In the article “The Building Blocks of a Good ADHD Diagnosis,” author Thomas Brown notes that ADHD should not be taken lightly and a complete diagnostic workup with multi-step procedures and a medical history review should be ordered and understood by the patient. An evaluation is recommended to be completed by an experienced licensed psychologist in order to provide the full evaluation and avoid a misdiagnosis.

In an ADHD evaluation, the clinician has several options to determine if your child has ADHD and would likely include the following steps or refer to another clinician who can provide a full psychological assessment that includes these steps.

Clinical interview: Find the root causes of ADHD by talking directly to the patient: “Why do you think you (or your child) may have ADHD?” “When? How do you notice it? When is this difficulty most evident? Has this pattern existed most of your child’s life, or is it something that started happening recently?”

Brown states that ”the clinician’s job is to identify patterns that may point to ADHD, or recognize that symptoms actually stem from something else.” Brown notions that a clinical review should cover:

• Challenges, symptoms

• Strengths, skills

• Family life, day-to-day stressors

• For children: school performance — grades, tests (including standardized test scores and how long they take to complete tests), whether or not they can complete homework on their own or need a parent’s help, etc.

• For adults: work performance — deadlines, productivity, etc.

• General health — including sleep and eating habits

• Family medical history, including other possible instances of ADHD

• Drug use (both prescribed and illicit)

• Previous evaluations (if any) and their results

• Related and comorbid conditions — mood disorders, anxiety, and learning disabilities are common in people with ADHD

DSM-V Symptom Review: Determine if a patient has the ADHD symptoms (at least 6 of the 9) listed in the Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition (DSM-V). 

Normed rating scales: These rating scales (Connors Scales, BASC, the Brown ADD Scales, or the Barkley scales) are used to see where a patient is at relative to others their age given their rated symptoms in various situations. Brown declares that “it is also often helpful for adults to have someone who knows them well complete a scale from their perspective.”

Standardized psychological assessments: There are many psychological tests that could help evaluate one’s reading, writing, and math skills that could help determine where one’s strengths and weaknesses lie and what could help. Sometimes ADHD is misdiagnosed if these assessments are not completed as there are other factors that affect focus and concentration, such as anxiety, depression, or learning disabilities. Brown states that “the vast majority of children with ADHD have at least one specific learning problem [which could] overlap genetically and in terms of functions like working memory. These tests include Woodcock-Johnson Test of Cognitive Abilities, Wechsler Individual Achievement Test (WIAT), Wechsler Intelligence Scale for Children (WISC-V).

Physical exam: Because ADHD-like symptoms are sometimes caused by internal medical problems such as thyroid conditions, physical exams ensure that a medical problem has not been overlooked and may be requested by the clinician.

In Brown’s opinion the following evaluation tools may be used in some cases to add to an ADHD assessment, however these are not known to be accurate tools for such an evaluation.

• Brain imaging: “ADHD is not a problem of brain structure, rather, it’s about communication within the networks of the brain” (Brown). However brain imaging may be helpful in providing Neurofeedback Treatment, which is a known treatment for ADHD symptoms.

• Online “reaction” tests: These tests dictate whether a subject has ADHD based on their ability to hit or retain from hitting a certain key every time a particular target comes into view. 

• Genetic testing: The testing of a few genes to see if they make up the genes in ADHD. 

ADHD Diagnosis Red Flags:

• Too quick to grab the prescription pad: When a clinician or doctor does not take their time to do a full evaluation but instead quickly prescribes a medication for ADHD.  

• Failure to include information from the school: When a clinician does not review a patient’s sense of how they function to the fullest by completing rating scales or interviewing closely related persons, teachers, or parents as part of the clinical interview.  

• Failure to use rating scales and psychological assessments: If a clinician does not decide to use rating scales and psychological assessments, then they will likely base their diagnosis of the patient’s symptoms on their personal opinion which can lead to a misdiagnosis. 

• Too fundamentalist about symptoms: If your clinician is too strict on the 6 symptom rule and neglects you from having the possibility of getting a prescribed medication to adhere to your ADHD because you only have 5 of the symptoms, then that is a red flag. 

• Saying, “Don’t worry, it’ll pass!” When your clinician dismisses you or your child’s concerns about ADHD symptoms that are disrupting your life and mental health.  

After the full assessment is completed a complete understanding of why the ADHD symptoms are present and what the next steps would be in managing the symptoms. A good report of the evaluation will provide specific recommendations for treatment along with an accurate diagnosis.

For more information on how Hilber Psychological Services can help you with understanding your or your children’s ADHD symptoms and the next steps for ADHD treatment, as well as connect you with experienced psychologists who can provide an evaluation, please contact us.

