Disorder. It's also important to know if the kid has a real low IQ, or a major learning disability. It could be a clue that there is something else going on instead of attention deficit hyperactivity disorder.

What we find to be very valuable is the Test of Variables of Attention (TOVA).

The TOVA is an extremely boring computer test that requires the kids to respond to a target stimulus by pressing a button, or to not respond when there's a non-target stimulus. The fact that it is so boring is a work of genius because it helps to differentiate between kids who have trouble with "boring," and kids who do all right with "boring."

The TOVA is really a terrific tool, but it should never be given just by itself. It needs to be given in the context of the whole diagnostic workup. Also, the TOVA can be given with no medication, and then if medication is going to be used down the road, given again with medication in their system. This can tell the clinician if the subject is at the right dosage or not, or how well he responds to that particular dose of that particular medication. The TOVA is a very helpful tool.

Clinical observation of the child is very important. If possible, ideally, somebody observes the child in the classroom. In the real world, we don't know anybody in private practice who can go out in the classroom to observe a child these days, but if a school nurse or school psychologist can go observe them, it can be very, very helpful.

Obtaining an EEG from a neurologist is rarely helpful.

EEGs will show differences from non-ADD children. Typically there is excessive slow brainwave activity, particularly in the Theta band (4-7 Hz.). However, ninety-five percent of all Attention Deficit Hyperactivity Disorder kids have "normal" EEGs. What we mean by "normal" is they don't have big epileptic spikes, or things like that, that a neurologist would say are "abnormal." But when you compare them side by side with a non-ADD kid, they are much different.

An EEG may be helpful if the child is going to be treated with EEG biofeedback, but in terms of being helpful for a diagnostic work-up, it is rarely helpful. However, if the parent interview revealed that the child had some potential neurological problem, as seen in sleep walking, or a history of seizures, and so on, then an EEG would be a good idea.

In summary, then, an adequate diagnostic interview, designed to give an accurate diagnosis a very high percentage of the time, while not costing the family thousands of dollars, would look like this:

Physical Exam - Office Visit
Clinical Interview - Parents (45-60 minutes)
Clinical Interview - Child (45-60 minutes)
TOVA test
Parent and Teacher Rating Scales
Office visit to review information and develop a treatment plan
Begin Treatment

That's it! If there are further diagnostic questions, then more testing would be required. But in the majority of cases, this is all that is needed to make a highly reliable diagnosis. Except for the physician's examination, the cost for this should be about $500-$700. You can learn more about attention deficit hyperactivity disorder by visiting the ADHD Information Library.

Douglas Cowan, Psy.D., is a family therapist who has been working with ADHD children and their families since 1986. He is the clinical director of the ADHD Information Library's family of seven web sites, including learn more about attention deficit hyperactivity disorder, helping over 350,000 parents and teachers learn more about ADHD each year. Dr. Cowan also serves on the Medical Advisory Board of VAXA International of Tampa, FL., is President of the Board of Directors for KAXL 88.3 FM in central California, and is President of NewIdeas.net Incorporated.

Lincoln Stretch rentals Alsip ..

In The News:

Tech guru Kurt "CyberGuy" Knutsson offers solutions to fixing a personal computer that freezes up. There are a number of reasons this might be happening.

The rollout of Apple's iOS 17 brought a subtle "Rebound" notification tone that's gotten some criticism. Kurt "CyberGuy" Knutsson explains a fix.

Fitness centers and workout studios are starting to establish policies that prohibit shooting phone videos to protect people's privacy.

Stay up to date on the latest AI technology advancements and learn about the challenges and opportunities AI presents

Apple recently notified a small number of iPhone customers in 92 countries that their phones may be under attack by mercenary spyware.

An artificial intelligence-powered home security system can fire paintballs and tear gas at trespassers. The camera identifies human faces and animals.

Technology expert Kim Komando gives her tips and tricks on enhancing your user experience a smartphone and other devices you use everyday.

A new camera called NUCA uses artificial intelligence to create deepfake photos of subjects by stripping away clothing in close to real time.

The Kimberley Kube trail-ready camper has a compact but spacious design and combines luxury, functionality and ruggedness for a weekend getaway.

Stay up to date on the latest AI technology advancements and learn about the challenges and opportunities AI presents now and for the future.

Emails instructing you to reset your password for an account may be legitimate, or they may be scams. Kurt "CyberGuy" Knutsson explains.

Northrop Grumman's Manta Ray uncrewed underwater vehicle aims to revolutionize undersea missions — it glides through the ocean without human assistance.

Learn how to work Google's calendar application to streamline and organize your daily tasks from technology expert Kim Komando.

If you do not want Facebook to have automatic access to your private photos, follow our tips to protect yourself. Kurt “CyberGuy" Knutsson shows you how.

Kurt “CyberGuy" Knutsson goes into detail about Apple’s recent iOS update that allows iPhone users to instantly translate spoken language simply by using the Action Button.

Safeguarding your digital life with a reliable physical backup isn't just a precaution, it's a necessity. Kurt “CyberGuy" Knutsson provides the essential backup checklist.

Kurt “CyberGuy" Knutsson reveals how a Redditor exposed false recycling claims at their apartment, highlighting a report that only 21% of U.S. recyclables are processed.

Kurt "CyberGuy" Knutsson offers a travel toolkit featuring five technology tools to help you with booking flights and hotels for your summer vacation.

The bubble behind the clock on your iPhone can appear in different colors. Kurt "CyberGuy" Knutsson explains what each of those colors mean.

Scammers are using the power of artificial intelligence to mimic voices of people and are using the fake voices to commit crimes, like kidnappings.

Stay up to date on the latest AI technology advancements and learn about the challenges and opportunities AI presents now and for the future.

Tech guru Kurt "CyberGuy" Knutsson explains the science behind the Invisibility Shield, a 6-foot shield that makes people become invisible.

The International Olympic Committee on Friday announced plans to use AI in various Olympic aspects, including athlete identification, training and judging.

Tech guru Kurt "CyberGuy" Knutsson explains an easy trick to avoid squinting while working or surfing the web by zooming in on your personal computer.

Streaming giant Roku has recently been targeted by a pair of cyberattacks, and the company confirmed over a half million Roku accounts were compromised.

What Makes a Good Evaluation for Attention Deficit Hyperactivity Disorder?

Parenting