Assessment of Attention Deficit Hyperactivity Disorder (ADHD) - Research Paper Example

? al Affiliation Assessment of ADHD Medical assessment Medical assessment of ADHD starts with a diagnosis based the behavior of a person followed by an assessment to find out the possible causes of such behavior. First, behaviors are assessed to find out if they are within the scope of normal limits. The traditional assessment method is used in this case. This method does not look for causes of the behaviors observed. It is solely based on the DSM-IV behavioral criteria for ADHD (Barkley, 2005, p.92). The second approach assesses the brain and metabolic dysfunctions which are likely to cause the symptoms of abnormal behaviors and attention deficits. This stage of assessment is not common in general clinical practice. It requires assessment conducted by Health Professionals trained in Medicine, Psychology, Psychophysiology and Clinical Neuroscience or Nutritional and Environmental medicine. The assessment may include brain function evaluation through neuro-imaging, investigation of diet, nutrition and sensitivities to food. Tests may be conducted to determine the causes of metabolic dysfunctions, recurrent abdominal upsets and chronic ear, nose and throat infections which are probable causes of brain dysfunction and consequently abnormal behaviors and attention deficits (Brown, 2005, p. 21). Rating scales and check lists Rating scales and checklists assist clinicians to obtain information from teachers, parents and others about functioning and symptoms in different settings, which is important for a sufficient assessment for ADHD and monitoring its treatment. The symptoms must be manifested in more than one environment for instance in school and at home in order to meet DSM-IV criteria in diagnosing for the condition (Barkley, 2005, p.96). This is only one of many components of a comprehensive evaluation that should include interviews and medical examination. According to the American Academy of Child and Adolescent Psychiatry, the most commonly used scales are: the Child Behavior Checklist completed by the parent, Teacher Report Form (TRF), Barkley Home Situations Questionnaire (HSQ), ADD-H: Comprehensive Teacher Rating Scale (ACTeRS), Conners Parent and Teacher Rating Scales and the Barkley School Situations Questionnaire (SSQ). The Agency for Healthcare Research and Quality (AHRQ), says that ADHD-specific rating scales produce more accurate results when distinguishing between children whether a diagnosis of ADHD was initially conducted or not compared to global rating scales and nonspecific questionnaires that assess a variety of behavioral conditions (Barkley, 2005, p. 103).  Behavioral assessments Not all inattentive, overly hyperactive, or impulsive persons have an attention deficit disorder. This is because most people will at times unintentionally blurt out things, randomly shift between tasks, or become forgetful and disorganized (Jensen & Cooper, 2002, p. 41). To assess for ADHD, several critical questions are put into consideration. Some of these questions include: are the behaviors long-term, excessive and pervasive? Do they happen more frequently than in other persons the same age? Is it a problem that is continuous or just a reaction to a situation that is temporary? Do the behaviors manifest in different settings or only in a specific place? The behavior pattern of the person is then compared against a set criteria and characteristics of the disorder (Brown, 2005, p.33). The Diagnostic and Statistical Manual of Mental Disorders version IV (DSM-IV) manual contains these characteristics and criteria. Disorders with symptoms similar to ADHD One of the difficulties of using a questionnaire in diagnosing ADHD is that the condition is often accompanied by other disorders. Quantitative EEG which is an examination of brain function can do a better job in differenting between the disorders that have a lot of behavioral overlaps. The following are several of such disorders. Learning Difficulties: Many ADHD children also have a learning disability (LD). This means they have some trouble in mastering certain academic skills, language, typical reading and writing or mathematics. ADHD is not a specific learning disability but it can interfere with attention and concentration of a person and therefore make it twice as hard for a child with LD to perform well in school (Barkley, 2000, p.84). A person is diagnosed with Learning Disorder when his achievement in standardized tests in written expression, reading and mathematics fall substantially below that which is expected for his age, level of schooling and intelligence. The learning disorder significantly interferes with academic activities or achievement that requires reading, writing or mathematical skills. There are several statistical approaches used to establish if a discrepancy is significant. PANDAS Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcus (PANDAS) commonly referred to as PANDAS is an autoimmune disorder. Typically, a child who has an undiagnosed case of PANDAS is likely to be taken to the Pediatrician or Psychologist to get treatment for an onset of OCD symptoms, ADHD symptoms or oppositional behaviors (Brown, 2005, p.73). Anti-depressant or stimulant medication may be prescribed and counseling or a behavioral intervention initiated. The symptoms will gradually subside as streptococcus antibodies reduce and the infection passes. The clinicians and parents may believe that they were successful in their intervention. However, another infection occurs and the symptoms return thereby repeating and the process all over again. The streptococcus