ADHD Assessments Level Up Wellness Group

ADHD Assessments

(Psychology & Occupational Therapy)
There is a lot of confusion and misinformation about Attention Deficit Hyperactivity Disorder (ADHD).

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Myths About ADHD

Only boys have ADHD and they will grow out of it.
Adults don’t have ADHD.
Your child behaves that way because you don’t discipline them or you’re a “bad” parent.
ADHD is over diagnosed.

What is ADHD

ADHD is a neurodevelopmental disorder that typically manifests during childhood. The symptoms of ADHD include inattention, impulsivity, and/or hyperactivity. Individuals with ADHD may have difficulty paying attention, controlling impulsive behaviors, or they may be excessively active. There are three types of ADHD: predominantly inattentive type, predominantly hyperactive-impulsive type, and combined type. Individuals with the predominantly inattentive type of ADHD may have difficulty paying attention or be easily distracted. Those with the predominantly hyperactive-impulsive type may be excessively active or have difficulty controlling impulsive behaviors. Those with the combined type of ADHD exhibit symptoms of both inattention and hyperactivity-impulsivity.

Gender Differences

Boys are often more frequently diagnosed with ADHD, typically displaying externalized symptoms like hyperactivity and impulsiveness. In contrast, girls with ADHD may exhibit more internalized symptoms, such as inattentiveness and daydreaming, which can sometimes be overlooked or misinterpreted as simply being quiet or shy. Consequently, ADHD in girls might be underdiagnosed or diagnosed later than in boys.

ADHD and Sensory Struggles

Individuals with ADHD often experience sensory sensitivities, making them more reactive to environmental stimuli. This can manifest as being easily overwhelmed by loud noises, bright lights, or tactile sensations, intertwining ADHD symptoms with sensory processing challenges.

ADHD & Autism

ADHD and Autism, while distinct disorders, often share overlapping symptoms such as attention challenges and sensory sensitivities. It's not uncommon for an individual to be diagnosed with both, reflecting the complexities of neurodevelopmental conditions.

Untreated ADHD

Untreated ADHD can lead to a range of life challenges, including academic difficulties, strained relationships, lower self-esteem, depression, anxiety, and an increased risk of accidents. Early intervention and management can significantly improve outcomes and quality of life.

ADHD & Women

Many women with ADHD go undiagnosed until adulthood. Their symptoms, often characterized by inattentiveness rather than hyperactivity, can be misattributed to anxiety, mood disorders, or simply being labeled as "daydreamers." This late diagnosis can delay essential support and understanding, potentially impacting self-esteem, mental health, and life success.

ADHD Assessment

It's crucial to distinguish ADHD (Attention-Deficit/Hyperactivity Disorder) from other diagnoses for several key reasons:

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ADHD is experienced by both males and females and isn’t caused by bad or lazy parenting.

ADHD presents different in girls than in boys, as the symptoms are different.

ADHD is a complex neurobiological condition caused by brain differences.

“It is a lifespan disorder with the majority of children with ADHD continuing to struggle with symptoms as adults. ADHD also runs in families with a heritability chance of 57% for a child if a parent has ADHD, and a 70%–80% chance for a twin if the other twin has ADHD (Barkley 2015)”- CHADD Website.

If you have ADHD as an adult, you will have also had it as a child, although it’s often not detected until adulthood.

The signs are usually there from an early age – from comments in school

reports about getting easily distracted to struggles with romantic and social
relationships. These things may have impaired your life, prompting you to
perform inconsistently and struggle to keep jobs.

You might find it difficult to complete tasks, get upset easily over minor issues, and regularly experience intense feelings of frustration, guilt or blame.

You may have developed strategies to manage your daily challenges, but

this can be an extremely exhausting experience. The good news is, there are
things you can do to take control, regulate your emotions, and move forward
with your life.

Untreated ADHD can lead to anxiety and depression.

“Possible explanations for increased diagnostic rates include improved awareness about ADHD among healthcare practitioners and parents, more screenings by pediatricians and other primary care givers, decreased stigma about ADHD, availability of better treatment options, and more cases arising from suspected environmental causes such prenatal exposure to toxins or high blood lead levels.” CHADD

What are Executive Functions?

