What Makes a Good Evaluation for Attention Deficit Hyperactivity Disorder?

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.

---

Speaking on Behalf of Our Children: Stop Blaming the Victims

How many times have you flipped through the pages of... Read More

Who Are You When the Professional In You Meets Baby?

Are you a professional?Notice how the questions differs from, "Do... Read More

Childhood Friendships

Childhood friendships are as special as they are a necessary... Read More

Parental Involvement in Learning

Whether children attend public or private schools, they benefit when... Read More

How to Cope With Colic

When my oldest daughter was born, I walked the floor... Read More

MORAL ARMORS Irrational Parenting, Part III

Not Letting Them Think.We all implicitly know that anything questioning... Read More

More Water, Not Less, Will Help End Bedwetting

Children are notoriously bad at drinking enough liquids. They are... Read More

Parenting Your Teenager: The Bottom Line Issues

Q. When you consult with a family with teens, what... Read More

Quality Time with Your Teen

It's sometimes difficult to find ways to be involved with... Read More

How To Develop Your Babys Brain

Have you ever wondered why toys for babies tend to... Read More

How to Stop Divorce Parental Conflict from Bursting?

It is not the divorce but the conflict arising after... Read More

Some Tips for Healthy Parenting

Looking back through my files I've come across several great... Read More

Homeschooling --- A Superior Education For Your Child

Home-schooling provides children with a superior education. Parents can quickly... Read More

The Most Innovative New Approach for ADHD, a Natural Remedy

What's new and effective in the treatment of Attention problems?... Read More

Spend Time Not Money With The Kids This Winter

Spending quality time with your children doesn't need to cost... Read More

Twin and Multiple Births are on the Rise

Did you know that the number of twin births have... Read More

The Parent Teen Relationship: How Effective is Yours?

It was the homework that did it. Each night became... Read More

Two Means Trouble

You have two kids who are 14 months apart. How... Read More

A Mothers Love

Once upon a time there was a beautiful bird whose... Read More

How To Be Your Childs Sex Educator

The debate in many towns continues throughout this country about... Read More

What You Should Know About Counseling for Attention Deficit Disorder

At the ADHD Information Library we are big believers that... Read More

Guide to Choosing a Computer System for Your Child

Before going further into choosing computers for children, I believe... Read More

Parenting Your Teenager: 4 Dangerous Myths

MYTH: All teens have to rebel, and the teen years... Read More

Turn off the TV -- and Turn on to Physical Activity!

Imagine having no television for an entire season. Such was... Read More

To Test or Not To Test - That Is the Question

Little Suzy has really been having a hard time getting... Read More

Failure or Future? Its Up To YOU!

We all want to comfort our children after they suffer... Read More

Are Public Schools Anti-Parent?

Some public schools try to turn children against their parents... Read More

Hiking with Children

There is nothing quite like hiking with small children. The... Read More

How to Handle Child Tantrums?

Child tantrums are a way for children to express their... Read More

So You Want to Adopt?

Many reasons will cause some people to feel the need... Read More

Got To, Get To ? Change The Way Your Family Thinks

I recently heard a story that has literally changed the... Read More

Psychological Effects of Child Abuse

Many children who suffer from the psychological effects of child... Read More

Communications for Family Emergencies

You know that children can get into trouble. The older... Read More