Author: Karen Chesnutt (page 2 of 4)

Tell Me the Test For: ADD/ADHD

Many parents come in to my office and ask about testing for ADD/ADHD.  Most hope there is a test that clearly identifies this disorder. Unfortunately, there is no one test that can make this diagnosis. Let me tell you the process that helps us sort out ADD/ADHD from other patterns.

One type of test that we use is a questionnaire, like the Vanderbuilt Scales, the Connors scales or the Achenbach scales. Some doctor’s office will use these so parents can give some feedback about what actually happens at home. Some of the questionnaires are designed for teachers to complete. The goal is to get a better picture of all areas of life. The data from questionnaires is only as good as the observations of the person completing them, so we need other information as well.

The second kind of test that is used is what we call a “continuous performance” test. These are tests made up of routine tasks (ones that really are not interesting to ADD/ADHD persons). Usually, they are given on computers that constantly monitor if you are paying attention.  For example, you would be asked to click every time you saw a specific letter. The computer, then, would track how long you could stay focused on the task. It would be able to tell if you had been distracted or gotten sidetracked. The amount of time for each task is variable, some as short as a minute or two.

These continuous performance tests give us some interesting information but it is not enough. A lot of people don’t like doing this type of task, but not all of those people have ADD/ADHD. We can learn something about attention span, but it is not enough to make a diagnosis.

We also can use the WISC V to help with the diagnosis. There is a pattern on this test, where certain subtests tend to be lower with people with ADD/ADHD. The tests that are the most sensitive are the Digit Span subtest and the Coding subtest. Both seem to be lower in people with ADD/ADHD.  Is this enough to make a diagnosis?  Not yet.

It is important to get a good description of behavior in a variety of situations. We also need to rule out other problems that can mimic ADD/ADHD, like thyroid problems or anxiety. It is only when we have a good history, and good data that this diagnosis can be made.

 

Gratitude

Many types of treatment for psychological distress talk about using gratitude as a way of coping. It is included in the mindfulness approaches to well being. It is a powerful tool to help us over the “speed-bumps” in our lives.

It may have another application. There was a recent article in Psychological Science (June 2014, Vol.25 ,6, pg. 1262-1267) that did some testing of the concept of gratitude and the results were interesting. These authors were interested in how people behave with money. We know that spending money can often have an emotional component. For example, people who are experiencing some sadness tend to spend money more impulsively than those who are not emotionally down. The standard thinking is that in order to delay gratification (in this case resisting spending money), people would have to exert a large amount of self-control. It is hard not to impulsively buy something that we see and want. We want it NOW!  It certainly seems hard to resist! If you are sad, you may not have the energy to resist.

These authors found that gratitude could have the opposite result. People who practiced gratitude were much more able to resist impulsive spending with a lot less effort. They were able to focus on longer term goals instead of resorting to impulse buying. Imagine how helpful it would be if you didn’t always need to struggle to resist the impulse to spend!

They also found that the results weren’t just because the people were in a good frame of mind. Their study showed that gratitude really made the difference.

What should you do?

Practice gratitude, not only because it is helpful in your emotional life, but it will also be helpful in your financial life!

Other Intelligence Tests

Besides the two major tests for intelligence, there are many others that are used, often for specific purposes. These are called “intelligence” tests, but really are tests of cognitive (or learning) abilities. These can be helpful in certain situations, but should not be confused with formal IQ tests.

Group intelligence tests are often used by schools. These serve as benchmarks for educators but have little or no relationship with formal IQ tests. These test results should be used very cautiously. There are many questions surrounding them about what they actually measure and about their accuracy. In fact, I do not use this type of data at all.

There are some other cognitive tests that are given individually.  The Woodcock Johnson Test of Cognitive Abilities or the Cog-Med tests would be examples of this type of test.  These serve specific purposes in schools. Often they may be used to help understand a learning disability or they may be used to determine who should be included in gifted programming. These tend to be tied more to educational theory than they are to psychological ideas about intelligence.

