ADHD assessment - Research Paper Example

?Introduction ADHD (Attention Deficit Hyperactivity Disorder) is a mental condition that initially appears during childhood stage. The affected childdemonstrates unusual levels of inattention and hyperactivity. However, one or both of these two symptoms may occur at the same time (Barkley 1990). The prevalence rate of attention hyperactivity disorder among the children ranges from 3-5% (DuPaul and Stoner 2003). There could be very subtle differences between children afflicted with the condition and their normal peers. However, in an ordinary setting, children with ADHD are excessively inattentive and distracted easily. In addition, children with the disorder demonstrate heightened levels of restlessness and are liable to making rash mistakes (DuPaul and Stoner 2003). Generally, Abikoff, et al (1977: p105) noted that children suffering from ADHD have “deficits compared to others of similar age”. The deficits are manifested while undertaking and completing tasks involving control of impulses and activity level modulation. ADHD persists into adolescence and the adulthood stages. Affected adults and adolescents demonstrate malfunctioning of various domains, including difficulties in establishing and maintaining relationships, poor achievement among other behaviors. Polancyzk, et al (2007) noted that adolescents and adults afflicted with ADHD demonstrate unusual behaviors in relationships with friends and siblings, including arrogance, intrusiveness, and unwarranted aggression. This paper examines various tests of assessing ADHD applied in contemporary clinical setting. According to NIHCE (2009), the presence of excessive activity, lack of attention and other impulsive behaviors do not necessarily confirm the presence of ADHD in an individual. Normal people demonstrate some of these behaviors under certain circumstances, but that does not imply that they suffer from the condition. Barkley (1990:59) argues that there is “no single perfect biological or psychological assessment of ADHD”. According to NIHCE (2009), diagnosis of the disorder is made from a number of examinations and investigations aimed at determining five aspects. These include the degree and seriousness of the major symptoms associated with the ADHD disorder and the nature of the symptoms when investigated in diverse circumstances (NIHCE, 2009). The third aspect that assessments seek to establish is the source(s) and developmental pathway of the observed symptoms. Fourthly, the assessments determine if any symptoms demonstrated by the individual compares with other people of similar developmental stage. Finally, the tests are used to establish the availability of other physical, mental health and learning disorders. For these reasons, NIHCE (2009) argues that effective assessment of ADHD requires a multidisciplinary and multimodal approach that involves professional from various fields, including medical, psychological, mental and sociological among others (NIHCE 2009, p24-29). Several approaches are used in the assessment of ADHD. Some of the tests include clinical interviews, standardized rating scales, medical assessment, educational, and occupational adjustments in addition to psychological and psychometric assessments (AACAPWGQI, 1997). Qualified medical professionals such as pediatricians, clinical psychologists and other specialized medical practitioners in the related fields usually administer clinical interviews. The formats of the interviews are strategically semi- structured in order to elucidate and examine pertinent issues. However, some fully structured interviewing tools such as Diagnostic interview schedule for children (DISC), Diagnostic interview scale for adults and diagnostic interview for DSM-IV are sometimes applied in clinical assessment of ADHD (NIHCE, 2009). However, the fully structured interviewing instruments take long time and are not flexible enough. These shortcomings undermine their widespread application in medical practice in examining ADHD (Marsh and Terdal 1997). Clinical interviews are usually intended to unravel the entire range of medical problems and their historical source in addition to health, family, demographic and educational background information. Lahey, et al (1998) emphasized importance of investigating the past treatment methods for treating the person afflicted with the disorder in the family setting while conducting the clinical interview. In most cases, an elaborative clinical interview on a child takes a maximum of three hours and usually conducted in two sessions. Application of standardized rating scales is another test for ADHD. According to NIHCE (2009), standardized rating scales assists in the examination of mental health, and challenges associated with behavior changes and social interactions. These scales contain normative information that enhances comparative assessment of the patient with the general population and or particular clinical groups (DuPaul and Stoner 2003). NIHCE (2009) listed three examples of standardized rating scales, which include broad- band instruments that examine general psychosocial and behavioral performance of the patient. Examples of broad-band instruments include the strengths and difficulties questionnaire. This broad-band instrument is one of the most widely applied in contemporary clinical practice for assessing ADHD. Other broadband-based instruments include Achenbach scales, which examine patients aged from 18 months to 59 years. Others include Conners Rating Scale (CRS), specifically