In the article “The Building Blocks of a Good ADHD Diagnosis,” author Thomas Brown notes that ADHD should not be taken lightly and a complete diagnostic workup with multi-step procedures and a medical history review should be ordered and understood by the patient. An evaluation is recommended to be completed by an experienced licensed psychologist in order to provide the full evaluation and avoid a misdiagnosis.

In an ADHD evaluation, the clinician has several options to determine if your child has ADHD and would likely include the following steps or refer to another clinician who can provide a full psychological assessment that includes these steps.

Clinical interview: Find the root causes of ADHD by talking directly to the patient: “Why do you think you (or your child) may have ADHD?” “When? How do you notice it? When is this difficulty most evident? Has this pattern existed most of your child’s life, or is it something that started happening recently?”

Brown states that ”the clinician’s job is to identify patterns that may point to ADHD, or recognize that symptoms actually stem from something else.” Brown notions that a clinical review should cover:

• Challenges, symptoms

• Strengths, skills

• Family life, day-to-day stressors

• For children: school performance — grades, tests (including standardized test scores and how long they take to complete tests), whether or not they can complete homework on their own or need a parent’s help, etc.

• For adults: work performance — deadlines, productivity, etc.

• General health — including sleep and eating habits

• Family medical history, including other possible instances of ADHD

• Drug use (both prescribed and illicit)

• Previous evaluations (if any) and their results

• Related and comorbid conditions — mood disorders, anxiety, and learning disabilities are common in people with ADHD

DSM-V Symptom Review: Determine if a patient has the ADHD symptoms (at least 6 of the 9) listed in the Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition (DSM-V). 

Normed rating scales: These rating scales (Connors Scales, BASC, the Brown ADD Scales, or the Barkley scales) are used to see where a patient is at relative to others their age given their rated symptoms in various situations. Brown declares that “it is also often helpful for adults to have someone who knows them well complete a scale from their perspective.”

Standardized psychological assessments: There are many psychological tests that could help evaluate one’s reading, writing, and math skills that could help determine where one’s strengths and weaknesses lie and what could help. Sometimes ADHD is misdiagnosed if these assessments are not completed as there are other factors that affect focus and concentration, such as anxiety, depression, or learning disabilities. Brown states that “the vast majority of children with ADHD have at least one specific learning problem [which could] overlap genetically and in terms of functions like working memory. These tests include Woodcock-Johnson Test of Cognitive Abilities, Wechsler Individual Achievement Test (WIAT), Wechsler Intelligence Scale for Children (WISC-V).

Physical exam: Because ADHD-like symptoms are sometimes caused by internal medical problems such as thyroid conditions, physical exams ensure that a medical problem has not been overlooked and may be requested by the clinician.

In Brown’s opinion the following evaluation tools may be used in some cases to add to an ADHD assessment, however these are not known to be accurate tools for such an evaluation.

• Brain imaging: “ADHD is not a problem of brain structure, rather, it’s about communication within the networks of the brain” (Brown). However brain imaging may be helpful in providing Neurofeedback Treatment, which is a known treatment for ADHD symptoms.

• Online “reaction” tests: These tests dictate whether a subject has ADHD based on their ability to hit or retain from hitting a certain key every time a particular target comes into view. 

• Genetic testing: The testing of a few genes to see if they make up the genes in ADHD. 

ADHD Diagnosis Red Flags:

• Too quick to grab the prescription pad: When a clinician or doctor does not take their time to do a full evaluation but instead quickly prescribes a medication for ADHD.  

• Failure to include information from the school: When a clinician does not review a patient’s sense of how they function to the fullest by completing rating scales or interviewing closely related persons, teachers, or parents as part of the clinical interview.  

• Failure to use rating scales and psychological assessments: If a clinician does not decide to use rating scales and psychological assessments, then they will likely base their diagnosis of the patient’s symptoms on their personal opinion which can lead to a misdiagnosis. 

• Too fundamentalist about symptoms: If your clinician is too strict on the 6 symptom rule and neglects you from having the possibility of getting a prescribed medication to adhere to your ADHD because you only have 5 of the symptoms, then that is a red flag. 

