Gifted Issues Discussion homepage Forums Twice Exceptional Revisiting possibility of ADHD - advice welcome

I was posting here midway through last year when we were going through a rough patch with DS6 (nearly 7) and I decided I wanted to have him assessed for ADHD. At the time the psychologist did not think a diagnosis was warranted, but that if a behavioural management program was not successful, we should re-evaluate.

I guess my main question is, for those of you who have gone through an assessment for ADHD, what tools were used to determine whether or not your child had ADHD. Last year DS was administered the WJ iii IQ test as well as achievement tests, Conners Kiddie Continuous performance task, comprehensive executive functioning inventory, connors early childhood. We will be completing the Browns ADHD rating as will his teacher, and the psychologist will look at the report from last year's assessment. Are there any other tests you think are valuable?

More specifically, with the WJ-iii, what areas of relative weakness would indicate looking closer at ADHD?

And then, finally, how has a diagnosis of ADHD helped you and your child?

Thanks for any comments.

The WJIII is not really intended to be a diagnostic instrument for ADHD. The assessments you had/will have that are more directly relevant to ADHD: K-CPT, CEFI, Connors, Brown ADHD. Other than K-CPT, most of them are indirect measures (rating scales). It's a little tricky Dx'ing ADHD in very young children, as a lot of the concerning behaviors are developmentally within the range, and also because so much of young child behavior is affected by the adult-created environment.

All that being said, the kind of WJ cog and ach tasks that tend to be more vulnerable to weaknesses in sustained attention tend to be timed tasks (which also tend to be repetitive), and memory tasks. It is not, however, totally strange for a child who actually has ADHD to do well on these, since it's not as hard to recruit attention and impulse control for a few minutes at a time. Nor do weak scores in these areas necessarily mean ADHD, as there are many other possible causes.

DD actually did better on the CPT than DS, even though DD has more obvious/severe ADHD. She scored in the average range but in a noisy, chaotic classroom she is like a space cadet. I don't think there is any perfect test, you just kind of have to weigh the evidence. I'm still not sure if DS has ADHD or not, because people talk about poor focus, but I don't notice the same sort of distractability at home. So it's hard to say what is causing the focus issues, it could be any number of things. He claims that in math, for instance, he is so excited to be there and talk to the older kids. To the teacher, though, it might look like ADHD.

Thanks for that aeh. Wouldn't it be so much easier if these things were clear cut? I am constantly questioning how much of his behaviour is due to the interaction between the home environment/disciplinary system that we create and his amazing little self. What age do you think it becomes easier to make a diagnosis? I don't want to be looking for a diagnosis if one is not warranted, but I also don't want to leave him unsupported if he does qualify for a diagnosis.

Thanks for the information about the WJ. If I pm you his subtest scores would you be able to tell me if you see anything noteworthy, even if it is not ADHD related? He does have a lot of variance, for example there was a 39 point difference between his sound blending and auditory attention scores with sound blending being the stronger score.

Certainly. pm away!

You might also consider alternate hypotheses, such as central auditory processing disorder.

I think many aspects of children start to sort out as they reach middle elementary/intermediate age (8, 9, 10 yo, or so). They also begin to become more self-aware, and thus able to describe their experience to you, which helps in understanding what internal and external factors are at work.

As aeh notes, there is significant overlap in the symptoms for AHDD-inattentive and auditory processing disorder (APD). Our DD when 7 was assessed by a specialist audiologist to rule out APD before confirming ADHD. The audiologist explained in detail exactly how the combined tests allowed her to separate out whether task performance was affected by auditory issues vs. attention. It was (fascinating and) highly informative.

By the end of grade 2, DD, though not the most self-aware, was able to articulate fairly clearly how much she herself was frustrated by her struggles to maintain attention in the classroom.

Thanks for sharing blackcat. I did wonder about the CPT as it is a computer based tasked that DS had never been exposed to before, and in novel situations he can be quite focused, especially if it is something he has never seen before and it is on a computer screen!

So would APD also lead to impulse control issues and physical hyperactivity symptoms? I guess maybe I should have a more specific open discussion with DS. We have had discussions about how he feels when he gets in trouble for things, and touched on his difficulty keeping his hands to himself, but you are right, he is getting old enough I can probably start to get more information out of him on how his experiences are affecting him.