made for young patients has two versions for teachers and parents (Pelham, Fabiano, and Greta 2005). The second category of standardized rating scales are the narrow-band scales that address specific symptoms of ADHD (NIHCE, 2009). Conners Scales for young people is one type of these scales. Others include the Brown Attention Deficit Disorder Scale that has two versions targeting adults and young persons. Others include ADHD Rating Scale IV, the Child Attention Profile (CAP) and the Home Situational Questionnaire. The third and final category of standardized rating scales comprises of unclassified instruments that examine other types of the mental health symptoms related or coexist with ADHD. These instruments assess the most commonly symptoms associated with ADHD such as depression, anxiety, self-confidence and behavioral challenges (NIHCE, 2009). Assessing ADHD using rating scales presents several shortcomings that could undermine effective diagnosis of the condition. Abikoff, et al (1977) argued that the scales have a moderate inter- rater reliability. In addition, their sensitivity and specificity is not complete for conclusive diagnosis of the condition compared with the full diagnostic assessment instruments. According to Abikoff, et al (1977), most of the rating scales are limited to description of the symptoms and hence they do not address the extent of impairment and developmental appropriateness of the disorder. Therefore, if comparative developmental suitability scale is included, it becomes a challenging task for the examiner to analyze the patient’s behavior comparatively with that of a normal person at the same developmental stage. This makes these scales vulnerable to operational and analytical errors (NIHCE, 2009). Educational and occupational adjustment is another method of assessing ADHD. The test involves examination of how an individual adapts in educational institutions and working place for school going people and working adults respectively. In educational institutions, tutors could be asked to provide additional and particular information about the academic performance and the social behavior of the student in structured questionnaires. If a functional problem is identified in the process, clinical specialist then subjects the student to a thorough observation. The clinical examiner could observe the student in the same setting and if necessary to a less structured environment (Jensen and Cooper 2002). Medical assessment is another test for examining ADHD. Medical tests for ADHD are usually undertaken on referral patients, who after undergoing critical examination from psychiatrist or pediatricians are recommended for further investigations (Marsh and Terdal, 1997). Medical assessment is undertaken for various purposes including ruling out undiagnosed ailments with symptoms that closely resemble or mimic those of ADHD. According to NIHCE (2009) patients with some medical conditions such as hearing problems, epilepsy, malfunctioning of the thyroid gland and anemia caused by dietary deficiency of iron sometimes demonstrate symptoms similar to those portrayed by patients suffering from ADHD. Medical assessment also evaluates and addresses the prenatal and postnatal risk factors that are scientifically proven to contribute to the development of ADHD among the young children (NIHCE, 2009). The postnatal and prenatal medical assessment also examines the presence of genetic disorders that could contribute to development of ADHD on the young children. Barkley, (1990) notes that there could be other inherent neurological, physical and developmental ailments coexisting with ADHD and medical evaluation is essential to rule out or confirm the presence of these disorders in the patient. Some developmental problems such as developmental coordination disorder, chronic tic disease and sleep disorders are some of the medical ailments that could coexists with ADHD or mimic the symptoms of Attention Deficit Hyperactivity Disorder (ADHD) (AACAPWGQI, 1997). ADHD is also examined using psychological and psychometric evaluation. These tests are normally conducted by professional teachers and clinical psychologists in circumstances where they suspect the patient demonstrates poor learning skills, suffers from dyslexia and other challenges characterized by problems of acquiring nonverbal learning skills (NIHCE, 2009). According to Lahey, et al (1998) psychological and psychometric assessment could assist in explaining the presence of lack of concentration or inattention. In addition, the tests could enhance the diagnosis of ADHD and facilitate adoption of relevant management program for the affected patient (NIHCE, 2009). Challenges in acquisition of learning skills could be caused by a variety of factors, including presence of global learning disabilities such as hyperkinetic disorder. Therefore, Barkley (1990) emphasizes on the importance of comprehending the intellectual state of an individual in order to develop and execute a suitable therapeutic intervention that complies with the developmental need of the patient. Psychological and psychometric assessment could reveal other cognitive impairments that affect memory and attention or concentration of a person (NIHCE, 2009). Therefore, it is important to subject the patient to more intensive tests for ADHD and closer attention of clinical and educational professionals. There are various tests available for assessing attention. Some of the most common tests for measuring attention include the Test of Everyday Attention for