So you have just returned home from your third meeting with your child's teacher. She tells you that your child is not getting his work done, he cannot sit still, and he is simply not going to have any success in school unless something changes. She suggests that you talk to someone to see if he has ADHD. What do you do next?
This can certainly be a difficult time in any family, so we would not want you to be uninformed as you take the next important steps. Here are the things that we recommend if you have a child that ought to be looked at for possible Attention Deficit Hyperactivity Disorder.
First, there should be an "adequate" physical exam by the child's pediatrician or family practice doctor. This doesn't have to be an extensive, expensive exam, but should be able to rule out possible problems like Mononucleosis, Thyroid problems, lead poisoning (if it is common in your area), and potential attention problems caused by medications, such as allergy medications. Then, with a clean bill of health, we move on to step two.
Second, get an evaluation for attention deficit hyperactivity disorder. Usually a psychologist or other mental health professional will do this evaluation for ADD ADHD. But please, only get counseling or therapy from professionals who have a lot of experience treating attention deficit hyperactivity disorder. Therapists who do not have a lot of experience with ADD ADHD will just take your money and then probably blame you, the parents, for the child's disorder. Find experts on attention deficit hyperactivity disorder in your area. Ask around at your local CHADD chapter. Call you local Psychiatric Hospital and ask for the Child or Adolescent Unit. Then ask for the "Charge Nurse." Ask the Charge Nurse who the best psychiatrists and therapists in your town are. They know.
The Evaluation
When you get an evaluation for attention deficit hyperactivity disorder, there should be a good parent interview. It's absolutely essential that somebody sits down with the parents and spends 45 minutes to an hour with them. The psychologist or therapist needs to find out what's going on now, why did the parents pick up the phone and call now instead of last week, and so on. A good developmental history on the child must also be taken. Important questions are:
How did mom do during pregnancy?
Were there any problems at all during pregnancy?
Was there any exposure to drugs or alcohol prior to birth?
When did he learn to walk or crawl?
How about speech development, any problems?
Did he have very many ear infections?
Have there been any head injuries, high fevers, or seizures?
Head injuries and seizures can look just like attention deficit hyperactivity disorder, but aren't. They may require different treatment options.
Then a good family history is great. The family trees of Attention Deficit Disorder kids are often very similar. Look at one and you may say, "Gee, there's no wonder this kid has it," because most of the time, about 80 percent of the time, you can trace the impact of this gene as it runs through families causing things like depression, obsessive-compulsiveness, alcoholism, attention disorders or learning disabilities throughout the family.
The clinician must also know:
Is child depressed?
Does he have anxiety problems?
Is he hallucinating?
Is he delusional?
Is it a head injury?
Is it a seizure disorder?
Parent rating scales are very good and should be given. The ADHD scales we like are by Ned Owens out of Texas. Keith Connors has a fine tool that you have probably seen if you are involved with attention deficit hyperactivity disorder children at all. It is very important for the parents to fill out these behavior rating scales. Ideally the teachers will fill them out also. You want the teacher's input because they see 30, 32, or 35 kids every single day, year in and year out, and they know what is normal behavior and what is not.
Note: One of the things we have noticed is that lately we are having more trouble with the teacher rating scales because the teachers ten years ago, eight years ago, five years ago used to rate the kids pretty reliably compared with the "normal" kids in the class, the non-ADD kids in the class. But what we are seeing lately is very often the teachers are comparing the child that we want rated against the "worst kid" in the class, who might be totally off the wall. And so the rating scale comes back reporting that the child we want rated isn't much of a problem at all. We have to give directions to the teachers to rate them versus "normal kids," not against the "worst kids" in the class.
Also, an in-depth clinical interview with the child is important. This interview is needed to determine the child's reality testing, his degree of maturity, his degree of verbal skills, and so on. Ask the child if he's hallucinating. Sometimes he is, but he hasn't told anyone. Ask the child if he's anxious. Some kids have tremendous fears, but have not shared them with anyone. There is a lot going on with kids that their parents are not aware of.
Psychological Testing for Attention Deficit Hyperactivity Disorder - ADHD
Psychological testing as part of an evaluation for Attention Deficit Hyperactivity Disorder can be helpful. We used to give tests such as the WISC-R, an IQ test, the Wide Range Achievement Test (WRAT), and the Bender-Gestalt test, which is a visual motor integration test. Bored already? Well, they are boring things. But they can be helpful. There are certain patterns that one might expect on these tests if the subject had attention deficit hyperactivity disorder of some type. But it's art, not science at that point. The patterns are not "diagnostic" for Attention Deficit Hyperactivity Disorder. It's also important to know if the kid has a real low IQ, or a major learning disability. It could be a clue that there is something else going on instead of attention deficit hyperactivity disorder.
What we find to be very valuable is the Test of Variables of Attention (TOVA).
The TOVA is an extremely boring computer test that requires the kids to respond to a target stimulus by pressing a button, or to not respond when there's a non-target stimulus. The fact that it is so boring is a work of genius because it helps to differentiate between kids who have trouble with "boring," and kids who do all right with "boring."
The TOVA is really a terrific tool, but it should never be given just by itself. It needs to be given in the context of the whole diagnostic workup. Also, the TOVA can be given with no medication, and then if medication is going to be used down the road, given again with medication in their system. This can tell the clinician if the subject is at the right dosage or not, or how well he responds to that particular dose of that particular medication. The TOVA is a very helpful tool.
Clinical observation of the child is very important. If possible, ideally, somebody observes the child in the classroom. In the real world, we don't know anybody in private practice who can go out in the classroom to observe a child these days, but if a school nurse or school psychologist can go observe them, it can be very, very helpful.
Obtaining an EEG from a neurologist is rarely helpful.