Executive functioning skills weaknesses are often present in individual with ADHD. Dr. Russell Barkley is an research and expert in the field of ADHD.

Common Attention Deficit Hyperactive Disorder Symptoms (ADHD)

Steps of an ADHD Assessment

STEP 1: INITIAL CONSULTATION

An initial consultation is carried out with one of our psychologists. This consultation will go through a complete developmental and medical history and is completed over the phone.

ADHD is a developmental disorder therefore in order to be diagnosed, a history of ADHD symptoms needs to be confirmed prior to the age of 12 years. Hence a complete history of development needs to be understood to ascertain whether the issues are developmental ADHD, or there is another cause behind the attention concerns (which has made attention problems arise later in life).

Concerns will be discussed regarding the following areas:

Attention skills
Executive planning and organisation
Vocational skills (adult)
School concerns & learning issues(child)
Social development & social skills
Learning skills & academic history
Psychological state & history
Behavioural concerns
Sleep

Energy levels & fatigue
Visual skills
Hearing
Motor skills & development
Language skills & development
Sensory processing
Medical history & neurological injury
Nutrition & digestive concerns

At this stage we will determine what formal ADHD assessment is going to be required. All assessments are individually designed according to your areas of concern, however we do have a core ADHD battery that we will perform (see below) We do all the formal processing assessments at our centre, if issues are noted with a potential sleep disorder, a hearing issue or other health issues such as anaemia, you may be referred back to your family doctor to rule out these problems.

STEP 2: FORMAL ASSESSMENT

Part A – Psychology

Diagnostic and Statistical Manual (DSM-5 screening questionnaires)

In order for ADHD to be even considered as a diagnosis according to the international benchmark of diagnosis (DMS-5), a minimum of 6 criteria for inattention symptoms &/or 6 criteria for hyperactive/impulsive symptoms need to be met, in TWO OR MORE areas (e.g.., home, school etc). As part of every assessment, we screen for ADHD with various rating questionnaires from different people.

Preschool: For preschoolers, we obtain questionnaires from both the parents & preschool teachers. They cover not only the ADHD criteria but also other emotional, behavioural and social issues. They also cover the criteria for Autism Spectrum.

School-age: For school-aged children, we obtain both parent and teacher ratings. these include not only ADHD ratings but also a comprehensive screening of co-morbid disorders such as depression, anxiety disorders, oppositional defiant disorder, autism spectrum. We also have a comprehensive screening of executive functioning. Where applicable we also have the student complete self-ratings.

Adult: For adults we have them complete both adult ADHD rating scales as well as ratings of executive functioning. Where the patient feels comfortable, we also like to have another person rate the individual.

Attention testing (ages 5-adult: note the precise tests differ by age):

Visual selective attention
Auditory sustained attention
Visual sustained attention
Switching attention
Divided attention

Impulse control (to auditory information)
Impulse control (to visual information)
Visual attention span
Auditory attention span

Executive Functioning:

Planning (open-ended task)
Planning (sequential task)
Time management

Preservation
Strategy generation

Learning/Academic Assessment:

It is important for learning/academic assessments to be completed as part of an ADHD assessment. ADHD is the most common neurobiological disorder that exists with a learning disability. “ADHD affects between 5-12% of the population or about 1 or 2 students in every classroom. ADHD is the most common disorder that co-exists with learning disabilities, but is not considered a learning disability. Many individuals who have ADHD also have learning disabilities, so assessment for LDs is important if there are academic difficulties.”

Memory (ADULTS):

If issues are noted with significant levels of memory problems, formal memory testing may be recommended. Most of the time issues with memory are more related to issues with attention processing and encoding of the information, rather than true memory retrieval. That is, the information was never properly laid down in memory stores in the first place. However, for people who are highly forgetful the following tests may also be recommended: Visual immediate memory (memory encoding), Verbal immediate memory (memory encoding), Visual delayed memory (retrieval), Verbal delayed memory (retrieval), Visual recognition memory (retrieval vs encoding), Verbal recognition memory (retrieval vs encoding).

