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Learn about Proper Diagnosis of ADHD
One of the areas of greatest controversy in the assessment of children's
learning and behavior problems is the diagnosis of ADHD. Mentioned as the
source of difficulties for many children struggling with their behavior or
capacity to learn, ADHD is an easy assumption with a relatively quick and easy
fix. The problem is that there is no definite method of assessment for a clear
diagnosis of this disorder.
Inadequate Diagnostic Procedures
Many children are identified as ADHD by their symptoms alone.
The common behavioral problems of inattention, impulsivity,
hyperactivity, disorganization and learning problems often
are viewed as sufficient to substantiate the ADHD diagnosis
and prescription of medication. Unfortunately, this often results
in the improper diagnosis and treatment.
There is no sure-fire method of diagnosis of children's problems.
Various specialists rely on different assessment techniques.
Often, there is great reliance on the use of symptom rating
lists. These require parents and teachers to rate the intensity
of symptoms by number. Scores are then calculated and various
comparisons are made. Based on these scores, a diagnosis of
ADHD can be made. Unfortunately, these types of rating systems
have a large amount of bias based on the individual rater.
If a parent or teacher believes the child has ADHD, there is
a greater likelihood that they will tend to rate certain behaviors
higher. If they are against "labeling" the child,
there will be a tendency to lower scores.
Other times, individuals will make the diagnosis strictly based
on parent report. This occurs often in the pediatrician's office.
Parents complain of ongoing difficulties with behavior at home
or school and the pediatrician provides a prescription for
a stimulant drug! to assist. While the doctors have knowledge
of the symptoms of ADHD, they are not specifically trained
for the differential diagnosis of ADHD from other problems.
Differences in Mental Health Approaches
Mental health professionals don’t have a consistent approach
to the diagnosis either. Often, those with Master's level training
have not been provided training in the differential diagnosis
of various psychological disorders. Each practioner relies
on their personal experience or belief system to consider this
diagnosis. Psychiatrists rely on an extensive interview, family
history and individual examination of the child. This provides
diagnostic assistance as to the family background, genetic
evidence of ADHD and analytic assessment of the child's neurological
and psychological functioning. Often, the psychiatrist will
rely on the child's response to trial doses of medication to
make a definitive diagnosis.
Brain Imaging Techniques
With the new developments in medical technology, some physicians
have utilized brain scans for assessment of ADHD. This technique
scans the brain and provides a picture of the brain's metabolic
activity. Some physicians have based the diagnosis and the
type of medication based on the images observed. While this
may have some future benefit, the National Institute of Health
has indicated that any use of brain imaging for diagnosis of
ADHD is premature. Much research must be completed before these
theories can be confirmed as accurate.
Psychologists’ Reliance
on Objective Testing
While psychologists differ from each other as do other professionals,
it is often the reliance on objective psychological testing
that provides a clearer. In the past, psychologists attempted
to develop a specific profile on cognitive tests that would
be indicative of ADHD. In the revision of the Wechsler Intelligence
Scale for Children-III (WISC-III), a Freedom from Distractibility
Scale was developed. Unfortunately, this did not consistently
provide a definitive method of diagnosis.
ADHD is a neurological processing disorder. The research has
led professionals to believe that there may be some relation
to the metabolism of glucose in the brain. Glucose is the "gasoline
of the brain." While there is not evidence that these
individuals lack sufficient glucose in the body, there does
appear to be some support to the idea that the brain cannot
absorb the glucose at a high enough level to work effectively.
ADHD affects the coordination of various parts of the brain
so that sufficient information does not get processed to make
good decisions. Information from our five senses each is sent
to a different part of the brain. The brain must then process
the information interpreting the sensory messages and sending
the proper information to the decision making part of the brain,
the frontal lobes. The frontal lobes then take all of this
information and determine the proper reaction . Since huge
amounts of information are being sent to the frontal lobes
continually, it is difficult for this to be sorted out sufficiently.
Often, the in formation provided cannot provide consistency
for proper understanding. Thus, the individual becomes disorganized
and confused. ADHD individuals have greatest problems with
more complex reasoning involving many steps. Many ADHD children
have expressive writing difficulties. Writing is the more complex
piece of human reasoning that exists. It was the last to evolve
in the species.
In the proper diagnosis of ADHD, an adequate assessment of
the brain's ability to coordinate and organize is necessary.
Since each of us have unique strengths and weaknesses, it would
make sense that each of us would have unique problems related
to ADHD. Use of neuropsychological or cognitive testing provides
this proper assessment. While some psychological testing batteries
included a large amount of tests, the proper diagnosis of ADHD
does not require this degree of assessment. One of the most
accurate tests available to psychologists is the Wechsler Intelligence
Scales. These tests include the Wechsler Preschool and Primary
Scales of Intelligence (WPPSI) for 2to 6 year olds; the Wechsler
Intelligence Scales for Children-III (WISC-III)for ages 6 through
16 and the Wechsler Adult Intelligence Scale-III (WAIS-III)for
adults. Each of these tests has been developed over many years
to provide an excellent source of diagnostic information. They
are individually administered by ! a psychologist who is able
to receive a great deal of information through objective scores
and observation of the individual during the testing.
While tests of "intelligence" have been challenged
in the past as not actually reflecting intelligence, the Wechsler
Scales have been accurate measures of neurological functioning
in various lobes of the brain. With this information, the psychologist
is not looking for how smart the person is (many ADHD individuals
are highly intelligent) but rather looking at the consistency
of the performance. Since each individual has strengths and
weaknesses , specific differences will be observed that do
not usually exist in others without this disorder. Through
use of the Wechsler tests and other diagnostic procedures to
assess memory and learning ability, the psychologist can make
a proper diagnosis. Since there are several other disorders
with similar symptoms , it is necessary to differentiate ADHD
from other problems. Anxiety is often mistaken for ADHD. The
use of stimulant medication in these individuals is only going
to increase the problems rather than assist the person.
From the results of the assessment, the psychologist can also
understand the areas of learning that will be most affected.
Since each of us is a unique being, our profile of abilities
will be unique as well. Those with ADHD will have a unique
pattern of strengths and weaknesses that will be more drastic
than those without ADHD. These patterns can assist the psychologist
to develop recommendations for academic needs and predict certain
areas of greatest difficulty. Combined with academic testing,
the specific problems can be addressed through a plan to modify
academic expectations through the Americans with Disabilities
Act. This mandates every school to accept the ADHD diagnosis
in developing more realistic expectations for the individual
and the learning style.
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