• Saying, “Don’t worry, it’ll pass!” When your clinician dismisses you or your child’s concerns about ADHD symptoms that are disrupting your life and mental health.  

After the full assessment is completed a complete understanding of why the ADHD symptoms are present and what the next steps would be in managing the symptoms. A good report of the evaluation will provide specific recommendations for treatment along with an accurate diagnosis.

For more information on how Hilber Psychological Services can help you with understanding your or your children’s ADHD symptoms and the next steps for ADHD treatment, as well as connect you with experienced psychologists who can provide an evaluation, please contact us.

References

Brown, Thomas. “The Building Blocks of a Good ADHD Diagnosis.” Additude. 11, Oct.  2019. https://www.additudemag.com/how-to-get-diagnosed-for-adhd-ensuring-a-good-evaluation/

As a parent, it’s important to understand, connect, and help children grow to be successful adults in the way they can be successful. Sometimes it takes a random interaction or opportunity to understand other ways to support your children and other times you can be proactive for opportunities to support them in other ways.

In the article “The father apologized. ‘Mind if I try something?’ By the end of the flight, it clicked. He was astounded.’: Dad ‘nearly cries’ after speech pathologist teaches autistic son to communicate on a plane for the first time,” author Rachel R. Romeo contributed to a little boy’s life. 

Romeo described her experience with a father and his son on her 8-hour flight. The plane had not even taken off and the father was already apologizing in advance for his son’s behavior: “he warn[ed] [Romeo] that his 10 year-old son had severe nonverbal autism, and that this would likely be a difficult journey” (Romeo).

Romeo is a speech-language pathologist who has lots of experience working with minimally verbal kids and augmentative and alternative communication (AAC). In specific, she is used to the behaviors that the son was exhibiting: screaming, hitting, and grabbing. Romeo consulted with the father and asked him if he had ever tried to communicate in different ways with his son. 

Romeo received consent to try to communication therapy which his son. 

“I tried to see if he was stimulable for a communication board. I started by pulling up some standard images for basic nouns on my computer but I could tell that screens really bothered him. So, I... tried to create a low-tech board” (Romeo).

Through multiple assessments, Romeo learned that the boy likes to communicate through symbols as he caught on quickly to her drawings. On this 8-hour plane ride, Romeo was able to introduce other symbols that he might know. 

Romeo stated that “by the end of the flight, he had made several requests, initiated several times, and his behaviors had reduced quite a bit. The father was astounded – clearly no one had ever tried an AAC approach with him. I gave him the paper and showed him how to use it, and he nearly cried.”

Through this experience, Romeo was able to make a difference in this parent-child relationship by introducing a new communication system that no one had ever tried with the father’s minimally verbal son. 

This story illustrates the importance of parent-child relationships and communication to and from children. Feeling connected, communicating, and helping your children grow to be successful adults sometimes takes therapists, speech, and other opportunities to help them.

For more information on how Hilber Psychological Services can help you and your family with communication, parent-child relationships, parenting or child therapy, please contact us.

- Written by Lily Schmitt and Tanya L. Hilber, PsyD.

References 

Romeo, Rachel. “The father apologized. ‘Mind if I try something?’ By the end of the flight, it clicked. He was astounded.’: Dad ‘nearly cries’ after speech pathologist teaches autistic son to communicate on plane for the first time.” Love What Matters. https://www.lovewhatmatters.com/the-father-apologized-mind-if-i-try-something-by-the-end-of-the-flight-it-clicked-he-was-astounded-dad-nearly-cries-after-speech-pathologist-teaches-autistic-son-to-communicate-on-pl/

In the article “Anxiety or Aggression? When Anxiety in Children Looks Like Anger, Tantrums, or Meltdowns,” author Karen Young denotes that children have tantrums not because they want to, but because something in their environment is making them anxious.

