Attention Deficit/ Hyperactivity Disorder
Attention problems are one of the most frequent sources of complaint for which a neuropsychological evaluation may be requested. Often, parents complain that their children are unable to remain focused in the classroom, have difficulty following directions and are forgetful. Adults may present with complaints such as difficulty organizing or completing work-related tasks, distractibility and memory problems.
The role of the neuropsychologist is to help determine if the disorder is present. While this component of the evaluation is often done by medical doctors, including pediatricians, neurologists and psychiatrists, simply providing a yes or no answer to your concerns regarding the presence of the disorder is insufficient. This is because two individuals may each present with attention problems but their presentation, including the signs and symptoms as well as the impact on their academic, social or work life may be very different. When working with a neuropsychologist you will receive a specific breakdown of the symptoms of ADHD, how they impact you or your child and what course of action, whether treatment or school-based accommodations will prove useful.
Obtaining a neuropsychological evaluation for attention problems is also important for what professionals refer to as differential diagnosis and the presence of comorbid diagnoses. Differential diagnosis involves determining whether attention or other behavioral issues are due to ADHD or to some other condition that can appear similar. For example, individuals with Bipolar Depression (also known as Manic Depression) may present with many of the signs and symptoms of ADHD and the two disorders are frequently found in combination, particularly in children. Anxiety may also mimic some of the aspects of ADHD, including difficulties with attention and concentration and fidgeting. It is important to uncover why attention problems exist because both psychological treatment and medication differ depending on the disorder. Comorbidity refers to the presence of more than one disorder. In children with ADHD, we often find learning problems (difficulties with reading or math), emotional issues (inability to control anger), and behavior problems (being oppositional). It is important to determine whether these issues are due to ADHD or whether a second disorder is involved. If only the ADHD is treated then it is less likely that the problems that the child or adult faces will be properly dealt with.
Below is a discussion of the prevalence, signs and symptoms, and types of ADHD that children and adults may present with:
According to the Centers for Disease Control the prevalence of Attention-Deficit/Hyperactivity Disorder (ADHD), often referred to as Attention Deficit Disorder (ADD), in children ranges from 2 to 18% in community samples, making it possibly the most prevalent mental illness in this age group. While the prevalence rates of ADHD in adults is not clear (a British sample found that approximately 1 in 100 adults or 1% met diagnostic criteria), research has shown that approximately 60% of adults diagnosed with the disorder as children continue to be impacted by the disorder in terms of social, academic and emotional functioning. Approximately 80% of the inattention-hyperactivity-impulsivity factor is due to genetic factors.
There are three variants of ADHD: 1) Predominantly Inattentive Type; 2) Predominantly Hyperactive/Impulsive Type; and 3) Combined Type. The inattentive type of ADHD (ADHD-I) is characterized by failure to attend to details leading to careless errors, inability to sustain attention during activities, not listening when spoken to, poor organizational skills, forgetfulness and being easily distracted by extraneous stimuli. These children often require a lot of guidance from parents and teachers in order to complete their work and their work is often poorly completed. The hyperactive/impulsive type (ADHD-H) is characterized by constant motion including fidgeting with hands or feet, squirming in one’s chair, leaving one’s chair and walking around the classroom or in other situations where this is inappropriate, high levels of energy, irritability, difficulty awaiting one’s turn and interrupting others. The combined type of ADHD (ADHD-C) contains components of both variants of ADHD.
Adults with ADHD present somewhat differently from children and adolescents with the disorder, but research has shown that approximately 98% report difficulty following directions; 92% have poor sustained attention; 92% had difficulty shifting their activities; 88% are easily distracted; 80% report losing things frequently; 70% report fidgeting, interrupting, and speaking out of turn or not listening. It is less likely for adults to express the same type of hyperactivity signs that are common in children. Rather, many adults with hyperactivity report an internal sense of restless that makes it difficult for them to sit through a task or an activity for a prolonged period of time.
The impact of ADHD on both children and adults can be quite severe. Social relationships suffer, poor academic performance is common (individuals with ADHD are less likely to graduate high school with a diploma or attend college), work history is more erratic and there is a greater frequency of substance abuse (alcohol and marijuana), depression and anxiety disorders. Driving is an area of particular concern for young adults with ADHD. They are more likely to have traffic violations, get involved in car accidents, are more likely to be injured in such accidents and less likely to follow the rules of the road (as noted in studies of simulated driving).
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