Be Careful

Do not assume that these are IQ tests, even though sometimes they give out results using the term IQ.  These are good tests for their own purpose, but they are not substitutes for a formal IQ.

Here’s where they can be helpful:

  • If your child has had difficulty in school and is currently getting help. These tests can help monitor whether the plan you have in place is working.
  • If your child is experiencing problems in one academic area, in math for example, but is doing well in all other areas. Before beginning an extensive program of testing, some schools may administer one of these tests as a starting point.
  • These tests will give you a snapshot of how your child is doing at the present time.  These will not predict how your child will do in the future.
  • Some schools use them as a way to determine eligibility for gifted programs.

Note to Parents

Make sure you pay attention to the tests that uses and interpret these carefully.  

Adaptive Scales

This group of tests is one that causes a lot of confusion for parents. It is essential that you understand what these are and what they test. These are needed in New York State any time you look for help through one of the agencies that provide specialized services.

Adaptive Scales do not have anything to do with IQ. They are measures of what a person does in life. How well can they manage on their own?  Can they cook? Can they handle money? These are not tests that can be given in an office, but instead are questionnaires that are completed by people who interact with the patient regularly. Often, there are forms that can be used by teachers as well as caregivers. The profile that we get from these is only as good as the information we are given.

After all the information is gathered, the results are compared to people the patient’s age, so see how they compare.  There are usually four areas that are included: Communication, Socialization, Personal Care and Coping skills. The terms used can vary, but the skills are the same. The results are then compared to other test data for corroboration. For example, if a person is diagnosed with an Autism Spectrum Disorder, we would expect that there would be delays in socialization skills. Sometimes, we find people with strong IQs who are unable to cope with daily life and as a result, score poorly on these tests. Daily living skills and IQ are two very different categories.

There are two major measures of adaptive skills.  One is the Vineland Adaptive Behavior Scale and the other is Adaptive Behavior Scale. These are similar and in New York State, they are both accepted in making determinations about services. These have a wide age range (from 2 ½ through adulthood).

When Do You Need adaptive behavior scales?

  • When you are trying to get services outside of school for your child.
  • When you are trying to make a decision about whether your child is able to live independently, go to college or even go to a sleep away camp.
  • These can be helpful when there is some question about a diagnosis and information about how the child’s difficulties have impacted daily life.
  • You can use this information when you are trying to plan for your child. What skills do you need to focus on, to improve his/her move toward independence.

Help for Parents

Sometimes, parents use these scales to help them have a clearer picture of what their child is actually doing. It is easy to get used to the household routine, without even noticing how much your child is not doing. Many parents have filled out these questionnaires and been shocked by the fact that their child is significantly delayed in independence.

These results can also help parents plan for the areas where they want to focus their attention, what skills they want their child to learn.

Don’t forget that these skills have more to do with life success that even IQ!

“Those Test Scores MUST be Wrong!!”

I hear this so often from parents. They get a cognitive score or even an IQ score on their child and the number is very different from what they observe at home. Some tell me that their child is reading far above grade level. How can he/she not be scoring in the gifted range?

There is a simple answer. There are NO subtests on an IQ battery that test reading, or math or science. That is not the purpose of an IQ test; testing academic skills requires a different approach.

That is the reason we often do academic testing along with IQ testing. The academic testing is sometimes referred to as “achievement testing” and often includes reading skills (decoding and reading comprehension), math abilities (reasoning and calculation), science knowledge, spelling and writing skills. Some of these tests also include a measure of what they call “fluency.” This indicates how quickly the child can complete the task.

Why are these important?

