BACKGROUND
Diagnosing an attention deficit
disorder is a difficult task. This disorder is a significant problem
in the classroom today. Referrals include individuals with the
following symptom or symptoms: difficulty staying with a task;
difficulty completing an assignment; inability to listen to the
teacher; easily distractible; difficulty concentrating;
impulsiveness; "acting before thinking;" and shifting from one
activity to another without completion. In addition to exhibiting the
above symptoms, a second group of individuals appears to be highly
active. These individuals tend to be restless and fidgety, always "on
the go," and are constantly on the move while awake and during their
sleep.
Attention deficit disorders affect
approximately s 8 percent of children before they reach the age of
twelve. At least two percent of the
Adults appear to have this disorder.
Ten times more common in boys than
in girls, it tends to run in families. Recent research indicates it
generally appears to be a temporal developmental problem in which a
small part of the sensory neurological system appears to lag behind
in its development This lag results in the
child's inability to sustain attention to either visual cues,
auditory cues, or both. Since they cannot sustain attention to
stimuli in the environment for amy long period of time, they actually
never sense (hear, see, etc.) a great majority of the cues, facts,
and ideas in their environment. Therefore, the stimuli never get to
their brain to be remembered or retrieved by the child and used in
future situations. This disorder may also be related to other
physical problems or may be the result of inadequate, disorganized,
or chaotic environments. The problem sometimes begins by the age of
three and usually comes to professional attention when the child
enters school. More severe forms, with a greater number of symptoms,
are usually present in younger children. Unfortunately, symptoms vary
significantly from child to child; however the essential features
include signs of a developmentally inappropriate attention span and
impulsivity.
1. History: Upon Referral from their family physician, their work supervisor, or the school district for attention deficit testing, the individual’s history is obtained in order to determine the possible etiology of this problem. Since approximately ninety percent of classroom learning is either auditory or visual, both auditory and visual modalities are examined in detail. In work situations, it could be either or both modalities that may be crucial for the worker to be accurate and productive.
2. Mini QEEG
Evaluation: I
have found it quite useful to evaluate the patient's EEG recordings
at specific sites on the cortex of the brain to see if they have
significant problems maintaining appropriate Beta
wave ratios and Theta
wave ratios during relaxation and during a testing situation. There
is more and more research to indicate that this is a good indication
of true ADD orADHD.
3. Combinations of Auditory and Visual Stimuli: We use the Integrated Visual and Auditory Continuous Performance Test. This is the best test for children, teenagers and adults to determine how they respond to 15-18 minutes of concentration to both auditory and visual stimuli occurring in an integrated manner. This is the most similar to "real life" work and/or learning situations.
4. Auditory
Input Evaluation: An Auditory Sequential Memory Test is given
to determine their ability to pay attention to auditory cues over a
period of time, both immediate and long-term. These resu lts are
normed according to age and sex, and a profile of their ability to
learn or concentrate from an auditory standpoint is developed.
Auditory acuity screening and auditory discrimination testing is also
done if appropriate.
7. School/Work Progress Report: A standardized checklist is sent to the teacher/supervisor to complete. The teacher/supervisor is also encouraged to write comments concerning the patient's behavior in the classroom. This report is very useful both as an anecdotal record and as long-term behavioral data to substantiate or refute the hypotheses developed during the evaluation.
8. Generalized Anxiety
Evaluation: Sometimes,
individuals will act as if they have an Attention Deficit Disorder
when they are actually internalizing in an anxious manner. We normally
use three specific biofeedback tests to objectively
measure the amount of internal stress and anxiety they are
exhibiting.
If the patient is found to have an
Attention Deficit Disorder, we discuss all possible treatments and
their strengths and side effects. I introduce them to
Neurofeedback, Behavior therapy, Nutritional therapy, and
Medication approaches. These
are described in detail in our Treatment of ADD page. They
may choose one or combinations of treatments based on a differential
diagnosis and the effect of their treatment.
I refer them to a physician if they choose the medical route.
Research indicates that medical treatment is by far the quickest
treatment for this disorder, although often with the most side
effects and it may not work well in the long run.
Nutritional Counseling is often quite effective, but may take
more monitoring.
If they choose medication, I work closely with the physician in monitoring and titrating the medication, using our evaluational tools. I also counsel the work supervisors, parents and teachers, when appropriate, in appropriate dietary and behavioral techniques that can be useful in working with the child, adolescent, or adult. Regular followup is advised every 9-12 months once the optimal treatment is determined.
If medication is prescribed by the
physician the evaluation is repeated after two weeks to determine if
the prescribed treatment is useful and optimal.
If the patient does not have
Attention Deficit Disorder, we are prepared to do further testing or
recommend the next appropriate step for the parents or the patient to
take in determining the etiology of their problems.
These procedures have been used
reliably by our office for over 25 years. We have developed our own
norms over the years and have followed many of the children,
adolescents, and adults in a 7-10 year followups. The results
are varied but show that, when treated optimally, their achievement
improves dramatically, their behavioral problems decrease, and they
achieve much better than those diagnosed with ADD who do not follow
any consistent treatment. A partial list of relevant
research is available in our office for our patients.