The ADHD test: What it involves

Aug 12, 2017 | I'm a Parent

Your child’s teacher has asked for a meeting and possibly she shares information that confirms what you may or may not have noticed at home. This usually revolves around your child’s behaviour in school and terms such as ‘distractible’, ‘disruptive’, ‘inattentive’, ‘difficulty completing tasks’, ‘daydreaming’, ‘social problems’ and more will pepper the conversation.  Often the suggestion is made that he or she be tested for ADHD.  The reason is that this might provide a diagnosis of the problem, leading to the usual medications for the mental disorder.   But what is this ‘ADHD test’?  How does one test for this condition and what procedures are followed?

 

The truth is that there is no test for ADHD.  There are no objective diagnostic criteria for ADHD – no physical symptoms and no neurological signs.  Neither is there a blood test that can give markers for a possible ‘chemical imbalance in the brain’ or brain scan findings.  In fact, there are no physical or psychological tests that can be done to verify that a child has ADHD. 

 

What is used is mere observation of behaviours in a consulting room, contents of a questionnaire filled in by teachers and parents, and perhaps a report from a psychologist noting inattentive behaviour, poor sequential memory and restlessness during an intelligence test, tests of academic standing or personality test. None of the latter test results can be used to diagnose ADHD.   In other words, it is only the presence of behavioural symptoms of ADHD that constitute the ‘test’.  One of the most popular checklists used for diagnosis is called the Revised Conners Questionnaire.

 

The symptoms are listed in the publication used by psychiatrists for diagnostic purposes and known as the Diagnostic and Statistical Manual of Mental Disorders – 5th edition (DSM-5).  If the child shows about 6 of the behaviours listed for either hyperactivity/impulsivity or inattentiveness and these have persisted for at least 6 months, the diagnosis of ADHD can be made.  The Conner’s Questionnaire consists basically of a variation of the traits listed in the DSM-5.

 

Because it is common for children to behave well in a doctor’s office, many examining doctors don’t see the signs of ADHD during the brief consultation you are given.  Instead, doctors prescribing the drugs used to treat ADHD may do so on the grounds of reports from teachers and parents.  This is startling to consider because the doctor is supposed to then treat a presumed disease or disorder with brain-altering drugs without having seen any sign of it.

 

Get a second opinion  

 

It isn’t extreme to suggest that parents seek out a second opinion regarding the reasons for a child’s behaviours and difficulties.    While drugs might provide a welcome relief for all concerned, including an extremely hyperactive child, they are only treating the symptoms.  The real, underlying reasons for the observed behaviours and the distressing symptoms suffered by the child may go unnoticed and untreated and continue to plague the child for years to come.  Indeed, many continue into adulthood with stubborn challenges that impede the realization of their potential and happiness.

 

Many professionals are legitimately concerned that ADHD has become a ‘catch all’ diagnosis.  Making it more difficult is the truth that there is no actual test to prove that the condition exists in a particular child.  Because of this, one can’t be surprised that the quick fix has been to rely on medications such as Ritalin and other drugs to take care of the problem.  While they may be helpful in the course of treatment of the real causes, drugs have become an overused starting place.

 

Professionals who take the time and trouble to explore all the possible underlying reasons for inappropriate and maladaptive behaviours usually cast their nets wide.  Amongst other possible offenders giving rise to ‘ADHD look-alike’ behaviours are:

 

  • Food and dietary issues, including allergies and intolerances
  • Unhealthy digestive systems, affecting brain function
  • Family dynamics, including parenting techniques
  • Delays in brain development needing correction
  • Irregular functioning of certain neurological systems needed to support behaviour and learning
  • Neurological and physiological impairment due to pollutants or toxins
  • Stress and other emotional factors
  • Academic factors, including academic deficits or extremely high intelligence

 

Choices available to parents

 

Many parents are ready to accept that their child may have ADHD but are not willing to give them drugs.  This is understandable and commendable but it doesn’t help to ignore the condition.  These days, many strides are being made in the identification and treatment of those behaviours making life difficult for families.