Adults (Meaux, et al 2006) and Test of Everyday Attention for Children (NIHCE, 2009). Other neuropsychological tests involve the use of auditory and visual examinations. For example, the Auditory Continuous Performance Test for children evaluates their audio attention in a structured and non-structured environment (DuPaul, and Stoner 2003). Observational examinations have been used for a long time to assess individuals with the disorderly, restless and hyperactive behaviors (Pelham, Fabiano, and Greta 2005). Some approaches used in observation assessment of people with ADHD include having an autonomous observer assessing the conduct of the affected individual in an analog or natural setting to decipher the presence of the behaviors that are associated with ADHD. Some of the observed behavior include the time that the observed person spends on a specific allocated task, acting in manner that is not related with the given task and verbal intrusion (Pelham, Fabiano, and Greta 2005). Examples of observation assessment include the Individualized Target Behavior Evaluation (ITBE), an observational method specifically made for use by teachers and parents of affected child. According to Polancyzk, et al (2007), ITBE and personal problem behavior ratings have proven sensitivity to treatment, because they include classes of behavior appropriate for the needs of very particular child. NIHCE (2009: 372) argues that Individualized Target Behavior Evaluation (ITBE) “triggers the targeted idiosyncratic characters within the patient’s areas of impairment and establishes the rationale for each behavior under evaluation”. While a parent or teacher is using ITBE, he or she examines whether the child has achieved each behavioral goal within the allocated time (NIHCE, 2009). Test for impairment is another method applied for ADHD assessment. According to Jensen and Cooper (2002), the clinical specialist grades the current functional level of the child e using the background information collected during the entry at the assessment session. Another method includes delegating the role of gauging the functional abilities of the child to parent or teacher directly (Jensen and Cooper 2002). In the global perspective there are various techniques used to assess the functioning ability of child suspected to be suffering from ADHD or inflicted with the disorder. Some of these methods include the Children’s Global Assessment of Functioning (CGAF) (AACAPWGQI, 1997). Other approaches of examining impairment include Child and Adolescent Functional Assessment Scale (CAFAS) that provides multidimensional evaluation of impairment. According to Barkley (1990), global and multidimensional impairment measurements are highly effective in categorization of clinical and non-clinical cases. However, although the global impairment ratings have high efficiency in recognizing the impaired areas of functioning, Barkley (1990) argues that they are not widely applied in determination of the treatment outcome. Impairment is calculated using distinct trials of every domain of impairment instead of the global functioning measures with particular domains (Pelham, Fabiano, and Greta, 2005). Conclusion ADHD is examined using various tests, which have their own unique shortcomings and benefits. However, Polancyzk et al (2007) notes that involvement of the parent and teacher increases the effectiveness of diagnosing ADHD regardless of the method applied. The three commonly used methods of rating ADHD intensity, namely DSM-IV, logically derived techniques and experimental approach also demonstrate unique various levels of effectiveness and accuracy. Therefore, it is important for parents, teachers and medical specialists to coordinate and use diverse scientifically proven approaches to enhance early detection of ADHD in order to facilitate early treatment. References AACAPWGQI (American Academy of Child and Adolescent Psychiatry Work Group on Quality Issues) (1997). practice parameters for the assessment and treatment of children, adolescents and adults with ADHD. Journal of the American Academy of Child and Adolescent Psychiatry, 36: 85s-121s. Abikoff, H., et al. (1977). Validation of a classroom observation code for hyperactive children. Journal of Consulting and Clinical Psychology, 45:770-785. Barkley, R.(1990). Attention –deficit hyperactivity disorder: A handbook for diagnosis and treatment. New York: Guilford. DuPaul, G., and Stoner, G.(2003). ADHD in the schools: Assessment and intervention strategies. New York: Guilford. Jensen, P., and Cooper, J.(2002). Attention deficit hyperactivity disorder: State of the science best practices. Kingston, NJ: Civic Research Institute. Lahey, B., et al.(1998). Validity of DSM-IV attention deficit hyperactivity disorder for young children. Journal of the American Academy of Child and Adolescent Psychiatry, 37:690- 706. NIHCE (2009)(National Institute for Health and Clinical Excellence). Attention deficit hyperactivity disorder: Diagnosis and management of ADHD in children, young people and adults. London: BPS and Royal College of psychiatrists. Marsh, E., and Terdal, L.(1997). Assessment of childhood disorders. 3rd ed. New York: Guilford. Meaux, J., et al. (2006). Stimulant medications: A trade off? The lived experience of adolescents with ADHD. Journal of Specialists in Pediatric Nursing, 11: 210-230. Pelham, W., Fabiano, G., and Greta, M.(2005). Evidence based assessment of attention deficit hyperactivity disorder in children and adolescents. 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