Comprehensive ADHD Assessment
Concern about ADHD remains one of the most common referrral reasons to mental health professionals (Brown, 2000). And, unfortunately, it is also overdiagnosed in our culture and therefore many children are unnecessarily diagnosed and inappropriately medicated. As a licensed psychologist, Dr. Wilson uses an array of psychological tests, including standardized, objective measures to rule out the many other causes or conditions that can ‘mask’ or look like ADHD. The WPA ADHD examination is an extensive process that involves approximately four to five hours of testing, as well as gathering essential information from the child’s parent(s) and the child’s teacher. While Dr. Wilson uses these collateral informant behavior rating forms, they alone do not take into account the many other causes of inattentive or hyperactive behavior and therefore, if used solely as the basis for identification of ADHD symptoms, may lead to an inaccurate diagnosis. Therefore, Dr. Wilson also utilizes many objective measures to assist in identification of problems. Dr. Wilson is known to conduct comprehensive evaluations to effectively rule out the other conditions that may appear like ADHD symptoms before making this important diagnosis. Dr. Wilson’s philosophy is that every child or adult referred is “neuro-typical” until a body of consistent data suggests otherwise.
What is ADHD (ADD)?
Attention Deficit/Hyperactivity Disorder is a challenging condition experienced by a number of children, adolescents, and adults. Core symptoms include problematic levels of impulsivity, inattention, and hyperactivity. It is a biologically based disorder that when diagnosed properly and managed effectively, one can lead a full and productive life.
Symptoms found in childhood that suggest the disorder include inattentiveness, distractibility, impulsivity and for some individuals hyperactivity.
More specifically one might find a child:
Failing to give close attention to details and making careless mistakes
Having difficulty sustaining attention
Not appearing to listen
Struggling to follow through with instructions
Having difficulty with organizing tasks
Avoiding or disliking tasks that require sustained mental effort
Being forgetful in daily activities
One may also find the child:
To be excessively restless
To fidget with hands or feet or squirm in the chair
To have difficulty remaining seated when expected
To run about or climb excessively
To talk excessively
To create disruption in activities in which he/she is expected to do quietly
To have difficulty waiting one’s turn
To interrupt or intrude upon others
Why is a comprehensive multimodal method necessary for diagnosis and for guiding treatment?
First, there is no single definitive test for ADHD. More importantly, rating forms alone cannot sufficiently distinguish core ADHD symptoms from other, common behaviors in children.
Second, many of the symptoms for ADHD are displayed by all children, adolescents, and adults on occasion or to some degree.
Third, some of the same or similar symptoms are found in other disorders as well as ADHD. Mental disorders are not discreet, that is, the symptoms of one frequently overlap with symptoms of another and may appear to be one from a singular view, while a comprehensive evaluation helps tease apart the different symptom manifestations.
Fourth, other conditions, such as mood disorders, anxiety disorders, and other disorders of childhood, are found to frequently co-exist with ADHD in many children. The co-existence of other concerns is also at issue in adolescents and adults with ADHD. Learning disabilities experienced by many children with ADHD further complicate the task of identifying the scope of the difficulty and in providing the most effective treatment.
Finally, treatment of ADHD, as well as for other disorders, often includes the use of medication. Such an important choice should only be made with a thorough understanding of the range of the problems experienced by the individual child, adolescent, or adult and with the need for such a serious intervention being well established. A comprehensive assessment provides information addressing these concerns.
What is involved in a thorough assessment?
A thorough assessment should include gathering information from individuals familiar with the child, adolescent, or adult in more than one setting, i.e., school, home, place of employment or in the community, both in structured (rating scales) and semi-structured (interviews and narratives) ways. It should include consideration of other diagnostic possibilities and will include intelligence testing, achievement testing, and/or consideration of the child’s, adolescent’s, or adult’s emotional functioning. Visual and auditory continuous performance tests to provide further evidence of impulsivity and/or inattentiveness will also be included; not as a definitive means of diagnosis, but to help support or dispute evidence found elsewhere. In adult and adolescent assessment, there is a particularly strong need for the accurate and thorough gathering of historical data.
A word about adolescent and adult ADHD. While ADHD is often first diagnosed in childhood, an understanding of ADHD in adolescents and adults is also very important both for diagnostic and treatment concerns. Research has suggested that a number approaching 70% of the children properly diagnosed with ADHD continue to experience symptoms in adolescence. Furthermore some 50% of those individuals continue to be challenged by ADHD into adulthood. In addition, with the adult population, ADHD may have previously gone undiagnosed or overlooked as our understanding and awareness of the nature of the disorder is greater than in the past and is continuing to develop each year.
In adolescence the symptom presentation generally shifts from the prominent impulsivity and hyperactivity of childhood to a correspondingly greater experience of challenges with poor organization, forgetfulness, excessive daydreaming, poor follow through on tasks, the needing of excessive direction, and engaging in risky behavior. In adults, undiagnosed and unmanaged symptoms can lead to underachievement in work and social relationships. In addition, difficulty associated with organization, procrastination, inattention when receiving or processing information, compromised tolerance for frustration, displays of irritability, and forgetfulness are but some of the experiences of adults with ADHD.
How do I go about arranging for such an evaluation?
Call our office staff at The WPA Center for Pediatric and Child Psychology at (918) 337-6050 or use the “Contact Us” link on this webpage.
Dr. Wilson is a certified health service psychologist who has extensive experience in working with children and adolescents in the diagnosis of ADHD. In addition, because psychological evaluation and specialized assessment is a such an important part of his practice, he has a strong background and understanding of the diagnosis and treatment of other challenges or disorders of childhood and adolescence that may co-exist with ADHD or which may actually account for symptoms thought to be ADHD.