 

Integrated Learning Therapy (ILT) practitioners offer an holistic evaluation of such children (and older individuals).  Very often we do identify the real cause – and with the cooperation of the family, are able to offer substantial help through a home-based treatment plan.  This means that there aren’t weekly (and expensive) visits to a therapist but the family manages the programme in their own homes at times convenient for them.

 

For more information about our services and a list of practitioners available around the country, visit the website www.ilt.co.za. 

 

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Martin Doherty, writing for The Conversation, says that at the age of about four, children reach important milestones in brain development.

One of these is a huge improvement in understanding others’ thoughts and feelings. This is the start of empathy.  Another is in spatial thinking—understanding how objects are positioned and related. This is the beginning of the ability to read maps.

Martin and his colleague, Catherine Sayer, conducted a study with 175 two to five-year-olds to explore how children are able to use scale models to figure out where something is in the real world. At about four, children are able to use a scale model of a room to work out where something is. We thought that this might result from children’s understanding of how one thing can represent something else. But we actually found that four-year-olds’ ability to use scale models came from their spatial abilities.

At the same age, children start to understand that someone’s behaviour is due to what that person believes, not necessarily what is really the case. This has interesting consequences.

If you’ve played hide-and-seek with young children, you may have noticed that they aren’t always very good at it. They love the ritual of looking in all the wrong places first, but beforehand they may tell you where they are going to hide, hide in the same place every time, or not be especially hidden.

After their fourth birthday, they get much better at hide and seek. They understand that the seeker looks in the wrong places because they don’t know where the hider is.

At about three to four children also start to tell lies. They realize they can make someone believe something that isn’t true.

Understanding symbols

Martin’s earlier research with fellow psychologist Josef Perner suggests that four-year-olds don’t just start to understand how others’ minds work. Figuring this out is part of the development of an understanding of “representation”—that symbols, like thoughts, words, or pictures, can be used to stand for something else.

Children start to think about how words relate to objects. This means, for instance, knowing that “animal” can refer to something you already have a name for, such as “rabbit”. This might help children learn the new word.

Their ability to use a understand the components of pictures also improves around this age. Very young children use a lot of trial and error to complete a jigsaw, picking up random pieces to see if they fit. By the time they are about four years old, they start to use the picture as a guide, trying to connect lines and match bits of colour, while checking the guide picture on the box lid.

Developmental experiments

Another ability children develop at around four is using scale models. A classic set of developmental experiments involved a model of a regular household room. The real room had typical furniture—sofa, table, cupboard and so on—and the model had miniature versions laid out in the same way.

Children were shown where something was hidden in the model and told to find an object hidden in “the same place” in the room. Children of around four can find the object using the identical layouts. If shown a sticker under a particular chair in the model room, for example, they can go straight to the “same” chair in the other room. This is the fundamental understanding required to read maps.

Adults see scale models and maps as representations. Maps represent a town or a country. A scale model of, say, the Eiffel Tower represents the real thing. At first, Martin suspected children’s ability to use scale models is more evidence of understanding representation at this age.

He was wrong. Instead, the researchers found that this ability is based on a development in children’s spatial abilities that also occurs at about four. This is the ability to think about spaces and where objects are within them. Spatial abilities help with maths skills, and good spatial ability is linked to an interest in science, technology, engineering and mathematics.

Their experiment was simple. They compared the model room task with a test of understanding how representation works. The two abilities develop around the same age, but they found they were not related. Children who could do one task couldn’t necessarily do the other.

They also had a test of purely spatial ability. Children who passed the model room task also passed the spatial task. So it looks like the model room task relied on children‘s spatial thinking.

They don’t yet know why two important but apparently unrelated abilities arise at the same time. Perhaps it’s related to changes in the growing brain at this  interesting age.

Provided by The Conversation. 

Image supplied by Freepik.