Kids may consider the simplest things as a threat, such as a test, a teacher coming over to talk to them, or even them being late to something and worrying about the repercussions of being late. Young notes that “for kids with anxiety, any situation that is new, unfamiliar, difficult or stressful counts as a potential threat.” With this realization of a potential threat, our amygdala, a structure of our brain that controls our emotions, goes into high alert to either fight or flight. When it senses a threat, it floods our bodies with hormones and adrenaline to make the body react faster and stronger (Young). This causes our emotions to turn on and tears to be drawn.

The buildup of this anxiety is very difficult for children to control on their own. It is then where parents should step in and ask their child if they need to talk. For most children, it is very difficult to open up right away, but through consistent connection, parents can slowly peel back the layers. The goal of talking with your child is to help them understand why they are getting anxious and how to identify the signs of anxiety in order to later stop the response.

According to the Healthline some signs of anxiety are:

• Excessive worrying

• Feeling agitated

• Restlessness

• Fatigue

• Difficulty concentrating

• Irritability

• Tense muscles

• Trouble falling or staying asleep

• Difficulty breathing

• Avoiding social situations

• Irrational fears or worries

Young states some ways that parents can help assist their children to relax their brain and understand their anxiety include the following tools.

Explain where anxiety comes from

Anxiety can come from anything, anywhere, but it is how you cope or deal with it that will determine how long this anxiety will occur. It helps to list out the events or people in your child’s life that may be causing your child stress, anxiety, or anger. From there, you and your child can break down the scenario and regulate the instances your child interacts with this person or does an activity. Anything that is causing your child to be stressed should be looked into depth because although your child may not be physically showing their anxiety, their mental health is being strained.

Breathe

Deep breaths help you relax and regain control of the present situation whether or not you are having an anxiety attack or just need to slow down. It is always okay to take a second and get yourself together. As parents, it is important to encourage your children to take a few deep breathes when they are feeling stressed. This way they can check themselves and relax for a second before they go again. Kids these days are really anxious about getting their work done on time and especially without mistakes. It is necessary to let your child know that it is okay to make mistakes: mistakes are how we learn. Practice your breathing and practice making mistakes and learning how to fix them because both are okay to do.

Have your Powerful thoughts ready

Have your powerful thoughts ready in the sense that when you think that you or your child is going to be angry or upset, have in mind what you are going to say to yourself to calm yourself down and to keep yourself motivated to keep going.

For example, Young says to say ‘It’s okay warrior dude. We’re all good here. You can relax. There’s nothing that can hurt us here.’ Then, keep practicing your strong brave thoughts until they become automatic, which they will.’

Practice Mindfulness

Mindfulness is about stepping back and looking at yourself from an outside perspective and seeing your feelings come and go without any judgment what so ever. Do you see yourself tensing up? Do you see yourself getting short of breathe? Do you see yourself getting anxious? If so, take a moment to yourself and just breathe. Stay mindful of what is in the present rather than what will happen in the future. Young states that “mindfulness for children generally works best [if] it’s kept to about five minutes or less but let them keep going for as long as they want to.” Here are some fun ways to practice mindfulness with kids.

Name it to tame it

Acknowledge your emotions in order to figure out how to control them. Young declares that if you can see that your child is getting angry or is feeling a certain way, you should act on it:

‘I can see that you’re really angry right now.’ ‘It has really upset you that you weren’t allowed to run through the supermarket. I get that. It’s hard having to be still sometimes isn’t it.’

“Hearing the words that fit with their feelings will help to strengthen the connection between the right and left sides of their brain” (Young) along with your parent-child bond because your child knows that you understand how they are feeling and are noticing it too and want to help.

Lift them up

When kids are down on themselves for doing something wrong or throwing tantrums, lift them up and tell them it is okay not to be perfect all the time, teach them to focus on the good and what they are doing right, encourage them to be nicer to themselves. Here are some common ones that come with anxiety.

If you find that your child is getting anxious or anger easily, sit down with them and talk about what may be causing these emotions to occur. If you find the root of it, then they will more likely to find a better response because they understand why this is happening to them and they can work on changing it.

Young identifies that “as adults, it is critical to be open to the possibility that beneath an aggressive, disruptive child, is an anxious one looking for security and comfort.”

For more information on how Hilber Psychological Services can help you with understanding and assisting your children or teens with anxiety, worries, or parenting, please contact us.

