Attention-Deficit Hyperactivity Disorder

My child’s school has indicated that my child may have an attention deficit issue — what is the right way to proceed?

Renay Gartner, Psy.D.:  Neuropsychological assessment is a wonderful tool to help determine if your child really does have an attentional issue, and we frequently see children for this concern. For the first step, we recommend calling our registration department and asking to speak with one of the psychologists on the Assessment Team. It would also be beneficial to share that your child’s school indicated potential attention issues, as this will help direct you to our psychologists that have specialties in this area.

My school has recommended that we get our child tested. What is the value of testing? And how long does it take? What sort of testing is it?

RG:  Testing offers extremely detailed information regarding your child’s attentional skills, and also how they may relate to other areas of functioning. For example, we would be able to see how a child’s memory skills may be impacted by attention, how their executive functioning or organization could be affected, or even its impact on their behavior and academic progress in the classroom environment.

Testing usually takes about a day and half in our downtown office. After testing is complete, it typically takes about 4-6 weeks for us to finish our comprehensive report, and at that point we have a feedback session to go over our results in detail, as well as discuss recommendations.

Testing is a combination of paper and pencil, interviews, puzzles and even digitally-based testing. We pride our program on only utilizing the latest and most up-to-date tests/methods that are available on the market.

Will this testing help identify the problem?

RG:  Absolutely! In most cases, we determine where your child may be struggling and are then able to offer constructive solutions on how to work on these areas. We may also ask for school feedback throughout the testing process in order to integrate all areas of your child’s life, and better understand where/how the problems manifest.

And once we know the problem, can it be fixed?

RG:  After we complete testing, we ALWAYS offer recommendations to help with problem areas. We work with each family to find the best programs, interventions, specialists, etc. that fit within their individualized needs. Our goal is to make recommendations as accessible as possible.

What happens in the brain of a child with attention deficit disorder?

Smita Gautam, M.D.:  The brain is wired differently in people with attention deficit disorders. Typically, when we start focusing on a task the background activity in the brain (called the default mode network) quiets down so that the attentional circuits of the brain can function properly. This does not happen in kids with attention deficit disorder. So, the child is easily distracted by all sorts of stimuli which makes focusing on any topic very hard. Furthermore, the brain part (called the prefrontal cortex) that helps in noticing and correcting the distraction, is not well developed in kids with ADHD. As a result, distractibility remains unchecked. This same brain part is also important in other higher-level functions like time management, planning, prioritization and organization. So, a child with ADHD will typically have difficulties in tasks that require these skills.

How does the Neuropsychological Assessment team work with psychiatry?

RG/SG:  On the neuropsychological assessment end, psychiatry is a huge benefit for our children and parents, especially for those who are newly diagnosed and need a referral for medication and integrative care. On many occasions, parents learn about their child’s specific struggles for the first time through assessment, leading to the need to help them determine the correct interventions and level of care.

Psychiatry can be extremely helpful in being open to answering questions from parents who are unsure what the psychiatric route would look like, would benefit from general education or specific questions answered and, of course, those who have a child with a complex profile of difficulties that require someone with a medical background.

On the reverse side, when the assessment team receives a referral from psychiatry, it is extremely helpful to know what has already been tried, a history of presenting problems and what is currently being considered based on their presentation.

It is often very helpful for families after meeting with both assessment and psychiatry, with regard to advocating for their needs in the school setting, as we are able to present overall findings and request for additional services for the child at school.

For the diagnosis and treatment of ADHD, a neuropsychological assessment is not required. But in order to determine if there are also learning disabilities, language struggles, behavioral concerns, etc. that are present and may impede a child’s progress, we believe it is beneficial to also do a neuropsychological assessment. There are often additional struggles that a child may experience along with ADHD.

How do I know if my child needs to see a psychiatrist? 

SG:  If your child has difficulty focusing, and demonstrates problems with time management, as well as procrastination, and despite working on reminders and creating structure, the child is not thriving or these strategies are not changing behavior, then we would likely recommend your child should see a psychiatrist.

Should a visit to the psychiatrist happen before or after the assessment? 

SG:  We recommend the combination of both a neuropsychological assessment and a psychiatric evaluation because both are useful in helping to understand and treat ADHD. The order in which they take place is not important, but both are great tools to help understand and determine the most appropriate treatment path for your child or adolescent. An assessment will help to uncover any learning disabilities, and other language and behavioral concerns that may be present which are common with a diagnosis of this kind.

Is medication the only option to treat attention deficit?

SG:  In addition to medication prescribed by a child and adolescent psychiatrist, there are two strategies that we believe are useful to a child with ADHD — several integrative psychological studies demonstrate that nutritional supplements can also help with ADHD. As with most supplements, these are not regulated by the FDC, in terms of content and dosage so it’s very tricky to determine what to take and in what quantity since there is no consistency. A second strategy which is not as effective as medication, but has been proven to be helpful is mindfulness as it is useful for establishing flexible attention pathways for the child. If mindfulness is adopted by schools, this can help provide the necessary training for the child, particularly if parents continue this effort at home

How frequently will my child have to go through an assessment or visit the psychiatrist?

SG:  Neuropsychological assessment is a testing process described above that does not get repeated — it’s one and done. However, if your child sees a psychiatrist and is prescribed with ADHD psychiatric medicine, they will need to be monitored continuously, particularly in the early stages of treatment. In the early stages of receiving the drug, we monitor the child’s progress at least monthly and then, once the child is stable, every two or three months.

Will my child need medication forever?

SG:  As the child grows, things change with the brain’s development. About a third of all children will not need medication as their brain develops normally and things settle down. At least a third will probably need some medication, and another third will worsen and require additional help as they mature into adulthood. But there are also proven coaching strategies that are useful for this maturing group, that focus on strengths rather than weaknesses and can help enormously to teach young adults and college age students to cope and manage their diagnosis.

Are there sources for additional information? 

Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD) has an excellent website with more information on ADHD. ADHD Coaches Organization provides a valuable website for ADHD coaching which is more useful for college students and young adults. Both of these organizations are nonprofits.