| ADD/ADHD Diagnosis and Management |
How Do you Diagnose or Pinpoint the Problem?
Not to oversimplify, but ADHD generally refers to very problematic behavioral hyperactivity, resulting in problems with paying attention, holding focus, and controlling impulses. ADD generally refers to the inability to hold focus and pay attention, but in ADD, behavioral hyperactivity is not a serious problem. What people often call "ADD" is termed "ADHD-Inattentive type" in the psychology taxonomy. What people often call "ADHD" is termed "ADHD-Hyperactive Impulsive type" in the psychology taxonomy. Many folks with ADHD also have symptoms of ADD too.
People of all ages, from age 6 and up through older adults, come in to find out if their problems with hyperactivity or lack of focus meet criteria for a diagnosis of ADD or ADHD, or if their problems are due to something else. People can be distracted or impulsive for many different reasons. Therefore, I do a complete evaluation to get to the best explanation for the symptoms. I use observations, standardized tests, behavior ratings, response times (the TOVA test), other objective measures, and even projective assessments if needed. It is also important to get someone else's assessment of the patient's behavior, such as a parent or teacher for a child or teen, a spouse or friend for an adult.
The evaluation process is similar for kids and adults, although the tests vary. A typical evaluation includes: one session for an evaluation interview, two to four sessions of individualized testing, and a final session to present and discuss the results. You will get a multi-page report that explains the findings. While many of the tests are the same or similar for all evaluations, there is no pre-determined battery of tests that I give to everyone; we select the tests on a case by case basis, depending on the questions of the individual case as well as the age.
I try to use the minimum number of tests needed to get a good set of diagnostic impressions and recommendations. If the evaluation suggests other problems, we can discuss whether those areas need further in-depth testing; memory or learning problems are examples.
I often work with adults who may have never been diagnosed with ADD or ADHD, but who wonder if this could possibly be an explanation for long-standing problems related to lack of focus and underachievement. While ADHD is a disorder that arises in childhood, or at least by teen years, in adulthood, its symptoms often have morphed. Through the evaluation process, we collect the information that helps determine if ADD or ADHD is a likely diagnosis, or if something else is at work.
What are the Psychological Treatments?
Once we have the diagnosis, we can move on to psychological ways to manage the impulsiveness and inattention that interfere with learning and daily life. The work is all individualized, depending on personal strengths and weaknesses. I try hard to capitalize on strengths and de-emphasize problem areas.
With younger children, I recommend behavior management techniques to improve focus and stability and suggest remedial teaching strategies for parents and teachers. Some impulsive children have difficulty following rules, and behavior management programs are useful.
With adolescents, I recommend strategies for problem behavior areas and self-teaching/study strategies, as required. It is important for adolescents to learn how to stick-to things they enjoy, as well as to things they have to work hard for.
With adults, we often work on identifying areas of strength and capitalizing on those. Often with adults, there is important work to do regarding career choices and choices of partners, taking ADD/ADHD into consideration.
Procrastination and/or failing to finish things are common problem areas to address with all ages.
Interpersonal relationships can sometimes be troublesome, and we address those problems as well.
If you are interested in medicine, I can refer you to physicians who treat these problems. But even for people who end up trying medicine, it's a great idea to learn as much as possible about psychological management of ADD/ADHD.
I am a member of CHADD (Children and Adults with Attention Deficit/Hyperactivity Disorder). Complementary copies of their monthly magazine are available in the office waiting room.
Psychology to Go: Getting a Good ADD/ADHD Evaluation
1 Pick your psychologist wisely
· Find a qualified, experienced psychologist who you can open up to, work with, and feel confident in
· Licensed
· Belongs to relevant professional associations
· Has professional personality and demeanor
· You might talk to more than one psychologist over the phone before making up your mind
2 Open up about what’s bothering you and ask all the questions you want
· Expect an initial structured interview session to screen you in or out for further testing
· Be prepared to provide details about the problems you are having; come to the session with any relevant documents
· Ask any questions you have about the evaluation process
· Be yourself, express yourself, and open up
3 Find a psychologist who wants multiple perspectives on your problems
· Sometimes ADD/ADHD symptoms are really due to something else
· Expect a variety of assessment methods: checklists, computerized reaction tests (called “continuous performance tests”), multiple choice instruments, learning and memory tests as appropriate, even inputs from someone else who knows you well
· Expect a selective rather than a standard test battery: Saves you time, prevents being overtested, saves you money
4 Expect timeliness from start to finish.
· Find a psychologist who can provide the evaluation and a written final report within a reasonable time frame, something that fits your needs.
· The more flexible you can be with scheduling your testing sessions, the quicker the process can proceed
· Recognize that some tests will probably need to be done in the morning
· It is usually better to have several short testing sessions rather than one or two marathons: people with attention problems need breaks, short sessions won’t tire you out, you do better, easier to schedule
· You should be able to get a final report within a reasonably short time after your final testing session
· Make sure you have a final session to go over the fresults and get answers to your questions.
5 Get results you can use!
· Find a psychologist who can work with you in implementing any recommendations that come out of your testing.
· You are apt to get a better set of recommendations from someone experienced in treatment.
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