ADHD assessment:
Cognitive, neuropsychological and other associated tests
ADHD assessment does
not usually require psychological and cognitive test performance to
determine the presence of symptoms. However, ADHD assessment may
incorporate some of these tests because of the learning problems
frequently associated with this diagnosis. Neuropsychological testing
information and/or educational evaluation can be used to supplement
the clinician’s evaluation, to provide additional understanding of the
child's level of cognitive and attentional abilities, as well as
screening for suspected mental retardation or learning disabilities.
ADHD assessment may
also utilize measures of activity level, such as stabilometric chairs,
wrist actometers and solid-state actigraphs. While these objective
measurement devices will provide judgment-free ADHD assessment
information, their assessed correlations with behavior ratings by
parents and teachers has been inconsistent. At the present time, it is
recommended that these measurement devices not be used for diagnosing
clinical syndromes.
Several studies have
used direct behavior observation to provide information in ADHD
assessment, although this practice is not part of a routine clinical
evaluation. Several standardized evaluation methods have been used in
structured play rounds and in school settings. Structured playroom
settings may include counting the number of times a child crosses
grids marked on the floor, recording the number of toys touched by the
child or the amount of time the child plays with each toy or focuses
on a particular task. Typical measurements in a school setting include
monitoring the amount of the time that child spends on specific tasks,
remains in their seat, and so on and so forth. Observational
measurements have been found to enhance the differentiation of ADHD
children from non-ADHD children. Their utility in discriminating among
different clinical groups (i.e. inattentive/hyperactive) is not quite
as clear.
At the current time
there are no laboratory tests to indicate whether a child has ADHD.
Also, findings from such neuroimaging studies as CT scans and MRI’s
have not been consistent enough or specific enough to be used in
clinical practice.
Many children with ADHD
have difficulty and are impaired in their social skills, and
frequently experienced difficulties with their peers. Some of the
factors that may become important are the level of hyperactivity, the
age of onset of aggression, and the developmental level of the child,
which all determine the extent of rejection by their peers. Other
indications of social impairment may include the amount of times
suspended or expelled from school, as well as contacts with the
police. Information regarding social adjustment is incredibly
important in treatment planning as it may be relatively predictive of
poor outcome.
Comprehensive ADHD
assessment also involves considering interactions between the child
and their parents. These interactions play a role in the maintenance
of disruptive behaviors, poor social skills, the presence of
internalizing symptoms, and ultimately their response to treatment.
Experts have noted that reductions in negative and ineffective
parenting also may impact upon the ADHD child even in the school
environment. However, these changes seem to be achieved only when
relatively significant negative parenting issues have been resolved.
