Proper treatment always begins with a proper and
ADHD is one of the most frequently misdiagnosed psychological disorders. The primary reason is so many other disorders mimic common ADHD symptoms. Individuals with anxiety, depression, learning disabilities and social disorders all have problems with inattention, focus and concentration. Great care needs to be taken in the diagnostic process. Not only is it necessary to assess core ADHD symptoms but it is also essential to diagnose Executive Function disorders such as Working Memory, Initiate and Plan/Organize. In addition, it is necessary to rule in, or rule out additional disorders such as learning disabilities (such as reading impairments) and other emotional disorders that can contribute to the misdiagnosis of ADHD or co-occur with it. If all of these potential difficulties are not investigated the potential for misdiagnosis is too high.
The following is a sample process that may be used to complete a comprehensive evaluation:
A clinical interview with the parent(s) or adult is an important starting point. A wide variety of clinical information including developmental problems, induced vs. inherited origin of symptoms, academic difficulties, social and behavioral problems and potential emotional disorders are carefully investigated. In addition, at this time, multiple rating scales (which are age and gender normed) are distributed to further investigate core symptoms (inattention, hyperactivity, impulsivity), executive function symptoms (working memory, initiate, plan/organize, organization of materials, etc.) and emotional disorders in a variety of settings. Research has documented that single rating scale information regarding core symptoms is approximately 50-60% accurate. ADHD diagnosis based on single rating scale data is suspect.
A short clinical interview with the child to receive their view of critical information is helpful. An IQ, reading, mathematics and processing speed screen to gather information on potential learning disabilities and to eliminate potentially confounding variables that would interfere with an accurate ADHD diagnosis is completed as well.
During this session an Automated Working Memory Assessment is completed as Working Memory is very common and highly impairing accompanying disorder that needs to be more thoroughly investigated. In addition, a Gray Oral Reading Test (GORT) can also be administered to investigate if a working memory problem effects reading comprehension.
A thorough interpretation of results is extremely important as this is actually the beginning of the treatment process. Parent education about ADHD and its' related disorders is just as important as any other treatment including medication. Parents (or in adult cases the adult themselves) must become the experts for the entire treatment process to be optimally effective. At this point multiple handouts and even an informative video can be provided to parents or the adult to further their education about this disorder and any co-existing disorders.
Session 5 (optional)
While an overview of the major treatment approaches is given in Session 4, some parents or adult clients feel they will benefit from a more thorough explanation of the major evidence based interventions including medication, education, working memory training, educational management, environmental management and behavior management.