Part B – Occupational Therapy Assessment (Adult & Child)

Most ADHD assessment do not include an understanding of sensory processing, which can be a disservice to those who have ADHD. Our assessments our different. Our occupational therapist (OT’s). are trained in assessing and provided interventions for ADHD and various areas where indivisuals may struggle.

“Sensory processing disorders are impairments in responding to sensory stimuli such as impairments in detection, modulation, or interpretation of stimuli. Sensory processing problems impact the responses of children to sensory events in daily life”( Ghanizadeh, 2011). Greater research and understand into sensory processing is demonstrate that the child/adult sensory experience can lead to emotional and behavioral struggles. It is important that the sensory world is evaluated to prevent or decrease the susceptibility to emotional and behavioural concerns.

Our OT’s will complete their own clinical interview with the parents, adult, and child to gather an understanding of how the client experience the sensory world. You may feel that some questions that are being asked are repetitive. Please remember that we are all trained differently we are looking and trying to understand behaviour from the lens that we are trained in.

Our OT’s will complete a formal assessment to determine the sensory experiences of the individual and provide tailored recommendations for each client in the report.

Level Up’s goal is to ensure that we are supporting each client in their journey to emotional health and well-being. Our team collaborates with the client and one another, to ensure recommendations support your growth and goals.

SUPPLEMENTAL ASSESSMENTS

(Not included in stated fee and is recommended on an as needed basis)

Visual processing (If required by the occupational therapist) (NOT included in overall fees)

If issues are noted with vision such as skipping lines when reading, having problems maintaining eye contact with visual tasks or other people, seeing fine details, missing social cues, struggling with remembering visual information etc., visual assessment will also be conducted.

Higher level visual processing will also be assessed including: Visual discrimination, Visual memory, Spatial skills, Figure ground, Form constancy and Visual closure.

Auditory processing (If required by the speech and language pathologist) (NOT included in overall fees):

If issues are mainly noted with attention when listening to information, particularly when there is background noise, the primary issue may be one of auditory processing rather than a true attention deficit. Hence tests of basic auditory processing, auditory figure ground will be screened. If issues are found referral to an audiologist may be recommended.

ADHD INFORMATION

ADHD is NOT a behavioural disorder. It is a medical disorder characterized by impacts on executive functioning skills.
ADHD is a developmental delay
Any area that is impacted by ADHD is usually 1/3 behind in comparison to age-related peers. For example, if your child struggles with emotional regulation and is 9, their emotional functioning is close to a 6-year-old. You need to adjust your response and expectations for that delay.
Approximately 20-60% of people with ADHD also have learning disabilities. This isn’t a reflection of an individual’s intelligence or capabilities; rather, it concerns how their brain processes information.

What is a Learning Disability?

Types of Learning Disabilities: The most common LDs that co-occur with ADHD include:

Dyslexia: Difficulty with accurate and/or fluent word recognition and by poor spelling and decoding abilities.
Dyscalculia: Difficulty in understanding numbers, learning how to manipulate numbers, and learning math facts.
Dysgraphia: Difficulty with handwriting and with putting thoughts on paper.
Language Processing Disorder: Difficulty in understanding specific language components, whether spoken or written.

The Overlapping Nature of ADHD and Sensory Issues:

Attention-Deficit/Hyperactivity Disorder (ADHD) and sensory processing challenges (often associated with Sensory Processing Disorder or SPD) can coexist in individuals, and there’s growing recognition of the overlaps and interplay between the two conditions. While they are distinct disorders, there are some shared symptoms and common therapeutic strategies.