References

Brown, Thomas. “The Building Blocks of a Good ADHD Diagnosis.” Additude. 11, Oct.  2019. https://www.additudemag.com/how-to-get-diagnosed-for-adhd-ensuring-a-good-evaluation/

Mark Hyman MD is the Director of Cleveland Clinic’s Center for Functional Medicine, the Founder of The UltraWellness Center, and a ten-time #1 New York Times Bestselling author. At the peak of his career, he suffered a broken brain, causing him to turn into someone he no longer recognized. He felt like he suffered from depression, ADD, and dementia all at once. 

The epidemic of the broken brain is something you feel, hide, and fear. It is the leading cause of disability and effects 1.1 billion people around the world. 1 in 6 children, 1 in 2 elderly, and 1 in 4 people during their lifetime are effected by this epidemic. Mark Hyman MD created a docuseries, Broken Brain, to help transform your understanding of brain health. It is a series describing everything he learned on his journey to curing his broken brain, as well as diving in to the top brain disorders and learning why they happen and how to address their main root causes. This docuseries reveals what conditions like Alzheimer's, Dementia, ADHD, Autism, Depression, Anxiety, and Brain Fog have in common. Many root causes of brain disorders are outside of the brain. The rest of the body can play a huge part on mood, memory, attention, and behavior problems. 

Of all the highlights and benefits learned from this eight episode series, here are the top 5 take aways Mark Hyman MD and his team learned from the Broken Brain docuseries. 

1. The Gut-Brain Connection
According to Dr. Raphael Kellman, gut and brain expert, "Embryologically, the gut and the brain start out at the same point, and then one goes up and one goes down. When two cells start from the same place, they always retain a memory for each other. They’re constantly speaking to each other in so many different ways. They’re communicating messages to each other. These messages are part of a communication system that really outshines any type of communication system that we know of today with our modern technology." The gut is considered your second brain. Therefore, a healthy gut leads to a healthy brain. By keeping our intestines and microbiome healthy and clean, our brain will remain healthy. 

2. Brain Health is Connected to Blood Sugar
Blood sugar is related to a healthy brain, especially memory loss. Experts are calling Alzheimer's type 3 diabetes. Dr. Ann Hathaway states, "When your blood sugar is high, it pumps your insulin high, and insulin is inflammatory. Inflammation is a major factor in cognitive impairment and Alzheimer’s disease. Also, high blood sugar causes something called glycation, where the proteins throughout your body, including in your brain, get a sugar molecule added to them. That addition of a sugar molecule to a protein is damaging—that’s actual damage to that particular molecule in your brain." It is important to keep your blood sugar low so that no additional sugar molecules damage your brain. 

3. The Thyroid and Your Brain
An unhealthy thyroid can cause anxiety, depression, brain fog, and many other mental health disorders. Dr. Izabella Wentz suggests, "For people with Hashimoto’s and for thyroid disease, focus on eating a whole-food-based diet that’s minimally processed. I’ve seen the most benefit from patients going on a Paleo diet, as well as the Autoimmune Paleo Diet. We see symptoms like headaches, panic attacks, palpitations, weight gain, fatigue, all these symptoms begin to melt away when we get rid of the reactive foods and focus on eating organic, wild-caught, and real foods." 

4. The Role of Fats in Brain Health
A low-fat diet is not always the answer. By avoiding all fats, we avoid the good fats. Dr. John Ratey states "omega-3 fatty acids are perhaps as good a treatment for things like bipolar illness as are some of our bipolar drugs. With that came a whole lot of research looking at omega-3s as a way to treat mood, anxiety, ADD, and autism. It has a positive effect on all of those pervasive problems. Plus, it’s great for the heart, skin, bones, the connections in our body, and also treats arthritis and the like.” Don't cheat yourself of the fats your body and brain need to stay healthy.

5. The Role of Community in Brain Health
One of the biggest take aways these experts had from this docuseries is the importance of community. According to John Ratey, "real connection is vital, and I call this vitamin O—vitamin oxytocin. Oxytocin is the thing that mammals get when they’re in a community, touching one another, hugging, and they’re sitting down eating together. That sharing, that social bonding that happens, that glue that cements us together is really important." As we grow older, it is important to remember to take our prescribed medicine, get exercise, but most importantly stay social and connected to your community. 

Watch the entire 8 episode docuseries for free to learn more about your brain health. Watch episode 4 to learn more about ADHD and autism. Watch episode 5 to learn more about anxiety and depression.

If you have questions about these services and how they can affect you or your child or would like to schedule an appointment, please contact us. For more information on therapy, visit FAQ at Hilber Psychological Services

Written by Allison Parker and Tanya L. Hilber, PsyD

Reference: Hyman, Mark. “5 Things We Learned from the Broken Brain Docuseries.” Dr. Mark Hyman, Hyman Digital, 5 Jan. 2018, drhyman.com/blog/2017/10/27/5-things-learned-broken-brain-docuseries/.