  • Achievement tests can help in planning academic programs. Where should we provide academic support? Where should we mainstream a handicapped child, based on his/her strengths?
  • This type of test information really helps to measure how effective academic interventions are.  For example, if your child is getting extra reading help on a regular basis, has there been any change in scores?  If not, you will need to go back and modify the program.
  • Sometimes, we compare IQ data with achievement data. Some students score in the average range of IQ but then do poorly on the achievement tests. The question, then, is why is this child not acquiring academic skills at the rate we would expect.  There are many factors that interfere with learning so this situation requires some detective work.
  • Another comparison that is made is between achievement data and grades. Some students are doing poorly on their report cards, but when tested, show good ability. This is another case where we need to look for outside causes that may be impacting the student.
  • These tests give some benchmarks for students. Schools will sometimes measure progress by what goals a student has achieved but there is no way to independently measure progress. These tests give that additional data.

Specialized Achievement Tests

In addition to the batteries, there are some tests that provide a more detailed look at specific subjects. The most frequently used are the tests that assess reading. There is a wide variety available. Some look at reading comprehension. Others target oral reading ability. There are a number that evaluate a student’s ability to sound out, or decode words.

There are also several good tests that assess math abilities. These will help with progress both in math calculation skills as well as measuring math reasoning, as would be found in algebra.

Writing is another academic area that has gotten attention recently. There are tests that are sensitive to the organization of writing, the vocabulary used in written work, and the quality of the themes expressed.

Much less testing attention is focused on science or social studies. I suspect this is because people assume that reading and math are the foundational skills on which science and social students are built.

Don’t forget—achievement testing is important in planning educationally for your child!

Does Your ADD/ADHD Child Make the Same Mistake Repeatedly?

Parents of ADD/ADHD children tell me that one of their greatest frustrations is that their child repeatedly makes the same mistakes. Over and over. It almost seems like having poor outcomes has no effect on what a child does. Parents often impose negative consequences to try to change their child’s behavior, to no avail. Nothing seems to work.

Let’s think about the whole process. Imagine that you want your child to complete a two step process–hang up his coat and put away his backpack when he gets home.  Every day, the coat is on the floor and the backpack is not where it belongs. You have sent him back to correct it, interrupted him while he was engaged in a TV program, and lectured him endlessly about this behavior. It doesn’t change.

You expected that, after a consequence, your son would think , “I should have just hung it up when I came in,” and  “Tomorrow, I will do this when I get home.” The problem is that children with ADD/ADHD cannot think backwards in time (“I should have done it when I came in”) and cannot think forwards in time (“Tomorrow I will hang it up when I get home”). That’s the reason that consequences don’t change their behavior. It is not that your son/daughter wants to be disobedient. You are asking them to use a way of thinking that they cannot do.

Should parents just give up?  Absolutely not! You can get your son or daughter to learn these behavior routines. You just have to teach it in “real time.”  Here’s how to do it. Start outside the door and have your son/daughter practice hanging up coat and putting away the backpack.  This cannot be done verbally; your child actually has to perform the behaviors. The only consequence is that if s/he forgets to complete the two tasks, then you schedule more practice. This system can be used any time you want your child to complete several tasks in a row.  For example, it can be used to help with morning routines, packing backpacks, or getting ready in a classroom.

This process takes some time for parents. But, if you think about how much time and irritation you have put into such simple tasks, this actually might save you time! And, it helps you maintain a more positive relationship with your child. One other thing that happens for ADD/ADHD children is that once they have learned a sequence of behaviors, they tend to remember it. You won’t have to teach it again.

The important things to remember:

  • Children with ADD/ADHD cannot correct their behavior by thinking about what they should have done, or by thinking about what they will do.
  • The way to handle this is to teach the behaviors you want—not by talking about them but by having his/her body actually do it. Repeat it until they consistently get it right.
  • The only consequence is practicing the behaviors again.

What You Need to Know About Pink Horses!

There is an example that I use fairly often in my practice and that is to tell people not to think about pink horses. What they quickly realize is that they are actually thinking about pink horses! So what is the significance of this example?