Overlap in Symptoms:
- Hyperactivity and Sensory Seeking: Individuals with ADHD often exhibit hyperactive behaviors. Similarly, those with sensory processing challenges may display “sensory-seeking” behaviors—actions that help them obtain specific sensory input, such as spinning, touching objects, or making noises.
- Distractibility: Both ADHD and SPD individuals might seem easily distracted, but the reasons differ. ADHD individuals might be distracted due to difficulty sustaining attention, while SPD individuals might be overwhelmed by sensory stimuli.
- Impulsivity: Impulsiveness is a hallmark of ADHD, but those with sensory challenges might also appear impulsive when they react quickly (and sometimes inappropriately) to sensory input.
Differences in Root Causes:
- ADHD is primarily characterized by challenges with attention, impulsivity, and hyperactivity. Its origins are multifactorial, involving genetic, neurobiological, and environmental factors.
- Sensory Processing Disorder involves difficulties in how the brain processes sensory information. This can lead to over-responsiveness, under-responsiveness, or sensory-seeking behaviors.
Implications for Diagnosis:
- Given the overlap in behaviors, it’s essential to conduct thorough evaluations. A comprehensive assessment can help determine whether symptoms stem from ADHD, sensory processing challenges, or both.
- Professionals from different fields, such as psychologists and occupational therapists, might need to collaborate to achieve an accurate diagnosis.
Therapeutic Strategies:
- For ADHD, interventions might include behavioral therapy, environmental modifications, educational accommodations, and medication.
- For sensory processing challenges, occupational therapy is often the primary mode of intervention, with a focus on Sensory Integration Therapy. This involves tailored activities that help the individual respond more adaptively to sensory stimuli.
- It’s not uncommon for therapeutic strategies to overlap. For instance, creating a structured environment with clear routines can benefit both ADHD and SPD individuals.
Compounded Impacts:
- An individual with both ADHD and sensory processing challenges might experience amplified difficulties. For instance, the classroom setting, with its myriad sensory stimuli, can be particularly challenging for a child with both conditions.
- Social challenges can arise from misunderstandings or misinterpretations of the individual’s behaviors. Both ADHD and SPD individuals can struggle with forming peer relationships, and the combination of the two can exacerbate these challenges.

While ADHD and sensory processing challenges are distinct in terms of their root causes and primary characteristics, the interplay between the two can be significant. Understanding both conditions and their overlaps can lead to more effective interventions and support strategies.

Why Is a comprehensive assessment of my child or myself needed to just get an ADHD diagnosis?

Attention-Deficit/Hyperactivity Disorder (ADHD) is a complex neurodevelopmental condition characterized by persistent patterns of inattention, hyperactivity, and impulsivity. However, many of the symptoms of ADHD overlap with other mental health conditions, such as anxiety disorders, mood disorders, and learning disabilities. For instance, restlessness and difficulty concentrating could be indicative of both ADHD and anxiety. Likewise, impulsivity can be a feature of ADHD, bipolar disorder, and borderline personality disorder. Given this overlap, a superficial or limited assessment can lead to misdiagnosis, which can subsequently result in inappropriate treatment and management.

A comprehensive whole-person assessment is therefore crucial for several reasons:

Accurate Diagnosis: To ensure that the individual’s symptoms are accurately attributed to ADHD and not another coexisting condition, or vice versa. Misdiagnosis can lead to ineffective treatments and unaddressed underlying issues.
Understanding Comorbidities: Many individuals with ADHD also have other coexisting mental health conditions. Recognizing and addressing these comorbidities can improve overall treatment outcomes.
Tailored Interventions: An in-depth understanding of an individual’s unique symptom presentation and their life circumstances allows for personalized treatment plans that can be more effective than generic approaches.
Holistic Understanding: ADHD doesn’t just affect attention and activity levels; it can also impact self-esteem, interpersonal relationships, academic and work performance, and other aspects of daily life. A whole-person assessment provides a broader view of the individual’s experiences and challenges.
Avoiding Unnecessary Medication: Without a comprehensive assessment, there’s a risk of prescribing medication to those who might not need it or not prescribing it to those who do, which can have significant health and well-being implications.

In conclusion, given the symptom overlap between ADHD and other mental health conditions, as well as the multifaceted impact of ADHD on an individual’s life, a comprehensive whole-person assessment is essential. This approach ensures accurate diagnosis, effective treatment planning, and a more holistic understanding of the individual’s mental health landscape