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.
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.
How many times have you engaged your ADD/ADHD son or daughter in a “discussion” of who is at fault. If you have, you already know that he/she never takes responsibility. Instead, the entire focus is on who “really” is at fault.
Many families have told me that the blame/responsibility arguments can go on for hours. Unfortunately, there never is any resolution. People with ADD/ADHD cannot cognitively understand their own contributions to the problem. They cannot tolerate the self criticism implied in the blame. It is always someone else’s fault.
Don’t engage in this type of argument. It is a waste of time and you will not succeed in convincing anyone. Instead, when a problem arises, consequences can be assigned without any mention of blame. If something occurs, a broken window for example, parents would announce the amount of money each participating child would need to repay. No “blame” would be assigned or discussed. If the ADD student insisted it wasn’t his/her fault, the response would be that no-one said it was his/her fault. The outcome was that he/she had to repay a certain amount. In this way, the discussion of blame was avoided but responsibility was assigned.
Second, don’t argue about statements where your ADD/ADHD child blames someone else. If he/she says, “It’s Mom’s fault I didn’t have my homework,” ignore the blaming statement. Instead, restate it asserting that he needs to keep track of his homework. Pointing out that he is always blaming someone else will trigger an argument and will obscure the main idea, that his homework is HIS.
Over time, most ADD/ADHD people learn to accept at least some blame for their actions, but this usually does not occur until early adulthood. Until then, resist the temptation to play the Blame Game!
Psychologists often use pictures of faces to help describe emotions. Do these describe your child’s emotions?
Really mad or really happy with no in-between? People who have ADD or ADHD feel emotions very intensely. They are rarely “mildly disappointed.” People around them can quickly get worn out by the emotional firestorms. It is also very wearing on the ADD or ADHD person.
To treat this, I like to use a number scale, with each number representing a degree of emotion.
Zero might represent no anger, one would be mild irritation, all the way to number 9, which is the angriest you can be. Then I ask the ADD person to think about how much anger the situation warrants. One of my ADD patients responded that he “always did a 9 anger level!” He was right! He had to learn to use the steps in between.
Then I have the student label the behaviors that are used at each level. At a 1, there just might be a brief facial expression. At a 3, he/she might make a negative comment like “Oh Darn!” Five is beginning to look like real anger, with facial grimaces and raised voices. At seven, we change our speech patterns, our volume and increased bodily tension. At eight and nine, we begin yelling, making strong gestures and using strong words to explain his/her feelings.
ADD/ADHD does impact our emotional expression. It is important to teach students to modulate their emotions. It cannot be done without practice before the situation actually occurs. In fact, it takes many repetitions and some coaching, to begin to get this internalized. However, it is well worth the effort.
What should a parent do?
- Instead of yelling at your “emotionally intense” child, teach him/her how to modulate emotions. You could say, “this only warrants a 3 response” and help him/her understand what that would look like.
- Make sure you notice when he/she reacts appropriately and give approval and encouragement.
- Don’t give up—this takes time.