It is an important concept in working with behaviors. Very often, I hear parents tell their children, “Don’t do that!”  But telling them what NOT to do is self-defeating and counterproductive.  Just like telling you not to think about a pink horse has put that idea into your mind, telling your child to not jump on the couch may have just reinforced that behavior.

Another example of this is when we decide to embark on plan to change our behaviors. We may start dieting with the belief that we will give up all desserts. Just in thinking about giving these up, we may actually think about it more. How many times have we decided not to do something and then immediately gone out and engaged in that behavior. In part, it’s the pink horse problem.

So, what should we do?

Instead of focusing our thoughts on what NOT to do, we should focus on what to do. You will notice this in many good preschools, for example, where the teacher says, “I like how your feet are on the floor,” rather than telling them to stop squirming. In a similar way, instead of trying to give up desserts, start by deciding to eat more vegetables, for example. Thinking about what not to do is self-defeating. Thinking about what TO DO is empowering.

Are there other ways to use this principle?

Yes, this principle can be used in a variety of ways and situations. People have started using affirmations to help guide their behavior. Since these are usually positive statements (“I will notice people’s kindness to me today”), they really serve to impact our thought patterns. In a similar way, I like to use “rules” to help children learn behaviors. For example, I give children the rule that they need to greet other children when they see them at school; this is particularly needed if the child is having problems with social interactions.

In adults and sometimes in children, we see pronounced amounts of negative self-talk.  For example, “no-one likes me,” or “I’m not good at anything.” One of the approaches to address this type of self-criticism is to start with something positive to substitute.   Sometimes, we can do this ourselves and sometimes we can coach our children to make these thought changes.

Remember, think positive thoughts for behavior change.  (Notice, I did not say, “No pink horses!”)

The Stanford Binet Intelligence Scales

In 1916, two French psychologists, named Binet and Simon, were asked by the government to figure out a way to determine which children were below average in intelligence.  These men developed a test based on age and what would be expected at each age. So, if your child is five and can do all the items in the five year old scale, he/she would be considered “normal.” If your five year old wasn’t able to do any of the items on the five year old scale, he/she would be considered delayed. In this way, they could determine who should be placed in institutions for retarded children and who should not. Obviously, a lot has changed since then! (information from Stanford Binet IV manual)

Since then, the testing they developed has evolved and has been updated many times. In the more recent editions, they don’t focus as much on age criteria. They have developed a theory about a general foundation of intelligence that they call “g.”  They really can’t describe it well and they have theorized about what it might include. For example, they have called one factor “Fluid Intelligence.” They then have tested this in a wide number of children and have figured out what would be considered average, above average or below average. This is all done using complicated statistics.

Here’s a little about the test:

  • There is only one Stanford Binet test and it is used for ages 2-late adolescence/early adulthood
  • The names on the subscales are different from on other tests and can’t be directly compared

Why chose the Stanford Binet?

Age is also a factor when choosing a test. The Stanford Binet was the only test that was able to be used with 2 year old children for a long time. People working in Early Intervention programs would use the Stanford Binet for this reason. They understood that an IQ for a 2 year old was not particularly accurate, but that they were able to compare one child’s development with another in order to provide help, if needed..

Sometimes, psychologists may choose specific tests because of the nature of the tasks themselves. Some materials are more appealing to certain ages of children. Some subtests are difficult to administer.
My personal preference is not to use the Stanford Binet except for young children.  I prefer a test that has some specific connection with tasks that a child will have to actually accomplish. For example, I like to use a test that has some pencil and paper tasks, since those are definitely a part of a child’s school experience. I also like to use a test that has a test of complex language where a child has to explain things. This gives me some idea of how he/she will do in the language rich environment at school. Whenever possible, I like to have a test that will give more than a number, one that will help me develop a treatment strategy for the child I have tested.

What About a WPPSI?

Many parents ask me about a test called a WPPSI. What is it? What is it for? How accurate or valid are the results?  The WPPSI (Weschler Preschool and Primary Scale of Intelligence) is a test that is becoming more widely used. It is designed to begin measuring children’s abilities at about 2 ½ years of age and goes up to 6 years of age.

