Recommended Guidelines for an ADHD Evaluation
From time to time, we at ExecuThink like to make you aware of research and information that can help you develop and maintain cognitive health and fitness. As a clinical psychologist, I’ve evaluated and treated several thousand children and adults with attention deficit and learning issues. When appropriate, I’ve recommended various treatments — medication, research-validated working memory training, family education and counseling. Because of my experience, ExecuThink clients often ask me about attention deficit and ask for suggestions for how to diagnose and treat the condition, for a family member or friend.
A front-page article in The New York Times, “Drowning in a Stream of Prescriptions” (2/3/2013), told of a young man’s suicide and highlighted issues in the diagnosis and treatment of ADHD. The article is about a man who, after inadequate evaluation, was misdiagnosed with ADHD and wrongly prescribed stimulant medication. The medication caused amphetamine addiction and psychosis, ultimately resulting in his suicide.
So compelling was this article, I felt it important to provide information to you who have children with ADHD or are concerned about possible ADHD in family members. The fact is, ADHD stimulant medication addiction & psychosis are rare, but sadly, sloppy or inadequate ADHD diagnosis and incorrect treatment are all too common. How do you know if your child, spouse or other family member has ADHD? Here are recommended, gold standard guidelines to help you obtain an accurate, thorough ADHD assessment.
MAJOR GOALS OF an ADHD ASESSMENT:
1. To determine the cause of the problem — ADHD or something else.
2. To identify other conditions that may need treatment instead of or in addition to the ADHD.
3. To construct a list of problems to be addressed in the treatment plan.
4. To develop a treatment plan to address each item on the problem list.
5. To identify the pattern of the person’s psychological strengths and to consider how these may affect treatment planning. This identification may also include assessing parents’ abilities to carry out the treatment program.
6. To confirm the diagnosis, using multiple measures and, if necessary, second opinions.
QUESTIONS AT THE HEART OF AN ADHD EVALUATION
• Are the symptoms of inattention (AD/HD — Inattentive type symptoms) and/or impulsivity and overactvity (AD/HD – Combined type) present?
• Is there evidence that these symptoms significantly interfere with the person’s functioning, at school or work and home?
• Did these symptoms have a reasonably early onset or, if not, is there a good explanation why they appeared later, such as special environmental factors?
• Have these symptoms been an enduring and consistent feature of the person’s behavior across time and situations or, if not, are there convincing explanations for the inconsistencies?
• What evidence is there that the person wants to perform well but can’t? Are there better explanations for the individual’s underachievement than ADHD, such as being oppositional or having a learning problem or weak working memory? Is there any pattern to the ebb and flow of problems that might be tied to past events, particular situations or another psychiatric syndrome?
• Even if there is an oppositional, defiant or intentional component to some of the disruptive behaviors, is there also evidence that the child has an inherent inability to control himself or herself?
• Is there evidence that ADHD symptoms are complicated by other problems?
If your doctor or clinician fails to adhere to these guidelines, by all means, get a second opinion. Remember, doctors can’t treat a condition appropriately if they don’t know what it is. Please feel free to email me with any questions you have about this article. I am unable to answer specific clinical questions about particular individuals, but I can answer questions about specific tests, core components of an evaluation and types of clinicians who conduct evaluations.
Avner Stern, Ph.D.
Clinical Psychologist
astern@executhink.com