Last week in the article "Parenting 101: Discipline Part 1," we discussed the foundation for parents to create an effective discipline plan. Today, we will discuss the implementation plan of a parenting technique known as “1-2-3 Magic" based on the work of psychologist Thomas W Phelan. It is intended for the parenting of children ages 2-12 years old. This method is best used for “stop” behaviors, such as tantrums, arguing, yelling, whining, and/or teasing. 1-2-3 is based on a counting system used to stop behaviors. It should be done as the following:

• 1 is the first warning,
• 2 is the second warning,
• and 3 is the consequence.

It is important for parents to wait approximately 5 seconds between counting. This allows the opportunity for the child to correct his or her behavior.

Choosing Consequences: Remember to acknowledge your child’s age and developmental level when applying 1-2-3 Magic. For example, older children may have the choice between consequences, such as having a time-out or losing a privilege. If the child does not pick one, the parent may choose for the child. Consequences must be clear, concise, and specific. Listed below are some examples of possible consequences and tips for implementing them.

Time-outs:

• The time-out should be approximately 1 minute for every year of the child’s age. For example, a 5 year old should have a 5 minute time-out, while a 3 year old should have a 3 minute time-out.
• Younger children should be escorted to time-out without showing emotion or speaking
• Technology such as smartphones, television, video games, etc. should not be accessible while the child is in time-out
• The location of the time-out should be in a different room than where the parent will be (remember, children look for emotional reactivity in their parents, so by being separated children are not granted that power)
• If the child wrecks or destroys the room during a time-out, it is important as a parent not to react. Simply let the child live in that space. After a few peaceful days, the parent may go and clean the room if necessary.
• If the child is 4 years old or older, the time-out begins after the child’s temper tantrum is over.

Loss of privilege:

• When choosing the loss of a privilege, it is important for the child to lose something meaningful. It will have no effect, for example, if a parent takes away a toy the child no longer plays with.
• Some examples may include: Loss of going to a friend’s house, or the loss of time on electronics, such as the television, iPad, or video game consoles

In situations in which a child continues to have a temper tantrum and/or refuses to calm down, parents may “reverse” the timeout by simply walking out of the room.

For children who tend to try and test their parents when first starting 1-2-3 Magic, most will become compliant within 7-10 days. As a reminder, it is important for parents not to express too much emotion and not to talk too much during discipline.

Over time, the family will adapt to this new system. Parents may want to consider that when things go well in the family, they may “slip off” the wagon of parenting. It’s vital to stay consistent in parenting, even during long spans of time when things are going well.

One final tip to remember is that discipline is less about trying to “punish” a child or make the child feel bad, and more about teaching the child the difference between good behavior and bad behavior. As parents, it is important to prepare your child to be a functional adult in the real world where there are real consequences based on the choices being made.

There may be times when, as a parent, you could use extra support. If you feel that you would like to begin therapy to further explore parenting options or caregiver stress, please contact us at Hilber Psychological Services to set up an appointment. If you have any general questions about therapy, you can visit FAQ at Hilber Psychological Services.

As mentioned in a previous news post by Dr. Filizetti, Attention Deficit/Hyperactivity Disorder (ADHD) may "look" different in adults when compared to children. We know that ADHD persists into adulthood; however, it tends to affect adults differently than children. When we think of childhood ADHD, we often picture the hyperactive child that cannot sit still and struggles to focus in class. However, hyperactivity remits in adulthood, and is apt to interfere with ones performance in different ways. For example, adults with ADHD may be at higher risk for driving difficulties or speeding through traffic.  Adults may also struggle with reading comprehension or sustained attention while reading.

As required for a diagnosis of childhood ADHD, symptoms must be evident in multiple settings, and interfere with the person’s ability to succeed in a variety of areas. In children, ADHD interferes with  performance at school, home, and sports. However, adult ADHD may impact relationships, college  coursework, and/or ones ability to succeed in the workplace.

Adult ADHD: Assessment and Treatment

As with childhood ADHD, adult ADHD is evaluated and diagnosed by a psychologist. When you meet with the psychologist they will likely ask you about your personal history, observe you behaviorally, and administer a variety of tests to assess whether or not you meet criteria for ADHD. Upon completing an ADHD evaluation, the evaluator will recommend various types of treatments that best fit your individual needs. Treatment for adult ADHD includes: Neurofeedback, Biofeedback, Cognitive-Behavioral Therapy and/or medication management.

For more information about assessment or treatment of ADHD, feel free to contact Dr. Filizetti. Written by Dr. Kirstin Filizetti.