EEGs will show differences from non-ADD children. Typically there is excessive slow brainwave activity, particularly in the Theta band (4-7 Hz.). However, ninety-five percent of all Attention Deficit Hyperactivity Disorder kids have "normal" EEGs. What we mean by "normal" is they don't have big epileptic spikes, or things like that, that a neurologist would say are "abnormal." But when you compare them side by side with a non-ADD kid, they are much different.
An EEG may be helpful if the child is going to be treated with EEG biofeedback, but in terms of being helpful for a diagnostic work-up, it is rarely helpful. However, if the parent interview revealed that the child had some potential neurological problem, as seen in sleep walking, or a history of seizures, and so on, then an EEG would be a good idea.
In summary, then, an adequate diagnostic interview, designed to give an accurate diagnosis a very high percentage of the time, while not costing the family thousands of dollars, would look like this:
Physical Exam - Office Visit
Clinical Interview - Parents (45-60 minutes)
Clinical Interview - Child (45-60 minutes)
TOVA test
Parent and Teacher Rating Scales
Office visit to review information and develop a treatment plan
Begin Treatment
That's it! If there are further diagnostic questions, then more testing would be required. But in the majority of cases, this is all that is needed to make a highly reliable diagnosis. Except for the physician's examination, the cost for this should be about $500-$700. You can learn more about Attention Deficit Hyperactivity Disorder by visiting the ADHD Information Library.
Douglas Cowan, Psy.D., is a family therapist who has been working with ADHD children and their families since 1986. He is the clinical director of the ADHD Information Library's family of seven web sites, including http://www.newideas.net, helping over 350,000 parents and teachers learn more about ADHD each year. Dr. Cowan also serves on the Medical Advisory Board of VAXA International of Tampa, FL., is President of the Board of Directors for KAXL 88.3 FM in central California, and is President of NewIdeas.net Incorporated.
It can be hard being a parent with a teen... Read More
Being consistent when children are less than perfect can make... Read More
In "The Ring Bear," a picture book by Tigard resident... Read More
Who Can Register A Birth? The child's mother... Read More
Did you know that the school system is only able... Read More
On a recent Saturday evening, I noticed a young teen-age... Read More
This article on parenting is by a practicing relationship counsellor/therapist,... Read More
Paula's last child had just gone off to college and... Read More
Do your children have a McChildhood? Do they experience the... Read More
Although many parents become frustrated as they try to maintain... Read More
Child Safety Restraints and children in work vehiclesIf you take... Read More
Many times, we are so conditioned in how we speak... Read More
"Home Schooling ? Look Before You Leap"Are you considering home... Read More
Not nearly as often as it should. Most child abuse... Read More
Assuming there are no serious motor problems present, what can... Read More
Researched through personal experience!Budget Your Money. Even if you are... Read More
17 Quick Ways to Strengthen the Bonds of LoveOn Mother's... Read More
Every now and then I'll get a story sent to... Read More
There are a lot of sophisticated parenting theories and techniques... Read More
What makes parenting so challenging at times? One widespread research... Read More
If you had to spend 4 or 5 hours in... Read More
They Spur Members To Grow EmotionallyTatiana Tannenbaum grappled with a... Read More
Several similar terms describe the central attribute of a character... Read More
Just the other day, I was talking to some other... Read More
When you're a parent it's a difficult decision to know... Read More
Researching career education uncovered the following shocking statistic: The average... Read More
Here are ten simple pleasures you can enjoy with your... Read More
Q. My teenage son is turning 16 early next year... Read More
Some years ago when touring the Scottish Highlands, a man... Read More
'I felt great until I walked into the classroom -... Read More
Do you want your child to cooperate with you more?Children... Read More
Yesterday my husband Wade took the day off (that's one... Read More
As a parent you will be asked to assist with... Read More
Let's be honest! When it comes to parenting, men expect... Read More
Every school year parents and students dutifully trudge through the... Read More
Results of the Spanking Poll on Rexanne.com: Voters - 233Percentage... Read More
Jason Roberts listened to his son's explanation of the missing... Read More
Most people with children want to be good parents. The... Read More
Nanny 911 Interview with Montel WilliamsI saw an interview with... Read More
Traditionally, babies have been named at a christening/baptism.... Read More
Giving advice to a teenager is very easy; getting a... Read More
Words are truly powerful things. They are something that becomes... Read More
1. Encourage your babysitter by keeping their favorite foods/snacks on... Read More
1. The Law of the BeastAs parents we need to... Read More
I have three children, ages 19 and 16 (yes, the... Read More
If your child has Attention Deficit Hyperactivity Disorder then at... Read More
Look around: Your kids are counting sleeps until the last... Read More
Would you hand a child calculus problems once she was... Read More
Teens can freely access the Internet from computers at school,... Read More
Parents looking for a quick fix usually choose troubled teen... Read More
Most research into children's friendships shows that those children who... Read More
Sex has a lot to answer for ? babies usually... Read More
The Internet is one of the greatest inventions of all... Read More
Time management is an organisational concept traditionally associated with adults... Read More
When you hear the phrase, 'guerrilla parenting techniques', what images... Read More
Reading is the most efficient and economical way to help... Read More
You're trying to catch up on some sleep on a... Read More
Do you struggle to get your child to bed at... Read More
I really like all natural remedy for Attention Deficit Disorder... Read More
Lets face it becoming a mum is a bit of... Read More
Working with adults (as well as children and teens) for... Read More
Here are some tips that I have picked up from... Read More
Ok. So you're a dad to be. If you're like... Read More
Recently I took my two children to a popular new... Read More
A great many parents are concerned that the electronic games... Read More
Raising a pre-teen or teenage daughter (or son) is not... Read More
Parenting |