- Written by Lily Schmitt and Tanya L. Hilber, PsyD

References

Julson, Erica.”11 Signs and Symptoms of Anxiety Disorders.” Healthline. 10, April 2018. https://www.healthline.com/nutrition/anxiety-disorder-symptoms#section6

Young, Karen. “Anxiety or Aggression? When Anxiety in Children Looks Like Anger, Tantrums, or Meltdowns.” Hey Sigmund. https://www.heysigmund.com/anxiety-or-aggression-children/

Young, Karen. “Mindfulness for Children: Fun, Effective Ways to Strengthen Mind, Body, Spirit.” Hey Sigmund. https://www.heysigmund.com/mindfulness-for-children-fun-effective-ways-to-strengthen-mind-body-spirit/

In the article “Correction Through Connection. As it turns out, there is no other way,” author Karen Young addresses how punishment cause a strain on your parent-child relationship especially if it is consistently used. She states that “if [you’re] looking to support our children and teens towards a better way to be, the only way to do this is through connection.”

Young denotes that yelling, or any kind of shaming, will cause your child to be less inclined to do the task that is being asked or even learn from the task or the yelling. Anytime that a child perceives a threat, the body goes into a fight or flight response. This perception can be based on whether or not something is actually a threat: “it’s about the way the brain perceives what’s happening – and the brain will always perceive yelling, or any response that shames or belittles, as a threat” (Young).

Especially when shouting comes from an adult, a child is more likely to feel unsafe because they are so used to their parent acting one way and then suddenly the parent is disappointed or mad. When it comes to this, it is important to remember that your child’s brain is still developing and their frontal lobes (controls higher-order thinking) are probably not making the best decisions or judgments. It is critical to understand that your child is changing ad practicing as well: “as children grow, they will slowly take over the role of protecting themselves” (Young), but until then, allow for mistakes and change to occur as they grow.

The main goal that parents want to accomplish is seeing their child as a successful adult later on in life. This only happens if they have raised their “children and teens through to adulthood in a way that will help them discover the best versions of themselves” (Young). For this to happen, children need to know that their parents will keep them safe. If kids feel safe and secure, they are more likely to open up and communicate with their parents on what is going on in their life.  Kids are going to make mistakes, and they need to know that you, as parents, will not react and punish them. Young notes that if you “associate shame and fear so strongly with messing up” then they will be more scared to make mistakes and even less likely to talk to their parents. Through connection, your children are more likely to warm up quicker, open up, and ask questions. 

Now, this does not mean that there should be no rules or follow through, but instead guidelines and boundaries for your child to follow. Young states that parents “need to be mindful of not putting consequences in place just for the sake of feeling as though [you] are doing something,” but instead reflect on yourself and how your actions can affect your child’s learning ability. Sometimes this is in the form of extra rules or commands to feel like you are controlling the situation. Connecting with your child will invite them in and together can make better decisions and practice better behavior. You and your child need to help each other reinvent or invent a new sense of self. In the book, “Inventing Ourselves,” author Sarah-Jayne Blakemore illustrates that you, as parents, will understand your child better if you understand what is going on in their brain. 

Young declares that your children still need you in their life even though they may not always show it:

“They can only learn from us when they are feeling safe. This isn’t always easy – sometimes we will be completely over it all, but it’s when they are at their worst, that they will need us more than ever. If you can’t love them out of a bad decision, be the one to love them through it. It will be the most powerful, most soulful, most meaningful way to teach them a better way to be.”

For more information on Hilber Psychological Services can help you with connecting with children or teens, parent-child interactions and parenting, please contact us.

- Written by Lily Schmitt and Tanya L. Hilber, PsyD

References

Blakemore, Sarah-Jayne. “Inventing Ourselves.” Penguin Company. 2018.  https://www.penguin.co.uk/books/1110515/inventing-ourselves/9781784161347.html

Young, Karen. “Correction Through Connection. As it turns out, there is no other way.” Hey Sigmund. https://www.heysigmund.com/correction-through-connection-as-it-turns-out-there-is-no-other-way/