I guess it would be helpful to describe some of the problems we are actually having/seeing. Now originally he had a PDD-NOS diagnosis, he has since been assessed as not being on the spectrum, but his current psychologist is factoring in ASD possibilities as well, although the current thought is that it is more an impulse control issue than a lack of social understanding . . .

At school, there is trouble with him blurting out answers, wanting to talk incessantly and not listen to peers, getting out of his seat and getting into his peers space, getting very emotional and upset, having angry outbursts when he gets frustrated,

At home we have problems with staying on task, we have been working on the morning getting dressed routine since he was in ABA therapy at age 3, currently he has a laminated checklist for the morning, but he will swing his socks around his head, or start playing a game when he is halfway dressed, I continuously redirect him to the task. We have tried a number of reward systems and timers over the years, and he gets really excited for a couple of days or maybe a week, but then its like he gets bored with it as it is no longer novel, and it stops working. We always make the expectations and steps very clear. And sometimes I just think, how can we have been working on this for nearly 4 years, and still its such a big struggle. How are we supposed to tackle everything else if we can't even get this one thing sorted? Even if he is really excited about where we are going, like to a birthday party, if I send him down for a pair of socks from his room, I will find him reading a book.

We are finding homework a real challenge. He will spend about a minute on it before he wanders off to do something else. This is okay this year, but he will be going to year 3 next year . . .

He also has a lot of difficulty keeping his hands off of things. this is at home, or when we are out. In doctor's offices he will get up, and start grabbing at things in the office, he will be told by me and the doctor to leave them be. We have found a countdown to be quite effective to get him to stop a behaviour, but he cannot stay still for long before he starts grabbing for something else, or the same thing again. My parental instinct on this one is not that he is intentionally ignoring, but rather that he has a really hard time controlling his actions.

As far as hyperactivity, he is always on the go. In the evenings he can be focused on reading a book, but his body is never still, he will be kicking his legs up and down as he reads. When I was sitting next to him and asked him could he stop as he was bumping me, his legs stopped, but at the same time he started humming to himself as if he needed some outlet for the energy, then the humming stopped and the legs started again. Or if we have a family movie night, he sits next to me then starts climbing on me or rolling over me. Lots of times I think he is doing the pee dance, but he is actually just bouncing around.

His psychologist recommended I take a look at a book entitled Smart but Scattered, and it breaks EF down into 13 or something categories, and you can find your child's areas of strength and weakness, I was a bit disheartened when he scored in the low range on every single category.

All this being said, in so many ways he is such and affectionate, thoughtful little fellow, he definitely has strong emotions, and he can be quite empathetic. I know our management at home could be better, but I think we do a lot of positive things, and sometimes it just all seems to be falling apart despite our best efforts. It seems like hard work most of the time, and I know it is exhausting for him as well as us. He really conceptually grasps all the interventions we have done with him over the years, but he struggles to apply them day to day.

But he has managed to do fairly well in year 2 with his grade skip, and I know he puts a lot of effort in at school to try to behave well. His teacher is very good for him I think.

He sounds like DD to me. She has a dramatic improvement in symptoms on medication. I don't know if you're willing to try that, but you can always ask to get a provisional diagnosis and do a trial of meds. Usually they are started at very low doses, though, and those low doses don't work for everyone, so keep that in mind. We have tried a lot of different meds and what works for one kid may not work as well for another. So if you try one and don't see a big difference or there are side effects, another med might work better (again--not telling you that you should medicate, but sharing my experience if you do). We are medicating DD but not DS even though they probably both have ADHD to some degree. DS struggles a lot with executive functioning, like organizational ability, but is stronger with focus than DD, and I didn't see that much of a difference on meds (although we never made it past the lowest dose because he kept retching whenever he ate).

Thanks blackcat. I just had another call from DS teacher with some things that happened today and yesterday that will result in him having to sit out from an activity today . . . I am definitely becoming more open to the idea of trying medication as everything seems to be falling apart, and kids are starting to form negative opinions about him . . . so the cost benefit scale definitely seems to be swinging for me. Luckily the school year ends next month, and hopefully we can get next year off to a better start.

But I will not get ahead of myself, first step is getting a diagnosis.

Anyway, feeling pretty down about it all at the moment. I feel unable to help him. And my heart breaks for him.