Do we Ever Test Adults?

Most of the time, when we think about testing, we think about testing children.  In fact, we often have opportunities to test adults. There are many reasons that adults need to have an IQ test done.  Here are a few of them:

  • We often use IQ tests as part of a battery when there are medical problems that are being explored.  For example, when there is a question of dementia or memory loss.  After strokes or head injuries, adult IQ tests can be very helpful in determining deficits but also in identifying strengths.
  • When adults return to college or when they are exploring the possibility of a new career path, they often want to get a good picture of their skills.  Sometimes testing will help them make a decision about what kinds of supports they may need or about their ability to pursue a particular vocational path.
  • Sometimes people come in just to have some of their own personal questions answered.  They want to know if they have ADD/ADHD for example, or whether they have an undiagnosed learning disability.
  • This type of testing is often useful when people are concerned about whether they are showing cognitive change.

We usually use a test called the Weschler Adult Intelligence Scale (WAIS) for this type of testing.  It takes about 1 ½ hours to complete and involves a number of subtests. Some of the subtests are verbally based and measure vocabulary. Others are visual and look at how we you can copy block patterns or how well you can make designs. There are some memory scales as well.

After all the data has been collected, the psychologist will look for patterns in the scores to help describe your cognitive profile.  Because these tests have been given to thousands of other adults, we have some idea of the “normal” pattern of scores.  Your pattern is then compared to this norm and we look for differences. A little bit of difference is expected—we all are different!  But when there is a large discrepancy, we want to look at it more closely. Sometimes more testing is suggested so that we can get more information about why your scores are so different (Don’t forget, they could be both higher or lower than we expect!).

The next step always is to apply the results to the “real world.”  How do these scores impact your daily life?  Should you use different strategies to help you remember? Should you “talk yourself through” a difficult task so you can use your best skills in that area? Sometimes people find that they have lived their lives feeling that they weren’t “smart enough,” only to find out that they have one small area of weakness but that otherwise, they are fine!  For some of the patients I have worked with, this revelation has been very freeing for them, allowing them to try new things or move in new life directions.

Remember, though, that IQ tests only measure certain types of tasks. They NEVER should be used to judge your value as a person, or your ability to be successful.  They just give us a snapshot of specific tasks; our lives a so much more complex than that. So don’t overvalue IQ scores! Use them for what they are intended to do.

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.


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.