(Comment on this article)Is It Really AD/HD?Article Topics: ADD/ADHD, Assessment, Attention, Concentration,
Article types: General Information,
Submitted By: Richard Glatt, M.A. (C)OACCPP View Submitter's Profile (glatt) | <p>Parents, physicians and teaching professionals are often faced with the question: "Is it really AD/HD (Attention-Deficit/Hyperactivity Disorder)?" when thinking about a particular child, patient or student (and sometimes even themselves). This frequently results in apprehension and hesitation about seeking assistance, since there don't seem to be any clear-cut answers and varying opinions are quite typical. Fortunately, making such a determination has never been easier, given the availability of computerized continuous performance tests.</p>
<p>To assist with the identification process, psychoeducational assessments have typically involved the use of standardized cognitive assessment tools in combination with academic testing instruments to identify attention and learning difficulties. These methods have been very helpful despite their limitations. Increasingly, however, continuous performance tests (CPT's) are being used to: (a) help objectively assess individuals suspected of having "attention" problems (including impulsivity and/or hyperactivity) and (b) monitor the treatment of these specific areas. Used in combination with traditional psychoeducational assessment methods, which also involves obtaining a comprehensive development history with behavioural ratings and observations, CPT's can provide important information about response control and attention skills in order to assist with various aspects of the assessment process. In fact, one such test, the Integrated Visual and Auditory (IVA) Continuous Performance Test, was referred to in the scientific literature as "...a new, accurate cognitive test which can provide important objective data for inclusion in the assessment of ADHD" (Fine, A.H., PhD. & Goldman, L., PhD., 1995). It is also the first test of its kind to provide an objective measure of fine-motor hyperactivity.</p>
<p><b>Continuous Performance Tests (CPT's) </b>are brief computerized assessment instruments that measure errors of attention and impulsivity as well as the speed and variability of subjects' responses. CPT's have been well documented in both medical and psychological published research as being effective in identifying attention difficulties and evaluating medication and treatment effects. The most useful such instruments are multimedia CPT's in that they can identify both auditory and visual strengths and weaknesses. The inclusion of both senses in the testing process has been shown to maximize the sensitivity of this instrument to "real-life" demands, such as those faced by children in the classroom setting. CPT's are also effective for individuals ranging in age from about 5 years to adult and can differentiate between various types of attention problems (i.e. Inattentive, Hyperactive-Impulsive or Combined-type), while distinguishing them from various emotional, behavioural and/or learning difficulties - all of which can be found to co-exist with AD/HD.</p>
<p>The ability to identify AD/HD is especially significant because while most individuals who have overt impulsive and hyperactive tendencies can be readily identified, these who do not, often go unnoticed. This may be one reason why AD/HD is diagnosed much more frequently in males as compared to females and why adults are often under-identified. Recent evidence suggests that at least 33% of children with LD (Learning Disabilities) also have AD/HD, further confirming the need to differentiate the diagnoses. For those reasons alone, such testing can help avert common mislabeling and concerns with self-esteem, thus enabling the individual to gain an immediate understanding of their preferred learning style and attentional strengths.</p>
<p>Finally, to address any possible concerns about medication or treatment effectiveness, it should be mentioned that this is where continuous performance tests have been found to be especially useful. Suppose the physician responsible for this individual has suggested a trial run of a stimulant medication. How will you know if it is helpful and to what extent? Perhaps a higher dose may be more effective or a lower dose may be just as beneficial? Maybe an entirely different medication would be best? While this may seem to further confuse the matter, such questions can most often be answered by obtaining CPT (pre and post-medication ) results in order to objectively conclude the extent of change in cognitive functioning (performance). This type of evidence can then be used to assist in accurate medication titration (dosing) by providing immediate feedback to the physician, thereby avoiding lengthy medication trials and potentially undesirable side-effects. This way, often within several days or sometimes even hours of receiving a prescription, an individual, in consultation with a physician who requests this kind of objective feedback, can accurately determine which medication, if any, would provide the most benefit. Similarly, this type of testing can also be used to evaluate the effectiveness of any type of therapeutic intervention (e.g. psychotherapy, behaviour modification, computerized cognitive skills training, and the like) by conducting pre- and-post- intervention testing.</p>
<p>In order to answer the question that is so often raised: "Is it really AD/HD?", one only needs to ensure that fast and objective computerized continuous performance testing be used as a key component in the psychoeducational assessment process to accurately identify potential "attention-related" problems. As well, once a positive identification has been made, a secondary but equally useful function of this instrument is in the evaluation of medication and treatment effects. So "Is it really AD/HD ?" Now you can find out.</p>
<h4>References:</h4>
<p>Cohen, M.J., Riccio, C.A.., & Gonzalez, J.J.(1994). Methodological Differences in the Diagnosis of Attention-Deficit Hyperactivity Disorder. Impact on Prevalence. Journal of Emotional and Behavioural Disorders, 2(1), 31-38. </p>
<p>Greenberg, L. (1992). Treating Attention-Deficit Disorders in Children and Adults. The psychiatric Times-Medicine & Behaviour. January edition. 18-19.</p>
<p>Korkman, M .& Pesonen, A-E (1994). A Comparison of Neuropsychological Test Profiles of Children with Attention Deficit-Hyperactivity Disorder and/or Learning Disorder. Journal of Learning Disabilities, 27(6), 383-392.</p>
<p>Kotwal, D.,Montgomery, D.& Burns, W.J.(1994). Computer Assisted Cognitive Training for ADHD. Journal of Behavioural Modification. Summer 1995.</p>
<p>Stein, M.A. Szumowski, E., & Halperin, J.M. (1995). Continuous Performance Tests: Using the Computer to Aid Diagnosis. The Canadian, 2(1), 22-23</p>
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<p><b>Editor's Note: </b>Richard Glatt is a Psychoeducational Consultant in private practice. If you would like to speak with him or have any enquires, you may call: (613) 831-6606, fax: (613) 831-6385, e-mail: attention@igs.net or write Psychoeducational Services, c/o Main Street Family Health Centre, 1250 Stittsville Main Street, Stittsville, Ontario, K2S 1A3.</p> |
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