The Problem of
Some children are thought to have ADD and are put on stimulant medication based upon parental report alone; some are diagnosed based upon a checklist. Other children are given an intelligence test to determine whether the child has ADD. While paper and pencil inventories and the “point spread” between intelligence test sub-scores can pinpoint certain problems, they don’t necessarily indicate that the child has ADD.
One of the problems with assessing ADD has to do with the nature of ADD itself. ADD can manifest in many types of symptoms; impulsivity, poor school grades, moodiness, defiance and distractibility, to name a few. Some ADD children have hyperactivity, some do not. Many students with ADD are very bright; many also have learning disorders. When these kids reach their teens, ADD manifests differently. So no wonder it is so difficult to accurately diagnose this disorder.
Unfortunately, ADD is both over-diagnosed and under-diagnosed. It is over-diagnosed in that some kids have behavior problems or are anxiously depressed and they are wrongly considered as having ADD. This is particularly common when adequate testing has not been done. Sometimes too, some testing is done, but tests that rule out learning disorders are not used, and the true problem is missed. Of course, ADD treatment will not help those symptoms improve.
The way to get the most accurate diagnosis is to use a variety of instruments that test for ADD as well as to use other instruments to “rule out” disorders that can masquerade as ADD. An “ideal” assessment begins with a school observation and a parent interview. Then, parents and teachers should be given several different paper and pencil checklists each. An intelligence test should be given and distractibility factors should be calculated. In addition, a “continuous performance test” like the Connors CPT should be given as well. (The Connors present letters on a computer screen, and the child has to respond in certain ways. It measures both concentration and impulsivity).
An assessment isn’t complete without including some measures for depression, emotional or family problems. In addition, a variety of neuropsychological tests that screen for various “hard wiring” problems should be administered. Finally, all or portions of school aptitude and ability test, like the Woodcock-Johnston should be administered as well. Surprisingly often, these tests turn up problems that should be treated in addition to or instead of ADD.
With “state of the art” assessments such as these, the problem of over or under diagnosis should lessen. More importantly, the child will be assessed in his or her uniqueness, and the treatment can be tailored to his or her individual needs.
Ph.D. is the Director of Wilmes-Reitz Psychological in Calabasas.
He can be reached at 818.591-8270.
Stacey Cohen-Maitre, Ph.D.
WRP Assessment Specialist: Stacey Cohen-Maitre, Ph.D.
23945 Calabasas Rd., Suite 202
Calabasas, California 91302