Understanding & Treating ADHD: ADHD Symptoms

An Assessment of ADHD Symptoms

How we diagnose ADHD symptoms

Assessment of children suspected of ADHD should be conducted according to best practice. This includes gathering medical, developmental, social, and educational information, reviewing educational and medical records, in addition to previous evaluations, interviewing parents, teachers, other professionals who have worked with the child, and, when appropriate, the child. The use of standardized instruments are part of the evaluation as well. Standardized instruments are used to assess academic achievement, cognitive abilities, executive functioning, and continuous performance (typically administered on the computer) to compare the child’s results on the different measures to same age peers.

Rating scales are also distributed. Rating scales are given to teachers, parents, and the child (when appropriate) to assess the social, emotional, and behavioral functioning of the child compared to peers. Reviewing rating scales helps to examine the severity of the informants’ report of ADHD symptoms compared to the general population and assist in prioritizing treatment targets. Additionally, evaluators may conduct classroom observations to see how the issues manifest in an age typical setting. By performing a complete evaluation of the child, the evaluator determines if an ADHD diagnosis is appropriate as well as ruling out (i.e., differential diagnosis) impulse control disorders or diagnoses of other co-occurring concerns such as a learning disability/disorder or Autism Spectrum Disorder.

ADHD Symptoms in Context

When evaluating for the presence of a neurodevelopmental disorder, evaluators give special attention to the impact of the ADHD symptoms in context, while considering age typical behavior. The impact of the ADHDsymptoms on daily functioning in important life domains, such as school, home, community, social situations, and for adults, in their occupational setting, is examined prior to diagnosis. Occasionally, ADHD symptoms may be present, but do not reach a clinically significant threshold to warrant an ADHD diagnosis.

Sometimes, parents of a child recently diagnosed with ADHD, or other adults, may be interested in investigating whether they meet criteria for the disorder. The scope of the evaluation changes given the important life domains potentially affected (i.e., adults who are no longer in school or higher education may not require assessment of cognitive abilities or academic achievement). Generally, assessment of adult ADHD symptoms comprises of collecting background information (including medical, developmental, social, and educational history), a continuous performance test, and rating scales to be completed by the adult and others who are familiar with the adult (spouse, work colleague).

The Complexity of Diagnosing ADHD

Although the DSM-5 provides a set of criteria that are helpful in identifying if a child or an adult should be diagnosed with ADHD, its ability to inform treatment ends there. When addressing medical conditions such as a broken arm or bacterial strep, once a diagnosis is made, treatment typically follows (e.g., setting the arm and immobilizing it, or a penicillin antibiotic, respectively). However, with mental health issues, treatment is multicomponent and often complex. ADHD treatments are of the latter more than the former type.

Overall, a comprehensive evaluation of the child helps to determine the course of action needed to develop a treatment plan to support them at school and home.

Next we’ll consider other co-occurring disorders to highlight the need for a comprehensive evaluation, and review prevalence, risk, and prognostic factors.

ADHD Series by Dr. Glenn Sloman

Continue reading using the links below:

• What Is ADHD? Part 1
• ADHD Symptoms Part 2
• Who is Diagnosed with ADHD? Part 3
• Executive Functioning Part 4
• Another Way of Looking at Impulsivity Part 5
• Promoting Success with ADHD Part 6

References

Attention-Deficit / Hyperactivity Disorder (ADHD). (2017, July 18). Retrieved October 02, 2017, from https://www.cdc.gov/ncbddd/adhd

Biederman, J. et al. (April 2010). Adult Psychiatric Outcomes of Girls with Attention Deficit Hyperactivity Disorder: 11-Year Follow-Up in a Longitudinal Case-Control Study. American Journal of Psychiatry 167(4):409-417.

Biederman, J. at al. (July 2012). Adult outcome of attention-deficit/hyperactivity disorder: a controlled 16-year follow-up study. Journal of Clinical Psychiatry 73(7):941-50.

CHADD – The National Resource on ADHD. (n.d.). General Prevalence of ADHD | CHADD. Retrieved October 02, 2017, from http://www.chadd.org/understanding-adhd/about-adhd

Diagnostic and statistical manual of mental disorders DSM-5. (2013). Arlington, VA: American Psychiatric Association.

Najdowski, A. C. (2017). Flexible and focused: Teaching executive functioning skills to individuals with autism and attention disorders. San Diego, CA: Academic Press.

Thapar A, Cooper M, Jefferies R, et al. What causes attention deficit hyperactivity disorder? Archives of Disease in Childhood 2012; 97:260-265.

The Understood Team. (n.d.). 3 Areas of Executive Function. Retrieved October 02, 2017, from https://www.understood.org/en/learning-attention-issues/child-learning-disabilities/executive-functioning-issues/3-areas-of-executive-function

About The Author

Glenn M. Sloman, Ph.D., BCBA-D, NSCP is a Licensed Psychologist in New Jersey and Pennsylvania and a Board Certified Behavior Analyst at the Doctoral level. Dr. Sloman is also a Nationally Certified School Psychologist and a Certified School Psychologist in New Jersey. He earned his undergraduate degrees with honors in Psychology and Anthropology at the University of Florida. Dr. Sloman attained his Master’s in Education and Ph.D. in School Psychology at the University of Florida where he specialized in Behavior Analysis. He previously served as a program coordinator for Douglass Developmental Disabilities Center Outreach Program and supervisor of home staff in programming for individuals with an Autism Spectrum Disorder (ASD). Dr. Sloman has worked in New Jersey school districts as a case manager and school psychologist on a child study team developing and implementing individualized education programs (IEPs) and behavior improvement plans (BIPs), providing individual and group psychotherapy, social skills training, and staff and parent consultation.

Dr. Sloman is skilled in conducting psychological and psychoeducational evaluations, and functional behavior assessments (FBAs). He has experience providing outpatient psychotherapy to children, adolescents, and adults from ethnically and economically diverse backgrounds, and providing parent support and training.

Dr. Sloman has extensive experience in the treatment of children through adults who present with symptoms of anxiety, depression, ADHD, ASD, learning disabilities, oppositional defiant disorder, obsessive compulsive disorder, mood disorders, and social skills deficits. He also has expertise assisting individuals transitioning from high school to college life.

Dr. Sloman’s professional interests include Acceptance and Commitment Therapy (ACT) and applying Behavior Analysis in treatment and consultation. Dr. Sloman’s goals for his clients are to increase their psychological flexibility in pursuit of doing what matters to them and creating meaningful behavior change. He is a member of the American Psychological Association, the New Jersey Psychological Association, and the Association for Contextual Behavioral Science.