How is ADHD actually diagnosed?

Also, go to www.samgoldstein.com/articles/0101.html

Thank you SAR!
K.

K,

One of my son’s therapist told me that ADHD was a diagnosis attained by elimination. In other words, there was nothing else that can account for the symptoms. I was reading an article in our paper yesterday about the brain differences between kids with ADHD and so called normal kids. There appear to be some clear differences. This suggests that in the future we may have some more definitive ways to diagnose ADHD. In my experience with a neurologist, ADD-inattentive was diagnosed by questionaire results, interview, and I think the fact that my son has severe learning disabilities feed into the diagnosis. The neurologist told me that almost all kids with severe learning disabilities have ADD.

Now I will also tell you that my son’s Neuronet therapist thinks his problems are more processing problems than ADD. My son has been diagnosed with CAPD but his audtiory issues are much improved. There are still visual processing and integration issues though. It is really hard to totally sort out with a complex kid, even for experts.

Beth

K. -

How is he at home when he is working on homework that is straightforward (like math) and he knows exactly what needs to be done?. Once he’s gotten over the avoidance and he’s actually started working, can he stay with it?

We had so many other issues (dyslexia, dysgraphia) that it took me a while to realize our son might be ADHD-inattentive. By the time he was in 6th grade working on problems like XX times XXX, it became very obvious. He would completely lose focus between the ones and tens column, then again for the tens column and hundreds column, then again for switching to the next multiplier, then again between every column for the multiplier, then losing it again between each column when adding to get the final result. Imagine doing this for 20 problems! Homework time was a nightmare.

Same problem on writing assignments. Write half a word and then stop. Finish the word. Stop. Sing. Add two words. Stop. Twirl pencil. Another half word. Stop. Erase something. Play with the little eraser flecks.

And this is with me me sitting right next to him supervising. If I wasn’t supervising, he couldn’t stay with it at all.

That is my confusion, he has been diagnosed with severe to moderate APD that has not been re-mediated. He hasn’t had speech and language services since June and even then it was only about 30 minutes a week.

I feel he needs heavy duty speech and language services, FastForWord and heavy duty reading remediation.

Everything, to me, seems to point to his APD but it is convincing everyone else of that!!

K.

Beth,

This is correct. I look at ADD as basicly a problem paying attention. This can manifest in different ways with different levels of severity. So in a way the therapist that said that children with LD usually have ADD is correct. Children with LD often have trouble paying attention.
Unfortunately many people believe this to mean they should all be put on meds. This is just not the case. If you can improve the attention through dealing with the underlying processing difficulties, you should.
My son has problems with visual attention. He never ever has a problem paying attention to auditory stimulii and he never gets distracted by auditory stimulii.
Yet, has trouble paying attention when doing detailed written work. He also can’t read for long periods of time.

I think that there are many ways of dealing with these issues. There isn’t one correct answer for all children. I also think that some solutions will work no matter what the label.
IM certainly seems to have helped a few children with varying labels.

Once I get him to sit down and start his homework, he is usually fine. He gets his walkman out and gets going. Math is rather strong for him and he does well. It is also covering things he has already done so that has helped.

He has some trouble with English/Language arts work but not because he is fidgety, it is because of his lack of reading skills and processing speed. He gets frustrated because he can’t do it, it is easier for him to skip or give one word answers. He usually will do it but with assistance. Since he isn’t able to decode larger multisyllable words, he has to guess. Then what happens is that the reading doesn’t make sense!!

K.

by having our son’s teacher, tutor and me and my husband fill out the Conner’s questionaire. That plus his own observation led our psychiatrist to say that my son didn’t meet the criteria for ADD-inattentive, although he did say if behavior modification doesn’t help we could medicate the symptoms. In other words, my son may very well respond well to stimulant meds. despite not being formerly diagnosed (something the doctor is reluctant to do BTW)

When a child has an LD, its very difficult to tease these issues out. Is my son zoning out b/c the classroom is often confusing, because he’s anxious, or even possibly because sometimes he’s bored.

I have seen ADD/ADHD diagnosed in multiple ways. Some practitioners are satisfied with an interview and behavior surveys. They then compare this behavioral information with DSM-IV criteria and- should- rule out other possible diagnoses. DSM does not include APD so it is not necessarily considered as an explanation for the attention deficit. Other practitioners (usually neuropsychologists) are more interested in evaluating the underlying neurological dysfunction associated with the disorder. Generally they look at frontal lobe involvement that interferes with functions such as sustaining attention, filtering extraneous information, impulse control, planning, and cognitive flexibility. This type of evaluation would look at responses to both auditory and visual stimuli, which would help to weed out the influence of APD. Some practioners have also become interested in doing some brain imaging tests to look directly at brain activity during different rest and active states.

oops- I meant to respond to how ADHD is diagnosed…But since I’m here in the homework discussion…your son really shouldn’t be struggling so much with reading at home- if attention isn’t the issue. Homework should just be review of concepts and skills learned in school. Reading can be more demanding in school (at the “instructional level”) where a teacher is there to help him with unfamiliar words, etc. At home, reading should be at an “independent level”- all but a few words in a passage should be known to him. This way he can receive the practice and drill he needs to commit those familiar words/skills to memory and also work on improving intonation, reading pace, comprehension, etc. It might be a good idea to speak to his teacher about accomodations necessary for homework so that he is learning at his pace, is successful, and keeps his motivation up…

I think it is easier to sort out when it is clean like with your son. It is situations with visual attention. My son has so many different issues, all at least partially remediated, that it is tough. He also has some symptoms that I have a lot of trouble attributing to processing issues—difficulties with organization, for example.

My best guess is that he has some mild ADD-inattentive plus processing issues. My husband has some characteristics that suggest some ADD, although he never was diagnosed. He doesn’t have LD and I think ADD has to be much more severe to affect someone without LD. My nephew also has clear ADHD symptoms but is not medicated. His parents, both physicans, ascribe to the philosophy that if the kid is doing well in school than ADHD should be managed in other ways. My nephew is actually much worse than my son in terms of ADD like symptoms but without the LD, he does very well at school.

On the other hand, I have a friend whose son was diagnosed with both ADD-inattentive and LD. Once she put him on medication, his LD was no longer problematic. He is doing well without any help.

My son’s attentiveness has improved markedly following Interactive Metronome. I had intended to try medication this fall but keep pushing it back. I do notice though that there are more attention issues now that the school year is in full swing. My intention right now is to keep pushing on resolving the processing issues and then see where we are at.

Beth

Homework and at home reading would be at an independent level if he had been properly instructed on how to read! Almost six months ago, he tested at a 3rd grade level, he is in 9th grade. However, he has not had any reading instruction or speech and language services since June, so I am sure he has regressed.

Attention becomes the issue when he becomes frustrated because he doesn’t know how to decode a word and has to guess. Usually he is wrong, so what he is reading doesn’t make any sense.

K.

I can’t remember—has your brother been tested for CAPD? If so, and it’s been confirmed is the problem that the school district is ignoring the test results and refusing to take steps to remediate the CAPD?

He was tested and it was confirmed but the old school didn’t seem to care. I am sure that most of them didn’t even know what it was. The only one who seemed to have a clue was the speech and language path. and she told us that if she retested him after a year’s worth of speech/langu services, he would show no improvement.

He is also supposed to be receiving 30 minutes of speech and langauge therapy a week at new high school but nothing yet. Also, I am not sure how effective 30 minutes is going to be anyone, I feel he needs more.

I have a meeting this Thursday to review new test and go over old stuff, should be fun!

K.

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