Overview

Attention Deficit-Hyperactivity Disorder (ADHD) is a common condition that affects children, adolescents and adults. ADHD can lead to problems in school (difficulty learning, poor grades and test scores, reprimands for poor behavior), making friends or sustaining relationships, difficulties in the workplace, a higher risk of motor vehicle accidents, and greater chance of smoking or substance abuse. Latest research studies in the United States estimate that close to 7% of children carry a diagnosis of ADHD. Unfortunately many children and adults are misdiagnosed, or remain undiagnosed for years.

About Attention-Deficit Hyperactivity Disorder

ADHD is diagnosed based upon a pattern of common behaviors (inattentiveness, hyperactivity, impulsivity), but the diagnosis is not dependent upon what is causing the undesirable behaviors. However, to diagnose someone with ADHD, it is necessary that these behaviors cause significant impairment in daily functioning, and that there is not another identifiable cause for these behavioral traits. Furthermore, in children, an ADHD diagnosis requires that the behaviors/symptoms are persistent for at least 6 months and should be observable in at least 2 settings such as at home and school. [There is some controversy whether or not symptoms of ADHD must be present before age seven.] When a clinician at CNNH evaluates your child for ADHD, they are looking for the presence and severity of specific behaviors. Such symptoms vary depending on which of the three ADHD types the child appears to have: inattentive, hyperactive-impulsive, or combination of both (“combined” type).

Symptoms and signs of inattentiveness include:

• Careless mistakes in schoolwork, work or other activities.
• Descriptions of poor focus, such as “daydreaming” “easily distracted” “drifting” “not paying attention”.
• Disorganized; poor time management. 

• Inability to initiate or complete homework or chores. 

• Trouble staying with a task, with shifting attention (not counting mesmerizing activities like TV or video games).
• Difficulty in following or following through with multistep directions or instructions. 

• Forgetfulness.
• Not listening when spoken to directly.
• Avoiding or disliking schoolwork or homework.

Symptoms and signs of hyperactivity and impulsivity include:

• Always on the go/very active without purpose (to be differentiated from an energetic child). 

• Difficulty staying seated (“fidgety” “restless”). 

• Excessive talking. 

• Easily frustrated. 

• Impatient (need to be first; must always be the winner; difficulty playing games by the rules).
• Interrupting; blurting out answers before the question is finished. 

• Not respectful of others' personal space. 

• Difficulties with social interactions with peers.

Our Comprehensive Assessment and Treatment Approach

At CNNH, we are interested not only in detailing and understanding a patient’s behavioral patterns, but also exploring for identifiable biological or neurological mechanisms causing ADHD. We also feel that ADHD is too often diagnosed based upon subjective information or biased observers. Thus, we employ a series of objective tests to confirm suspected cases of ADHD. To achieve these goals, we employ a multidisciplinary team consisting of Neurologists, Advanced Practice Nurses/Nurse Practitioners, Neuropsychologists, Developmental Psychologists, Board Certified Behavior Analysts, Music/Creative Arts Therapists, Cognitive Behavior Therapists and more, as well as advanced diagnostic technologies.

It is important to understand that certain conditions can mimic or cause the same symptoms of ADHD, such as undetected seizures (Epilepsy), sleep problems, thyroid or metabolic disorders, learning or intellectual disabilities, hearing problems, sudden life changes (such as a death in the family, move, divorce), mood disorders such as anxiety and depression, and more.

The first part of the evaluation process is completion of an extensive patient database and validated symptom questionnaires, which are then reviewed in conjunction with our clinicians, followed by a comprehensive physical and neurological examination looking for biological clues, causes or mimickers of ADHD. There are a number of additional tests that are done depending on the information from the initial intake, including:

• Objective computerized tests of attention and vigilance (QuotientTM ADHD System; Mindstreams).
• Neuropsychological and Psychoeducational testing for:
  • cognitive strengths and weaknesses;
  • identification of any learning disorders;
  • executive functioning (mental organization, problem solving, concentration, attention, abstract thinking, planning, inhibiting inappropriate actions and more);
  • various forms of memory capacities;
  • visual-spatial abilities;
  • academic achievement or learning disabilities (reading, writing, mathematics and more).
• Neurophysiological testing using Dense Array Electroencephalography (brain wave testing).
• Functional Behavior Analyses for determining if a behavior is from an identifiable cause such as attention, avoiding a task, or secondary gain;
• Direct observation, data collection and analyses of behaviors within the classroom or other settings by our behavior specialists.

Additional testing that might be recommended in select situations includes laboratory testing, electrocardiogram, sleep studies, imaging of the brain (MRI), testing for central auditory processing deficits, and specialized developmental optometric testing.

Depending on the results of our comprehensive evaluations and consensus from our multidisciplinary team, there are a number of therapeutic options that may benefit someone with ADHD. These choices MUST be individualized, as every type of treatment or therapy will depend upon a number of personalized factors for each patient. Some options for treatment include:

• First and foremost are therapies directed at any identifiable mechanism or mimicker of ADHD (for example, if there is a sleep or mood disorder, that should be treated first).
• Cognitive Behavioral Therapies (“psychotherapy” or “talk” therapy) for those with depression, anxiety, or other mood disorders, and/or to reduce stress.
• Educational Interventions.
• Behavioral management approaches.
• Cognitive remediation.

Finally, there is consideration of the use of medications for ADHD. Generally, the philosophy at CNNH is that medications are treatments and not cures for ADHD, but in many cases, particularly when educational and behavioral interventions have not been fully effective, adjunctive medication approaches are necessary to achieve success. Prior to prescribing medication, we will ask that baseline laboratory and electrocardiographic studies be completed, and the various medication choices and their potential side effects will be discussed. For all patients, whether receiving medications or not, ongoing follow-up visits are important to assess and monitor the effectiveness of treatments and to make any necessary adjustments.