How to know if your child has ADHD or learning differences: the importance of an accurate diagnosis.

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In this 10-part series, which runs every other month through 2008 and 2009, EP will explore Attention Deficit Hyperactivity Disorder (ADHD).

Parents often are left wondering how to determine if their child's behaviors are "normal" or possibly diagnostic of ADHD or other problems. Professionals begin their investigation by asking if a child often:

* fails to give close attention to details or makes careless mistakes;

* has difficulty sustaining attention;

* does not seem to listen when spoken to directly;

* does not follow through;

* has difficulty organizing;

* often avoids tasks requiring sustained effort;

* loses things;

* is easily distracted;

* is forgetful;

* fidgets;

* leaves his or her seat;

* runs or climbs excessively;

* has difficulty being quiet;

* talks excessively;

* blurts out answers before questions have been completed;

* has difficulty awaiting turn; or

* interrupts others.

A parent's response to the above questions is just the beginning. This checklist is not diagnostic in and of itself, since a professional evaluation also includes an extensive personal and family history including developmental, medical, academic, social, and psychological issues as well as several checklists and some form of objective data.

General Guidelines for When Parents Should Consider ADHD

When a child's inattention or physical symptoms are consistent over time and are significantly different than his/her peers including:

* Great difficulty remaining seated

* Many excuses to go to the nurse/ bathroom

* Intolerance of boredom

* Always physically doing something as a way to self stimulate, such as playing with an object, picking, moving, adjusting him/herself in the seat, taking shoes on and off, etc. How "inattentive" does a child have to be before he or she warrants an evaluation?

* Trust the judgment of experienced teachers.

* If they are inattentive more than peers, it warrants an evaluation. Be careful with girls; inattentiveness is often not recognized in girls as they are often able to hide their inattention better through social conditioning.

* Watch for careless errors on simple work when it is clear that the child is able to complete more complex work.

It is important for parents to be aware that ADHD is associated with an extremely high rate of co-occurring disorders and is frequently accompanied by a learning difference. Psychiatric difficulties include major affective disorders (depression or bipolar disorder), anxiety disorder, obsessive-compulsive disorder, and Tourette syndrome. In addition, language disorders, reading disorders, and reduced processing speed are frequently associated with ADHD. In one report, 45 percent of children with ADHD had at least one element of language impairment.

General Guidelines for When Parents Should Consider a Learning Difference

Look for delays in development like:

* Crawling, walking, or other motor skills, talking, toilet training 

* Extreme sensitivities to texture, sound, light, touch, or taste

By Theresa Lavoie, Ph.D. Notice if any of the following behaviors occur frequently like:

* Head banging, rocking back and forth

* Repetitive behaviors/fixations

Notice any difficulty with writing like:

* Trouble staying within lines

* Taking a long time to complete tasks

Notice any struggles with the following:

* Spelling

* Filtering out background noises

* Pronouncing words or names

Look for any difficulty in learning and remembering:

* Left and right or telling time

* How to read or write letters/numbers

Look for any social difficulties like:

* Inconsistent eye-contact

* Few or no friends

* Discomfort with affection

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What Should a Parent Do to Figure Out if a Child is Struggling with a Learning Difference Either with or without ADHD?

The answer is that a comprehensive neuropsychological evaluation is needed. This is necessary because there is no one test--such as a blood test, MRI, or brain scan--that can determine what a child's cognitive functioning is. A neuropsychological evaluation measures abilities on many standardized tests, which are then compared with an age-matched and sometimes "grade-matched" normative sample from the general population. This allows professionals to learn about a child's intelligence, working memory, learning skills, general organization, processing speed, language processing, word retrieval difficulties, visual spatial integration, motor skills, attention and more. It is important to know that one cognitive skill cannot be fully understood without a comprehensive assessment of the whole person's functioning.

Important Information about Neuropsychological Assessments

* A neuropsychological evaluation is not simply an assessment of final scores but a close examination of how one approaches tasks, why particular strategies are chosen, and ultimately why certain errors are made.

* An evaluation measures change over time by allowing professionals to chart progress and calculate levels of improvement or decline.

* It helps to understand strengths and weaknesses and provide a sense of how an individual learns optimally, which guides treatment specifically designed for the individual.

* Cognitive tests measure global intelligence, which allows professionals to determine general expectations for an individual.

* Memory functioning is assessed by evaluating short and long term memory and ability to recall verses and recognize material while comparing differences between types of information such as auditory vs. visual.

* Processing speed provides the opportunity to understand the speed at which a person completes various tasks from reading to complex standardized tasks.

* Language processing is assessed by evaluating expressive and receptive language skills, quality of verbal output, and word retrieval skills. Visual spatial processing and integration are assessed as well as motor skills.

* Attention and executive functioning are assessed by determining abilities in divided attention, sustained attention, visual and auditory attention, and attention for tasks that are simple and those that are more complex.

* The evaluation measures academic skills, considering skills such as spelling, phonological processing, reading decoding, reading comprehension, rate of reading vs accuracy, and math skills when completing calculations vs. word problems.

* Psychosocial functioning assesses emotional states and any psychiatric conditions that may be present as well as the effect of worry, anxiety, and/or depression on one's functioning.

By Theresa Lavoie, Ph.D.

Dr. Theresa Lavoie is the Director of Psychological Services for ADD Health and Wellness Centers, specializing in the holistic treatment of children and adults with ADHD and coexisting conditions. Previously, she has worked as a Clinical Psychologist and Neuropsychologist in private practice specializing in the diagnosis and treatment of ADHD and as a forensic expert witness, has co-authored a regular column in ADDitude Magazine, Kiwi Parenting Magazine, and lectures nationally on current topics in ADHD.