ADHD and the Importance of Accurate Diagnosis

ADHD and the Importance of Accurate Diagnosis

by | Nov 7, 2016 | A PRIDE Post, ADHD

Nearly 10 percent of children and 4 percent of adults in the U.S. have been diagnosed with ADHD. But studies suggest that while many people with ADHD still go undiagnosed, others are wrongly diagnosed with ADHD when they are instead suffering from a range of other disorders.  ADHD is frequently portrayed and covered in the media and it is now part of the American lexicon.  Many people notice that their children are struggling with a lack of attention and quickly assume that they must have ADHD.  Often, parents and teachers can feel so certain that a child has ADHD that their strong beliefs can influence important medical decisions.  With the absence of psychoeducational testing confirming or disconfirming the presence of ADHD, psychiatrists, pediatricians and general practitioners often prescribe stimulant medication to children who superficially appear to have ADHD, but many times actually do not!

Like many DSM-IV diagnoses, the symptoms of ADHD actually overlap with many other diagnoses making a correct ADHD diagnosis more difficult than it may seem.  Inattention is just one individual symptom of ADHD, not the hallmark of the disorder that many think it is.  ADHD is a disorder of the brain’s frontal lobe.  The frontal lobe controls what are known as Executive Functions which include the skills of: Planning, Working Memory, Attention, Problem Solving, Cognitive Flexibility, Emotional Regulation and Inhibitory Control of Behavior.  The hallmark symptoms that separate ADHD from all other diagnoses involves the disruption of one’s Executive Functions and manifest as a lack of self control, recklessness, thoughtlessness, and an inability to think of about behavior before acting.  This kind of impulsive behavior can range from being extremely disruptive (i.e. the child that runs around the room during class) to more mild (i.e. the child who interrupts others while they are speaking).

Basing an ADHD diagnosis solely on criteria such as inattention or hyperactivity is what frequently leads to misdiagnosis. An incorrect diagnosis of ADHD can potentially be extremely damaging to a child (or an adult) because academic and medical decisions are frequently made based on this diagnosis.  Parents who are concerned about their children having ADHD should consult with an expert in the field who conducts psychoeducational evaluations in order to correctly differentiate ADHD from learning disorders, anxiety disorders, depression, Bipolar Disorder, and Asperger’s Syndrome.  These other diagnoses are frequently mistaken for ADHD and all lead to diverging courses of treatment and academic intervention.

Children who are experiencing depression and anxiety are often preoccupied with anxious and depressed thoughts which can be extremely distracting and may manifest as a child who is struggling to pay attention due to a mood disorder rather than ADHD.  Children with ADHD can sometimes struggle socially because they may be so scattered in their thinking that they have difficulty listening to what peers say leading them to miss subtle social cues.  This is often mistaken for Asperger’s Syndrome which is a much more severe disruption of a child’s ability to function in social settings.  At times the highly energized and impulsive behavior of a manic episode is mistaken for ADHD.  This is particularly dangerous as the stimulant medication that is successful in treating ADHD, makes manic episodes much worse.  The symptoms that differentiate a manic episode from ADHD are severe insomnia, irritability, and grandiosity.

Given the wide range of disorders that can mimic the appearance of ADHD, it is prudent for concerned parents to seek a psychoeducational evaluation for their children to ensure that the diagnosis that is made is the correct one.  This will lead to much more effective and expedient treatment and remediation of academic weaknesses.

 

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Dr. Maloff is a Clinical Psychologist who practices privately in Beverly Hills.  He specializes in psychological and psychoeducational testing.  His work is frequently used to inform medical, educational and psychotherapeutic decision making.  Dr. Maloff frequently participates in IEP meetings to ensure that private schools and public school districts are meeting a child’s academic needs.  He also provides expert testimony regarding psychological and psychoeducational testing in legal proceedings.

Jared Maloff Psy.D.

(310) 712-5480

www.BeverlyHillsPsychologist.com

 

Teaching Executive Functioning Skills to Your Children

Teaching Executive Functioning Skills to Your Children

by | Apr 29, 2014 | A PRIDE Post, Executive Functioning Skills

Executive functioning has become a very popular term in recent years, especially as it relates to treating children. In the past, diagnosis involving children’s attention, activity level, organizing and problem solving were made. However often little was discussed with parents regarding improving deficits, executive functioning, using behavioral techniques.

Executive functioning (also known as cognitive control and supervisory attentional system) is an umbrella term for the management (regulation, control) of cognitive processes, including working memory, reasoning, task flexibility, and problem solving, as well as planning and execution. It has also expanded to include organization and impulse control. Executive functioning affects not only children’s behaviors but expands to social abilities and their ability to learn. It includes their ability to self-regulate, to infer and ponder consequences, to encode information in memory.

What we deem largely as automatic, or multi-tasking, is often a skill that needs to be modeled and taught. Children can benefit from working on executive functioning whether they are typically developing, or have clinical diagnosis that includes impairments in these areas. Think about the things that cause stress in your home. Perhaps you begin to worry time and time again when your son doesn’t call you after baseball practice only to find out later he forgot to charge his phone. Perhaps your high school daughter realizes she has a project due the night before it is to be turned in, or maybe you have numerous calls from your child’s teacher with regards to forgetting materials, including books, pencils, homework. Many times, parents can be frustrated in the lack of executive functioning skills if they themselves have relative strengths in these areas. On the flip side, on many occasions when parents have difficulties in the same areas of executive functioning as their children, they sympathize with the children, and lack an understanding of how to help them other than to offer commiseration.

One of the greatest things parents can do to assist in helping their children grow in this area is scaffolding. Scaffolding is a teaching method that enables an individual to achieve a goal or task under adult guidance, or more capable peers. It is important to know what appropriate expectations would be, given your child’s developmental level. For instance, you wouldn’t expect your children to pack their own lunch at 3 years old.

Ways to increase executive functioning

  • Identify situations that cause inattention or frustration (identifying situations that make your child or adolescent stressed. Bringing this to their attention will help you both problem solve alternative behaviors to make the situation easier).
  • Change tasks frequently to decrease drain on working memory
  • Frontload information especially when task is novel or not routine (practice a song that will be sung in the classroom or go over key points in a chapter that will be discussed in class before the teacher presents material)
  • Cue your child to complete a task when in the same environment (i.e., ask children to clear their plate in the kitchen)
  • Offer breaks that allow for physical activity
  • Create a structured environment whenever possible
  • Pair tasks your child has mastered with those that are new or more of an energy cost
  • Encourage thinking of future scenarios (discussing an upcoming assignment or event with a child gives them the opportunity to collect appropriate materials and create a timeline).
  • Underline key concepts when reading (parent or child should underline or highlight main points being read. When answering questions, read questions first, then material).

Dr. Robin Morris is a Clinical Psychologist.  She holds a Masters in Family and Child Therapy and a Graduate Academic Certificate in Applied Behavior Analysis.  Dr. Morris resides in Mission Viejo where she conducts psychoeducational assessments, school/home observations used to determine appropriate placements and services, as well as functional Behavior Assessments.  you can contact her at (949) 351-3770 or email her at drmorris05@yahoo.com.  Visit her website at drrobinmorris.com

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