It is called an intelligence test, but this is one place that parents will need to be careful. It is a test of where a child falls relative to his/her peers. It is not the kind of test that will allow us to predict how a child will do in the future. We find it to be helpful in determining if a child needs some intervention in preschool. It also can be helpful in designing a specific program for a child. For some, we emphasize working with visual materials, because their profile seems to be too focused on language tasks. For some children, the opposite is true.

For psychologists, one of the important things to consider is not necessarily the names given to the subtests, but what the items really measure.  There are many variables that can change a score.  For example, on the WPPSI III, which is the current publication, there is a subtest that measures the ability to make a block design. What if a child doesn’t have the fine motor skills needed. His/her score will be lower but his ability to work with patterns may be unimpaired. With young children, as a colleague of mine used to say, “it is hard to get a fix on a moving target.” Young children are hard to assess.

A second consideration is how many items are given to a child. There are times when a child can only complete a few items. For example, when doing block patterns, maybe the child can complete one or two of the designs. How much confidence should we have in the results of just two items? Psychologists are very hesitant to draw conclusions based on such limited data.

You can imagine how difficult it is just to get a two or three year old to cooperate with testing, no matter how interesting it is. The session has to be short. The child’s concentration will vary. It is a new setting and probably a new person to the child. All these things will impact the child’s score. As a result, the WPPSI is helpful, but is not as accurate as we would like. We usually wait until a child is at least six years old before we begin to feel confident with test scores.

Do Your Kids Have “Grit?”

This is an important question to ask, especially at this time. Parents are asking questions about how to help their children become successful. They have tried enrolling them in many activities. They have provided them a great deal of help and support. They have constantly cheered them on. The question that Dr. Angela Duckworth asked in her research is, “Does Grit have anything to do with success?” She describes her research in her book titled Grit.

The results of her research were clear. Higher amounts of grit were associated with higher degrees of success. This was true in athletics, in academic pursuits and in careers. Grit, which she defined as perseverance and the ability to keep trying, had more impact on success than intelligence and social skills.

Grit, then, is clearly an important characteristic to foster in our children, and in fact, in ourselves. It does fly in the face of some parenting practices that emphasize having everyone being rewarded equally and where success is guaranteed in all tasks attempted. Grit focuses less on success without effort and instead focuses on the value of effort.

I have looked at children in my practice for a long time and I have noticed that the ones who have the most grit are ones who often have faced great difficulty. I remember one little girl who had significant, ongoing medical problems. To treat her condition, the doctors had to carefully monitor her health. Unfortunately, this included having frequent spinal taps. I saw her one day, before she was scheduled for a spinal tap. I expected to see a frightened child, complaining about having to have these tests. Instead, she came in with great composure and assured me that a spinal tap really wasn’t that bad because it didn’t last too long!  She said she had had to go through worse. My next patient came because he was going to have a shot and was totally disconcerted about it. He was in tears. He was yelling and complaining. He was refusing to go because he was sure it would be painful. The contrast in these two young people was amazing. She had incredible emotional strength as a result of her life experiences. He didn’t.  Who do you see as having grit, of being able to face whatever life presented?

I have been seeing a huge influx of boys in my practice who seem to lack emotional strength. Any kind of challenge, regardless of how minor it is, can defeat them. They stay home, usually protected and rescued by well-meaning parents. I have called them “Syndrome Y®” because of the group of characteristics they show. They have no motivation, no passion. They are the underachievers in school even though they are bright and capable. They do not have grit. I have described this in detail in other blogs. If you think your son may have these characteristics, you may want to consider working to increase his emotional strength. My book, The Syndrome Y Solution: Emotional Strength Building for Your Underperforming, Unmotivated and Underachieving Son, is designed to help parents build emotional strength and grit in their sons.

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