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Strategy 3

Get a Complete Assessment

Before an assessment for ADHD, make sure that all possible medical explanations for what you are seeing have been ruled out. For children, take your child to the pediatrician and ask, “Other than ADHD, are there any other medical reasons for why my child may be having problems concentrating or......” Once the proper medical screening has been completed, and other medical conditions are ruled out, you are ready for an ADHD assessment. Here is what should happen:

•A history

•Behavioral checklist

•Screening for Central Auditory Processing problems

•How you or the person being tested performs during boring tasks

•Intelligence testing to determine learning style

•Achievement testing

•A brain scan

Get a good history

The psychologist will ask you a number of questions about possible birth complications, early development, and school history. The history should include a review of other family members with ADHD (and go back as far as you can), as well as a clinical interview to determine if other factors may be contributing to the symptoms other than ADHD. Ruling out mild traumatic brain injury, for example, is important when assessing young athletes engaged in contact sports.

Completion of behavior checklists

Checklists will provide a standard way to ask different questions about what symptoms are present and how they are affecting daily functioning. For children and adults, I prefer to use the checklists located in appendix B and C. The questions result in a severity index, which gives an idea of how the presenting symptoms are impacting function. Many times only teachers complete checklists and this alone is not a valid measurement in determining ADHD. Teacher input for children should only account for 0 to 5 percent of the information used to determine the diagnosis of ADHD.

Screening for Central Auditory Processing problems

Central Auditory Processing difficulty (CAP) can often mimic the symptoms of ADHD. Many children and adults with ADHD also have CAP. A screening test is done at the psychologist’s office that takes about twenty-five to thirty minutes to complete. A positive finding often results in a referral to an audiologist knowledgeable about CAP.

Performance during very boring tasks

A number of continuous performance measures are used to determine how you or your child will perform on a very boring task. Your performance is then compared to others with or without ADHD. These tests, such as the Connors Continuous Performance Test (CPT), take approximately 15 minutes to complete. The analysis of your results by the psychologist can take a greater amount of time to be able to better understand how you perform when doing boring tasks in a quiet environment. I often wonder if a child or adult is having extreme difficulty completing the CPT in such a quiet office setting, how do they function when faced with such tasks in a busy classroom, or office/work setting?

Intelligence testing to investigate learning style

Traditional intelligence testing, such as the Wechsler Intelligence Scales for children, are administered to understand how new material is learned. The testing is combined with other tools of measurement to determine if a gifted profile may also be present. Children and adults with gifted behavior often look to be ADHD if they are not in an environment that is challenging or interesting. Learning disabilities are also identified using these results, combined with achievement and other testing. I tell children that this testing is about finding out the horse power “under the hood” of the car to see how fast they can go.

Achievement testing

This is about finding out how fast the car is in fact going. We test to determine grade scores (at what grade level someone is reading or writing at, for example) and standard scores (how they compare to others the same age), which can be compared accurately to the intellectual testing. Often, at this point, the information from testing and history gathering may point to a specific learning disability, gifted profile, CAP, or some other life event that is contributing to the problems noted.

The brain scan

While this is just one test of many that is reviewed to determine the diagnosis of ADHD, I believe it is one of the most important. ADHD is a neurological condition. If you don’t look at the brain, how do you know if it exists?

At our offices, we use the QEEG or Quantitative Electro Encephalogram. The information generated by the test is reviewed by a neurologist and expert in brain physiology. A number of doctors and scientists believe that there are many different “types” of ADHD, which can only be accurately determined by looking at the brain image. Deregulation in the prefrontal area of the brain may cause different symptoms than deregulation in the temporal regions.

Other neurological conditions, although rare, may also be identified from the QEEG. In a rare case at our offices, petite mal seizure activity was identified during one of our evaluations for ADHD, which resulted in a very different treatment path and level of understanding. This young adult had already been incorrectly diagnosed with ADHD, but luckily his parents wanted a second opinion. Yes, this is a rare diagnosis, but fortunately the parents in this case listened to their instincts and asked us to do a comprehensive evaluation.

Data analysis and report

Once the above tests are completed, a report is written incorporating all of the information identified in the assessment. The report is written for you to use to get the best treatment and programs to achieve success. When I started in practice, schools would sometimes call complaining that my recommendations were unrealistic. They would say that ADHD is a medical, not school, condition and therefore teachers and principals weren’t required to accommodate children or teens with the diagnosis.

In response to these calls, I wrote the Premier of Ontario and sometime later received a letter from the Minister of Education who said this among other things:

“You have also indicated that elementary and secondary schools are not providing support to students with a diagnosis of ADHD. School boards have obligations under the Ontario Human Rights Code to accommodate students with ADHD since the Ontario Human Rights Commission regards ADHD as a disability; therefore, such students have protections under the Code. In elementary and secondary schools, the duty to accommodate is met by the provision of special education programs and services.”

We posted the entire letter on our website www.drsvec.com so parents could print it and take it with them should they need to advocate at the school level.

As our testing procedures become more exact, it is more common to see a combination of factors impacting a persons learning and performance, as opposed to a single diagnosis of ADHD. This comprehensive testing is capable of pinpointing “flavors” of issues as I call them. The problem is that once identified, what does a school and parent do with someone with ADHD-Inattentive Type + Mild Disorder of Expressive Language + Gifted Profile in the Perceptual Visual domain?

We will get to that in later chapters, but the first challenge is to be comfortable with the assessment. As a parent, you want to do all that you can to help your child. If you suspect that your child has ADHD, there are no shortcuts. A comprehensive assessment is necessary.

As an adult with ADHD, you want to make sure the diagnosis is clear and understandable.

A diagnosis of depression, or anxiety disorder with ADHD, is often seen with adults assessed at our offices. Was depression part of a neurological pattern that was present with the ADHD, or did depression occur as a result of negative experiences and a reaction to untreated ADHD? This is an important distinction. If you believe that the depression was always there, then perhaps treating it with medication may make more sense than if the condition was brought about by secondary reactions to the ADHD condition.

The type of ADHD you have should also be linked to the type of treatment you choose. Prefrontal Involvement, Central Slowing, or Temporal Lobe ADHD as identified by the brain scan will each require a different approach and intervention. I will discuss this with treatment approaches in a later chapter, but the first step is to ensure that you have a proper diagnosis.

Key idea from this strategy

A *comprehensive assessment should include:

•complete review of possible medical factors that could be contributing to the symptoms;

•developmental and early learning history;

•test of focus and attention while completing a timed task in a lab setting (i.e., CPT);

•screening for Central Auditory Processing Disorder;

•Intelligence testing to identify potential gifted behavior and rule out some learning disabilities;

•Comprehensive achievement testing (i.e., WIAT);

•neuroimaging or brain scan reviewed by a neurologist and brain physiologist;

•comprehensive report with specific recommendations for home and school, or work and social for adults.

*You may be wondering if this is one big push to have you bring your child to our offices for assessment. Not so. I truly believe that, regardless of where you live, only a comprehensive assessment will do when the question of ADHD is at issue. Find a competent psychologist or clinic in your community that can do the tests I have outlined. Costs will vary. At our offices, at the writing of this book, we charge $2,750 for a child and $1,635 for an adult assessment with complete report, including the neurologist’s evaluation. It’s about the value of the service you receive. Parents tell me it’s less than the cost of putting their child in hockey camp for the summer, so you decide what is most important. Most clinics such as ours also assist with filling out insurance and government program forms that may pay for all or part of these types of assessments.