ATTENTION DEFICIT HYPERACTIVITY DISORDER IN CHILDREN, ADOLESCENTS AND ADULTS (ADHD)
New clinical and neuroscientific research (Barkley, 1997, 2006, 2012, 2015; Barkley, Murphy, & Fischer, 2008, Brown, 1996, 2000, 2009, 2013, 2014, 2017) has brought a new understanding of ADHD. This new understanding recognizes that ADHD affects people of all ages. It substantially expands the concept of attention and portrays ADHD in a much broader way as a complex syndrome of impairments of the brain‘s cognitive management system, also known as its executive functions.
Thomas E. Brown writes, “Executive functions are those capacities of the brain that allow a person to recognize the tasks that he or she needs to do, be motivated adequately to begin those tasks, plan for and organize how to accomplish the tasks, initiate the various components of the tasks without excessive delay, and sustain effort and actions needed to complete the tasks (Brown, 2017). According to Fuster (2015), executive functions mature slowly during childhood, becoming more complex and adaptive throughout adolescence and into adulthood. Because their development is dependent upon the slowest developing structures of the brain, executive functions do not fully mature until well into an individual’s mid- to late 20s.
Many tasks of daily life require the synchronized deployment of multiple executive functions. Driving a car, getting ready to go to school or work, crossing a street, reading and recalling information, solving a math problem, writing an essay, shopping for groceries, participating in a conversation, and preparing a meal are just a few examples.
ADHD is It’s not laziness, an excuse, or a fake illness. In fact, clients report that the harder they try to concentrate on their work, the worse it gets. The problem is described as an impulsive feeling like impatience that distracts and demotivates one from a difficult or boring task. The resulting deficits give the impression of a lack of self-control, as if there is no adult or “executive” in charge of the person. So they appear irresponsible. These “executive” functions are included below in the list of ADHD symptoms. These symptoms always begin in childhood and can be differentiated from immaturity by age 4 or 5 years. The symptoms may include some or all of the following behaviors:
- Impulsivity or acting without thinking ahead of the consequences (e.g., procrastinating, drinking or smoking cannabis and driving, over-spending, etc.)
- Inattention, difficulty sustaining attention
- Distractibility (e.g., wandering from subject to subject or from one activity to the next without completing them)
- Not completing tasks
- Disorganization (e.g., often losing things, tardiness, etc.)
- Poor planning
- Attention-seeking behaviors
- Poor mental flexibility
- Excessive motor activity
- Difficulty regulating mood
ADHD studies using the latest in brain imaging technology show structural impairment in neurological functioning. Looking at the SPECT (single photon computer tomography) images below of the prefrontal undersurface view of the normal, unmedicated and medicated brain. You can see the areas that are impaired in the middle and right images below. The “holes” or dark areas represent the cooler areas where the brain is not giving off much heat. In the image on the right, the medicated brain, the holes appear to be more closed up, but are actually warmer areas of improved brain activity.
The neurotransmitters found in these areas of the brain are dopamine and norepinephrine. Researchers have found lower production of these neurotransmitters here in individuals diagnosed with ADHD. Stimulant medication promotes activity in these areas resulting in improved function.
Psychological Testing Helps to Differentiate ADHD
from Other Disorders That Can Also Affect Attention,
Concentration, Memory and Cognitive Ability.
First thing to do when you or your child is presenting with difficulty focusing and controlling behaviors is to get an assessment and diagnosis. It is critical to rule out disorders which may similarly suppress these prefrontal cortex structures and be misdiagnosed as ADHD. A psychological evaluation can identify deficits in the executive functions and provide differential diagnosis leading to accurate diagnosis. Only a licensed psychologist can administer, score and interpret a psychological evaluation.
Psychological Testing for ADHD
Psychological testing and evaluation permits us to measure whether the inattention, distractibility, impulsivity, etc. are normal for your child’s age or not. If the behaviors your child is presenting is below what would be considered developmentally appropriate, then we call the behaviors “symptoms.”
The assessment process for children and adolescents involves an initial parent interview to provide a developmental history. Teacher and Parent rating scales are distributed and included for data across settings. (The child cannot have ADHD in one setting and not another.) Finally, the child is seen for 4 hours of psychological testing. The tests are scored, interpreted and reported with recommendations that are used in medical and school settings to provide treatment and appropriate classroom accommodations under Federal Law 504 and IDEA to maximize the learning experience for the child, adolescent or college student.
Family Therapy/Parenting Education is also provided to assist the parents in developing a more structured home environment that assists the child in organization and impulse control to promote personal growth and maturity by learning to delay immediate gratification.
Individual Psychotherapy for adults is often recommended to help you deal with more long-term habits that are affecting work and home and to promote personal success and marital happiness. Poor impulse control can be expressed as procrastination, over-spending, low self-esteem, difficulty in organizing and planning.
More about psychological testing at the Kovner Center READ MORE
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