antibodies continuously damage the brain through the repeated attacks. After each attack, the damaged brain tissues may not experience full recovery. In the long run if this condition is not detected it may cause the child to develop a chronic psychiatric disorder (Barkley, 2000, p.93). Oppositional Defiant Disorder and Conduct Disorder About half of the children with ADHD have another condition called oppositional defiant disorder (ODD) (American Psychiatric Association, 2000, p.51). Children with this condition sometimes lash out or overreact when they feel challenged or threatened. They may be stubborn, act belligerently or defiantly and have outbursts of temper. This condition sometimes progresses into conduct disorders that are more serious in nature. Such children are at risk of getting into trouble while at school, and sometimes even with the authorities. They may break laws, take risks that are unsafe, steal, destroy property, set fires and drive recklessly (Jensen & Cooper, 2002, p.37). It is important for children with these conditions to get help before their behaviors progress into more serious problems. Tourette syndrome Tourette syndrome (TS) is a neurological disorder. It is characterized by repetitive, involuntary, stereotyped movements and vocalizations called tics. The disorder gets its name from Dr. Georges Gilles de la Tourette. Doctor Tourette was a French neurologist who first described the condition in 1985. The first person to get diagnosed was an 86-year-old French woman. The early symptoms of this condition are noticed first during childhood. The disease has an average onset period of between the ages of 3 and 9 years (American Psychiatric Association, 2000, p.74). The condition affects people of all kinds. Its prevalence in males is about three to four times more often compared to females. In America, it is estimated that about 200,000 people have the severe form of TS. One out of every 100 people exhibits less complex and milder symptoms of TS such as vocal tics or chronic motors. Although TS may become a chronic condition whose symptoms last a lifetime, most individuals with the condition have their worst tic symptoms when in their early teens (American Psychiatric Association, 2000, p.82). The condition improves in the late teens and continues with this trend into adulthood. Mood disorders Most children with ADHD, especially girls and younger children experience other emotional disorders. About a quarter feel anxious. They may feel tremendous tension, worry or uneasiness, even when there is no cause of fear. Due to the fact that these feelings are stronger, scarier, and more frequent compared to normal fears, they tend to affect the behavior and thinking of the child (American Psychiatric Association, 2000, p. 87). This may further result in the child experiencing depression which goes beyond ordinary sadness. Children who are depressed may feel so "down" that they become hopeless and unable to manage everyday tasks. Depression can affect appetite; disrupt sleep and impair the ability to think. Because attention disorders go hand in hand with emotional disorders, every child with ADHD needs to be checked for accompanying depression and anxiety. It should however be noted that not all the children who have ADHD also have a co-morbid disorder. Nor do people with Tourettes syndrome or learning disabilities for instance, have ADHD (Barkley, 2005, p.67). But when these conditions occur together, they can seriously complicate the life of a person. Due to this reason, it is important to make sure a proper diagnosis of other disorders is done in children with ADHD. Issues with Assessment Misdiagnosis The fact is, the behaviors manifested by persons with ADHD can be as a result of many things. Anything ranging from mild seizures to chronic fear can make a child overactive, impulsive, quarrelsome, or inattentive. For example, if a formerly cooperative child becomes overactive and is easily distracted after the death of a parent, this will be due to an emotional problem and not ADHD. A chronic infection in the middle ear of a child can also make the child seem uncooperative and distracted. These same symptoms can be seen in a child who lives physically abusive family members or members who are addicted to alcohol or drugs. It is hard to imagine a child trying to focus in class when his well being or safety is in danger on a daily basis. The symptoms showed by such children may be similar to those of ADHD but their cause is completely different. In other children, behaviors that are ADHD like may just be their response to an unpleasant classroom situation (Brown, 2005, p.62). The child may have a learning disability and is not ready to learn reading and writing at the time. It may also be that the work is too easy or too hard, leaving the child bored or frustrated. Medicine Medication for Attention-Deficit Hyperactivity Disorder has been the preferred choice of treatment for many years. There are three groups of medications that are utilized namely: antidepressants, stimulants and tranquilizers. The best track record is held by stimulants. They work very well in 65 - 75 percent of cases. Children who have the inattentive ADHD often require a low dose to get the desired response. Antidepressants are also helpful. They come in handy especially when a person experiences bed-wetting as part of the ADHD symptoms. Tranquilizers are used but only in special cases such as when the features of ADHD are related to head trauma or neurological damage. Should the Predominantly Inattentive Type be a separate category? There is little research on the Predominantly Inattentive Type of