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Does my child have ADHD?

According to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition Text Revision (DSM-IV-TR), a diagnosis of ADHD entails the following:

1. Six or more symptoms of inattention (fails to attend to details or makes careless mistakes; has difficulty sustaining attention in play or on tasks; does not seem to listen when spoken to; does not follow-through on instructions and fails to finish activities; has difficulty organizing tasks or activities; avoids, dislikes, or is reluctant to engage in activities requiring sustained attention or mental effort; often loses things necessary for task completion; is often distracted; and often is forgetful in daily activities) to a level that is maladaptive and inconsistent with development.
2. Six or more symptoms of hyperactivity/impulsivity (fidgets with hands or feet and squirms in seat; leaves seat in classroom when remaining seated is expected; runs about or climbs excessively in inappropriate situations; has difficulty playing quietly; is often on the go; talks excessively; blurts out answers before questions have been completed; has difficulty waiting his/her turn; and interrupts others) to a level that is maladaptive and inconsistent with development.
3. Symptoms causing impairment need to be present before age 7, and impairment (social, academic, or occupational) needs to be present in two or more settings.

It is always important to remember that, for a diagnosis of ADHD, there needs to be a set of symptoms negatively affecting functioning – not just one or two. For example, because a child is able to hyperfocus (which, actually, is not a part of the diagnostic criteria), it does not necessarily mean that the child has ADHD, or is gifted. What is troublesome for a child with ADHD is controlling attention, particularly in situations that are not necessarily rewarding or require substantial effort. Hyperfocus can be a positive thing when it corresponds with task motivation, but it is troublesome when a child needs to shift his/her attention or focus on activities that are socially required (e.g., sitting at one’s seat completing schoolwork). Often, when people describe hyperfocus in children with ADHD, they are referring to the child who watches television or plays video games for hours. This typically is not the same way that hyperfocus is described in gifted children, where a child works on a Lego set or reads about space for hours.

While ADHD is considered to be a pervasive difficulty, the outcome varies depending on several issues, like intensity of the disorder, co-morbidity with other disorders, positive family environment, etc.

Psychological Testing

There are many reasons why a person is inattentive or forgetful, such as depression, stress, or anxiety. Therefore, a comprehensive evaluation is needed to definitively diagnose ADHD. One needs to know what is “causing” the difficulty to effectively “treat” the difficulty.

In our practice at the Assessment and Counseling Clinic, the assessment battery varies depending on (1) the referral question and (2) how the testing data unfolds. All scores from psychological tests should be interpreted within a context. For example, there are a multitude of reasons why a student would demonstrate slower than expected processing. Therefore, when I see a difference in IQ scores such that the verbal and nonverbal scores are far superior to the processing speed score, I try to discern what could be causing the discrepancy. If I think that the difference is related to attention, I would look at scores on measures of executive functioning, continuous performance tests, and behavioral rating scales and see if there is a pattern.

Typically, an ADHD assessment in our clinic consists of the following tests:

• Cognitive ability measure (e.g., WISC-IV, WAIS-III)
• Achievement measure to rule out a learning disability (e.g., WIAT-II or WJIII)
• Neuropsychological / executive functioning /memory measures (e.g., WMS, NEPSY-II attention battery or D-KEFS select subtests, Ray Complex Figure)
• Attention measure (e.g., CPT-II)
• ADHD rating scales (e.g., Brown ADD Scales – parent, teacher, and self; ADHD Rating Scale – parent, teacher)
• Psychosocial screener (e.g., BASC-2 parent, teacher, and self-report)
• Self-esteem measure (e.g., Piers-Harris, 2nd Edition)

Medications

In general, researchers have found that psychopharmacological treatments for ADHD reduce the core symptoms of ADHD (inattention, hyperactivity, and impulsivity), and improve the child’s general ability to handle task demands and academic productivity. They have not been shown to help with learning and applying knowledge to various situations. Researchers have also found that behavioral treatments are helpful, but not as helpful as medications in reducing the core symptoms of ADHD. They are, however, just as effective at reducing oppositional and defiant behavior and improving parent-child relationships.

Not everyone with a diagnosis of ADHD responds well to a psychostimulant medication treatment regimen. In fact, about 20% of individuals with ADHD/ADD do not respond positively to stimulants. However, one positive aspect to considering a trial of stimulant medication is that they are quick in / quick out. Sometimes, it takes various trials before one finds a medication that works with minimal side-effects. Some children will need to take medications as they get older, but others will not.

Behavioral and educational interventions to consider:

All Students

1. Implement a reward system for trying and maintaining organizational tools, such as assignment notebooks.
2. Involve your child in establishing motivators for positive behaviors. We all benefit from motivators. I am a runner, and I love to run. But, I work full-time and have two kids. Time is limited and I am tired a lot, so exercise seems to be the first to go. So, I typically register for a few races each season to keep me motivated to get myself out there to run. It is a motivator for me because I am competitive and want to perform well. The key to a successful reward program is finding out what is motivating.
3. Point out the positive behaviors that are exhibited, and emphasize the benefits of studying and obtaining good grades.
4. Consider structuring unstructured time. Have your child work with an aide to establish goals for the unstructured time – e.g., what parts of my homework will I accomplish during this unstructured time? Having your child participate and make his/her own goals will be important. Have these written out so that he/she can see them during the time.
5. Let your child break up his/her homework time into smaller chunks where he/she is “rewarded” with a 10 – 15 minute break after working for a set period. Of course, this system would need to be monitored initially, but hopefully with praise and positive results he/she would develop this method as a positive way to get his/her work done as he/she enters more independent environments (college or career). Sometimes setting a timer or having your child use a digital watch where he/she can self-monitor behavior helps regulate time on and off task.

Older Students

1. Approach the use of an organizational tool as a very “adult” thing to do, not something that is demeaning or for “dumb” people. Consider having a professional talk to your son/daughter about how he/she uses organizational tools to his/her benefit.
2. Normalize organizational tools – they are not for “stupid” people; rather, they can help “de-clutter” the brain of gifted people to allow for more creative activity to take place.
3. For middle school and high school gifted students with ADHD, this is the age where students typically don’t want to appear “different” or like they have any special needs. So, providing accommodations that are within a “normal” environment will likely be the most successful. This is also a time where students seem to have increased pressure for social status, and sometimes academics can be negatively affected by this shift in attention and focus. Normalizing the need to be social while emphasizing the need for attention to school, and rewarding this behavior, would be helpful.
4. In college, sometimes there are tutors or coaches available through student disability services that help with organization and time management skills. Also I would suggest that your child enroll in a class that addresses adjustment to college issues, if one is available. While not academically challenging, these courses teach necessary skills for successfully transitioning to the more independent college environment.

Permission Statement

This article is provided as a service of the Davidson Institute for Talent Development, a 501(c)3 nonprofit dedicated to supporting profoundly gifted young people 18 and under. To learn more about the Davidson Institute’s programs, please visit www.DavidsonGifted.org.