Attention Deficit Hyperactivity Disorder Diagnosis - Coursework Example

ADHD Diagnosis Diagnosing ADHD is one of the more difficult diagnosis to make, not because the criteria is difficult to understand but because of the turmoil in society about the diagnosis. Some think it is diagnosed too frequently, others are sure their child (student) have it but are not qualified to make such a diagnosis so the pressure the diagnostician to go in that diagnostic direction. Others, just want a problem in a child to go away and they think medication will do that easily. The Mental Health Diagnostic Manual has clear diagnostic criteria which must be followed. The diagnostician must be well trained and experienced in diagnosing the disorder and he/she must not allow others to pressure them into such a diagnosis. At the save time, the input of others along with objective assessment is necessary. Parent Interviews The parent interview consists of basically two parts. A complete medical, developmental and social history is necessary along with a understanding of the behaviors that have brought the child in for assessment. While we know that parenting likely does not cause ADHD we also know the climate of the home and the parenting style can contribute to behaviors that look like ADHD or can make the symptoms of ADHD appear much worse. The therapist must separate all these things and investigate all of them in this interview. The therapist should know the child’s medical history, developmental history, family medical and mental health history, the family makeup and daily routine including expectations of the child and discipline style and the behaviors that are of concern by the end of the interview (Koff, 2006). Child Interview The child interview greatly depends on the age of the child. For younger children it is more of an observation than an interview. This is the chance for the therapist to see first hand the behaviors the parents are concerned about. Many therapists make this a play session to aide in establishing a quick rapport with the child and observe behaviors in a more natural setting. This is also the time the therapist consults with the child about their feelings of safety in the home and elsewhere. The therapist is also doing an assessment of the child’s self esteem as often by the point of consulting professionals the child has experienced social, educational and family trauma of some sort due to their behaviors. The older child such as an adolescent may be very verbal or rapport is sometimes facilitated by taking a walk or “throwing the football around” while talking. The therapist should learn the child’s history of difficulties, safety issues, the child’s feelings about his/her environment (why he/she thinks he/she is having a problem) and if the child is willing to work on improving. The therapist should also a first observation of the child’s behavior by the end of this interview. Teacher Interview The interview with the teacher provides two things, and education history and repeated observations of the child from an individual qualified to make comparisons with other children of the same age. Remember the teacher also has an agenda. Of course the teacher has the child’s welfare at heart however by this time this child is causing problems in the classroom or the therapist would not be there. The teacher wants that stopped and she/he is not likely to want to go outside of her/his comfort level to do so. The interview with Dr. Siegfried stated that she is often met by school officials requesting a diagnosis of ADHD to obtain medication to help control the child’s behavior. The therapist must keep the diagnostic criteria along with training and experience when dealing with professionals as well as the family and the child. From the legal perspective, the therapist must remember to get permission in writing to consult with the school Koff, 2006. Child Behavior Rating Scales The Conner’s Child behavior scales are must commonly used. They provide a standardized set of questions specific for the person who is filling it out. They are generally passed out to as many people in the child’s life as possible. Each parent fills out their own test separately. Other caregivers may be given the test along with educators, and other family members. They are scored on a standardized scale and norm rated. It has proved to be a valid and reliable instrument. A nice feature is that it allows for graphing of the result from all participants for comparison of across location behaviors. This provides an objective back up to the interviews (Koff, 2006) Parent Self-report measures Parent self-report measures are similar scales that allow the parents to report their family system and parenting style in a way it can be objectively measured and categorized using normative data. Again it is an objective back up to the interview process. This allows the parent to look at the influences in the child’s life not at the child’s behaviors (Tasto, 2004). Legal and Ethical Issues Ethical issues include making sure the child is safe. In the case of this type of diagnosis the therapist will learn a great deal about the family and the child’s environment. Secondly the therapist must remain faithful to the diagnostic code and recommendations must be given the benefit the child even though adults may not appreciate them. Legally, the more information collected so the diagnosis can be proven both objectively and subjectively is important. At times these cases come up in connection to a divorce, custody or parent-school disagreement so good records must be kept and the diagnosis and recommendations must be supported. The therapist must be sure to have written permission from the parents to consult with people other than them about the child. The parents must also give permission writing for all testing done. Pediatric Medical Examination and General Neuropsychiatry Batteries It is important to involve the child’s primary physician in this diagnosis. First all physically possibilities must be ruled out. The child doctor also can give more objective insight into the family system. From the legal perspective the therapist must remember to get permission from the parents to consult with the physician. The physician should be consulted about the possibilities of other neurological issues so the child can be referred for neuropsychiatry batteries. These are usually referred to individuals, neurologists or neuro psychologists who specialize in this field. Always rule out all physical possibilities before diagnosing the child. It is the neuro psychologist that is most helpful in being certain of a diagnosis of ADHD and Asperser’s Disorder. Aspergers’s Disorder is a form or mild autism that is often overlooked but it has definite neurological symptoms that while mild are not present in the ADHD child. Recent finding show Asperger’s Disorder is more prevalent that has been known and it is one of the differential diagnosis that the diagnostician should rule out every time ( Tallent 1998). Intelligence/ Achievement tests Intelligence testing such as the WAIS tests are necessary to ascertain the child’s ability limits. While the scales may be less consistent in an ADHD child it must be remembered the only valid and reliable purpose of IQ testing is to obtain an idea, plus or minus 7, the learning ability of the child. That number is important, however, when comparing it to achievement outcomes. If the achievement test show scores significantly lower than the IQ score would predict then learning disabilities or attention issues should be further considered. If the scores on both test are what would be expected, then adjustments should be made for the child’s ability level if it is low but it is not an indication of anything else (Sattler, 2001). Continuous Performance Tests Continuous performance tests such as the TOVA are basically dull computer games. The child sits at the computer finding detailed information. The idea is to see what the child’s attention span is compared to the norms. It also shows how much the child is able or willing to pay attention to detail. Both the lack of ability to pay attention to detail and a low attention span are diagnostic of ADHD when other symptoms are also documented. These tests, however, are used less at this time because research has shown they show a high number of false positives. False negatives are low so they may have some value in specific cases. They seem to be more frequently used in the medical community (Tallent, 1998). Conclusion The diagnosis of ADHD like any other diagnosis is not to be made in haste. It is an appropriate diagnosis and it should not be eliminated in haste. The diagnostician must stay away from pressures and controversy about this diagnosis and follow the diagnostic criteria. The child’s needs are the governing factor. A child that has ADHD should be treated and a child who does not have ADHD should be treated for what ever they have that is causing concern among the adults. Putting the puzzle together is the challenge. References Knoff, H. (Ed.) (2006) The Assissment of Child and Adolescent Personality. New York: Guilford. Sattler, J.M. (2001). Assessment of Children, fourth edition. San Diago: Sattler Publisher. Tallent, N. (1998). On Individualizing the Psychologies’ Clinical Evaluation. Journal of Clinical Psychology. 87, 243-245. Tasto, D. L. (2004). Sefl-Report Schedules and Inventories. In Ciminero, A., Calhoun, K. & Anams, H. (Eds.)Handbook of Behavioral Assessment. New York: Wiley. Read More