Psychological Services

Real ADD: Use of Testing and Evaluation for Diagnosis

Self report measures; or the affected person’s own description of their symptoms are considered field as the “gold standard” or widely accepted method to diagnose the three subtypes of ADHD. The problem with relying so heavily on self-report measures is that for any symptom, ten diagnostic reasons can be given for the presence of that symptom. Only one would apply strictly to an ADHD diagnosis. We refer to the “Real ADD” as ADHD Inattentive Subtype.

For example, let’s take the symptom, “easily distracted”. What are some possible disorders that could create that problem? Stress, low blood sugar, insomnia, sleep apnea, hypothyroidism, cardiovascular disease, dementia, brain Injury, sleep deprivation, post traumatic stress disorder, pain and ADD, to name a few possibilities. How do we know this symptom is a result of ADD? Through careful neuropsychological testing we achieve the most accurate diagnosis. ADD is a genetic biochemical disorder most accurately detected using tests that measure brain functioning.

We have been testing for ADD symptoms for 20 plus years at United Psychological Services. Our evaluation consists of a specific battery of paper and pencil tests geared toward different age groups (5 to 8 years, 9 to 14 years, and 15 years and up). Our ADD testing takes 1 ½ to 2 hours and is well tolerated by most. Testing accurately assesses symptoms of thinking and processing speed, distractibility, information processing and visual spatial problems.

We have pinpointed a specific pattern repeated over and over in the testing when there is a genetic attention disorder present. That pattern is seen in children as young as five years and as old as eighty years. That pattern has been seen repeatedly in the same person when re-tested five, ten or even fifteen years later. The pattern does not change. This recognizable pattern is the cornerstone of our diagnostic assessment for ADD, built on years of experience. It leads to the remarkable accuracy that we can achieve. Research in other parts of the country has supported the accuracy of our testing methods and outcomes.

We use self-report measures as confirmation of ADD symptoms to make a final diagnosis of ADD.

Using neuropsychological testing allows us the advantage of seeing the potential for other disorders in addition to or instead of ADD. A child or adult may show the pattern of ADD symptoms; however there may also be suspected memory problems or deficits beyond that of a genetic attention disorder. In that case, we would complete memory testing, or testing of the frontal processes, visual perceptual, visual spatial or language testing to identify other disorders that are making the ADD symptoms more severe. In this manner we have found deficits that the medical field then diagnoses as related to sleep apnea, cardiovascular disease, different types of dementia, brain injury, seizure disorder etc. None of which are the actual problem.

Recently a sixteen year old returned to our facility for re-testing. He was still struggling in school despite taking medication from the age of five years (when we originally diagnosed him). When he was tested at five years there was suspicion of something affecting him in addition to ADD. However he was a very bright young man and the secondary issue was not revealed . Re-evaluation by our neuropsychological staff confirmed the presence of ADD and his test results were actually quite similar. However on a measure (that he was too young previously to administer) there was evidence of possible memory problems. Specific testing of his memory, in addition to the ADD testing, proved that he actually had memory difficulties. There were sufficient symptoms to suggest possible sleep apnea and he was referred by our facility for a sleep study. The sleep study was positive for significant sleep apnea which was interfering with his sleep and oxygen levels. Research has shown that long term sleep apnea can lead to memory and learning problems. This is a good example of how powerful testing for ADD can be when using brain behavior neuropsychological testing to diagnose attention issues and also provide evidence of the potential for additional brain problems. The suspected problem was confirmed eleven years later. This young man had been on numerous medications and was still getting failing grades. The problem was more complex than anyone thought.

When you consider that recent research indicated that up to fifty percent of those diagnosed with ADHD have a complicating mood or anxiety disorder, it certainly points to the need for complete neuropsychological testing.