Not achieving to potential?
Then an ADHD assessment may be worthwhile for you or your child.
ADHD 3 STAGE ASSESSMENT PROCESS
"Gold standard in ADHD assessment in Australia..."
STAGE 1: Initial consultation & DSM-5 screening questionnaires
An initial consultation is carried out with one of our clinicians. This consultation will go through a complete developmental and medical history. If the patient is an adult, you can attend alone or with someone who you feel can help explain your concerns. If the patient is a child, usually only parents (or caregivers) will attend, as it can often be inappropriate to talk freely about your child's problems in front of them. Of course, for older children, you are welcome to bring them if you feel it is appropriate, and we can ask them to leave if you wish to discuss more sensitive information.
ADHD is a developmental disorder therefore in order to be diagnosed, a history of ADHD symptoms needs to be confirmed prior to the age of 12 years. Hence a complete history of development needs to be understood to ascertain whether the issues are developmental ADHD, or there is another cause behind the attention concerns (which has made attention problems arise later in life).
Concerns will be discussed regarding the following areas:
- Attention skills
- Executive planning and organisation
- Vocational skills (adult)
- School concerns & learning issues(child)
- Social development & social skills
- Learning skills & academic history
- Psychological state & history
- Behavioural concerns
- Energy levels & fatigue
- Visual skills
- Motor skills & development
- Language skills & development
- Sensory processing
- Medical history & neurological injury
- Nutrition & digestive concerns
At this stage we will determine what formal ADHD assessment is going to be required. All assessments are individually designed according to your areas of concern, however we do have a core ADHD battery that we will perform (see below) Whilst we do all the formal processing assessments at our centre, if issues are noted with a potential sleep disorder, a hearing issue or other health issues such as anaemia, you may be referred back to your GP to rule out these problems.
DSM-5 screening questionnaires
In order for ADHD to be even considered as a diagnosis according to the international benchmark of diagnosis (DMS-5), a minimum of 6 criteria for inattention symptoms &/or 6 criteria for hyperactive/impulsive symptoms need to be met, in TWO OR MORE areas (e.g.., home, school etc). Therefore as part of every assessment, we screen for ADHD with various rating questionnaires from different people.
Preschool: For preschoolers, we obtain questionnaires from both the parents & preschool teachers. They cover not only the ADHD criteria but also other emotional, behavioural and social issues. They also cover the criteria for Autism Spectrum.
School-age: For school-aged children, we obtain both parent and teacher ratings. these include not only ADHD ratings but also a comprehensive screening of co-morbid disorders such as depression, anxiety disorders, oppositional defiant disorder, autism spectrum. We also have a comprehensive screening of executive functioning. Where applicable we also have the student complete self-ratings.
Adult: For adults we have them complete both adult ADHD rating scales as well as ratings of executive functioning. Where the patient feels comfortable, we also like to have another person rate the individual.
STAGE 2: Formal Cognitive Assessment
If enough evidence is present at the initial consultation and standardised rating questionnaires, we will then perform a formal cognitive assessment in order to determine the precise processing issues underlying the noted problems.
CORE ADHD TEST BATTERY:
Intellectual Functioning: According to age: Weschler Preschool and Primary Scales of intelligence (WPPSI-IV), Weschler Intelligence Scales for Children (WISC-V) or Weschler Adult Intelligence Scales (WAIS-IV). These tests measure:
- Verbal intellect/reasoning
- Nonverbal intellect/reasoning
- Working memory
- Processing speed
- Visual-spatial skills.
Attention testing (ages 5-adult: note the precise tests differ by age):
- Visual selective attention
- Auditory sustained attention
- Visual sustained attention
- Switching attention
- Divided attention
- Impulse control (to auditory information)
- Impulse control (to visual information)
- Visual attention span
- Auditory attention span
- Planning (open-ended task)
- Planning (sequential task)
- Time management
- Strategy generation
SUPPLEMENTARY PROCESSING TESTS:
If issues are noted on an initial consultation with any of the following, specific tests will be added to the battery to precisely evaluate the full cognitive profile.
Learning/ academic assessment:
If issues are noted with learning or academic skill, and concerns are present regarding a potential learning disability, a concurrent learning disability assessment can be conducted as part of the ADHD assessment. Areas tested could include: Reading tests (decoding, comprehension, reading fluency and speed), Writing tests (spelling and essay composition), Numeracy tests.
If issues are noted with significant levels of memory problems, formal memory testing may be recommended. Most of the time issues with memory are more related to issues with attention processing and encoding of the information, rather than true memory retrieval. That is, the information was never properly laid down in memory stores in the first place. However, for people who are highly forgetful the following tests may also be recommended: Visual immediate memory (memory encoding), Verbal immediate memory (memory encoding), Visual delayed memory (retrieval), Verbal delayed memory (retrieval), Visual recognition memory (retrieval vs encoding), Verbal recognition memory (retrieval vs encoding)
If issues are noted with vision such as skipping lines when reading, having problems maintaining eye contact with visual tasks or other people, seeing fine details, missing social cues, struggling with remembering visual information etc., visual assessment will also be conducted.
Functional visual skills will be assessed by an orthoptist including: Acuity, Fixation, Accommodation, Convergence, Divergence, Tracking/scanning.
Higher level visual processing will also be assessed including: Visual discrimination, Visual memory, Spatial skills, Figure ground, Form constancy, Visual closure
If issues are mainly noted with attention when listening to information, particularly when there is background noise, the primary issue may be one of auditory processing rather than a true attention deficit. Hence tests of basic auditory processing, auditory figure ground will be screened. If issues are found referral to an audiologist may be recommended.
STAGE 3: QEEG Brain Scan (If neurotherapy desired)
Whilst brain scans are not diagnostic if of themselves in regards to ADHD, they can be a very useful tool in understanding whether issues are noted at a physiological level. At BrainX we use brain scans primarily as a means of guiding neurofeedback therapy. Neurofeedback aims to target precise brain regions that are dysregulated and underlying the noted ADHD symptoms. Brain scans allow us to identify how dysregulated the brain is, know which areas are most highly dysregulated, and over time to monitor the changes in brain dysregulation, particularly following therapy like neurofeedback. QEEG brain scans are not a compulsory part of our standard ADHD assessment, however many parents request brain scans in order to provide more objective data about core brain functioning and to see whether brain-based training such as neurofeedback is warranted. Many parents also choose to have a brain scan as a baseline of looking at brain maturity and then if they choose to medicate they can reassess to see whether the medication is having the desired brain changes. Ultimately anyone over the age of 7 who wishes to conduct neurofeedback will require a QEEG brain scan.
Benefits of an ADHD assessment
- Accurate assessment leads to targeted treatment in all areas that are creating problems
- Correct treatment leads to better outcomes: increased attention, better performance, optimised potential
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