ADHD, previously referred to as attention deficit disorder (ADD) without hyperactivity. The research that does exist suggests several qualitative differences in the attention problems experienced by individuals with ADD as compared to those with the other types of ADHD which contain hyperactive or impulsive behavior. The Predominantly Inattentive Type of ADHD seems to be associated with greater degrees of passiveness, daydreaming, sluggishness, slow processing of information, difficulties with selective or focused attention, mental fogginess and confusion, hypo-activity, social quietness or apprehensiveness and inconsistent retrieval of information from memory. By definition, this form of ADHD is considerably less likely to be associated with defiant behavior, impulsiveness, oppositional tendencies, and delinquency or conduct problems. If further research continues to demonstrate such differences this would be good reason to regard this subtype as a distinct and separate disorder from that of ADHD Assessment for ADHD in Adults Lack of consensus with regard to the appropriate criteria for ADHD diagnosis in adults makes assessment for the condition particularly challenging. Those who evaluate adults need to consider history of symptoms during childhood along with the current symptoms and impairment levels. Much of the information will come from the self-report given by the adult under evaluation. The evaluator should follow the following steps. First, obtain the developmental history of the patient with emphasis on school performance in the past and any evidence of the core symptoms of ADHD when developing. The evaluator should attempt to corroborate all the collected information through reviewing other sources such as spousal reports, past report cards, and parent reports. Secondly, the clinician should inquire about how core symptoms of ADHD impact on current performance in school, at the workplace and social in relationships. Lastly assessment for the presence of other medical or psychiatric conditions that may cause hyperactivity, inattention or impulsivity should be conducted. Several self-report and ADHD-specific rating scales can then be used to test for the presence of ADHD in adults. Myth that ADHD is a Childhood Disorder Early discussions on ADHD theorized that a person outgrew the disorder with time. Long term studies show that 70-80 percent of children who have ADHD exhibit signs of distractibility and restlessness moving on into adolescence and young adulthood. A large percentage of those with the condition suffer co-morbid psychiatric disorders, social isolation, academic failure, and rejection. Estimates from research indicate that 1.5 to 2 percent of grownups have ADHD. The range of adolescents with ADHD is between two and six percent (International Consensus Statement on AD/HD, 2002, p.91). Research also shows that children who have persistent ADHD develop more severe ADHD and greater risk factors later in life. These adverse factors have an impact on the expression of ADHD. They also increase the risk of having associated disorders which compromise ones adjustment over their lifespan. It is therefore worthwhile to note that ADHD is a lifelong condition that requires a good framework of development in order to make appropriate diagnosis and treatment (Barkley, 2005, p. 47). Over-Diagnosis of ADHD Some critics believe that ADHD is over-diagnosed. They claim that many of the children diagnosed with ADHD do not actually have the disorder. Despite such claims, it remains a tall order to find evidence that will prove that ADHD is over-diagnosed or that there is over prescription of stimulant medications. Moreover, some specialists suggest that in ADHD is sometimes undiagnosed or left untreated. ADHD is a complex problem with prevalence rates of between two to nine percent. These rates vary depending on what rating scale applied and the criteria for making a diagnosis, changes in diagnostic criteria and the use of cut-off scores. The changes made in special education through legislation in the early 1990s served to increase general awareness of ADHD. It provided a legal basis to diagnose and treat ADHD in the school environment. Such legal mandates increased the number services in schools available to children with ADHD. The legislation may have led some to conclude that ADHD was a new disorder and that was over-diagnosed (International Consensus Statement on AD/HD, 2002, p. 95). References American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders DSM-IV-TR (4th ed.). Washington, DC: Author. Barkley, R.A. (2005). Attention-Deficit Hyperactivity Disorder: A handbook for diagnosis and treatment. (3rd ed.) New York: Guilford Press Barkley, R. A. (2000). Taking charge of ADHD. The complete authoritative guide for parents. New York: Guilford Press. Brown, T. E. (2005). Attention deficit disorder: The unfocused mind in children and adults. New Haven,CT: Yale University Press. Brown, T.E. (2000) Attention-deficit disorders and comorbidities in children, adolescents, and adults. Washington, D.C.: American Psychiatric Press, Inc. International Consensus Statement on AD/HD. January 2002. Clinical Child and Family Psychology Review, 5 (2), 89-111. Jensen, P.S., & Cooper, J.R. (2002). Attention Deficit Hyperactivity Disorder: State of science best practice. New Jersey: Civic Research Institute. Johnston, C. (2002) The Impact of Attention Deficit Hyperactivity Disorder on Social and Vocational Functioning in Adults. In P.S. Jensen & J.R. Cooper (Ed.), Attention Deficit Hyperactivity Disorder: State of the science • best practices (pp 6-1 – 6-16) New Jersey: Civic Research Institute, Inc. Read More