The Assessment of ADHD: Finding out what it isn’t, to know what it is. Most people or those w/ loved ones that have attention problems assume that ADHD is the cause. Attention is found in almost every mental and many medical conditions. The term attention problems is too vague, similar to someone saying ”I’m having car trouble" e.g., flat tire, broken timing belt, is the wheel falling off? Filling out a checklist of ADHD related symptoms can cause a lot of false positive results. See #1, most if not all conditions have attentional dysfunction, especially AUTISM. Medications for ADHD can make someone that does not have the disorder improve cognitive functions. It wakes up the part of the brain that is underactive, underdeveloped, or slowing in ADHD Can be abused, can cause side effects, and may not even be necessary or may not alleviate the most important dysfunction, adaptive dysfunction, functional impairments, academic underachievement/failure. Methylphenidate slows growth by about 1 to 1.5 cm per year. Catch-up growth usually occurs during a 2-year period after methylphenidate withdrawal.  Medication is not a panacea, it sets the stage for optimal brain functions, does not cause a comprehensive behavioral change. Importance of life coaches ABA’s, therapists. Gerard Chambers Psy.D., Ph.D. PSY#23778 Clinical Neuropsychologist

WHY ASSESS ADHD? What is the most obvious diagnosis? [Not a trick question]. Inattention Poor productivity (amount) Executive dysfunction Substandard task completion (quality) Job/academic failure (4D’s) ANSWER? ADHD is a diagnosis of exclusion: What about Alice in Wonderland? [Comorbidity] The 5-11% Continuum What is the difference between symptoms and a disorder? Everyone has symptoms. Distress, Dysfunction, Deviance, and Dangerousness What do I see when I see this vignette, depending upon age….. Schizophrenia, depression, anxiety, panic disorder, generalized anxiety disorder, prodromal psychosis, post concussion syndrome, FTD dementia, medical conditions such as diabetes, MS, OSA, thyroid condition, sleep disorder, bipolar disorder, Autism, etc. etc. etc. A diagnosis of exclusion: diagnosis made by eliminating other possible causes of the symptoms of the disorder. 3-5% Prevalence rate Comorbidity of ADHD: Many adults with ADHD also have co-occurring psychiatric disorders, including anxiety (47%), mood (38%), impulse control (20%), and substance use disorders (SUD, 15%) Adults with ADHD are more likely than children to have one or more anxiety disorders, SUD, personality disorder, and social phobia, but children are more likely to have comorbid oppositional disorder and separation anxiety. Conduct disorder is the most common co occurring diagnosis with ADHD. Discuss frontal lobe mass continuum. 5%-11% ASPD What this means is that treating the comorbid condition is essential, and if ADHD remains, it was there to begin with, if the diagnostic criteria are no linger met, there was never any ADHD. Some physicians use the Alice in Wonderland technique. This is a phrase I use when doctors see a symptom, and treat each symptom with a pill. One pill makes you larger, one pill makes you small, and the one that mother gives you don’t do anything at all….(OTC or fad homeopathic medications do not work consistently, not regulated standardized). When you see things on TV about medications, its not the medication that is bad….it is the diagnosis that is bad. Also, medications do not help you to clean your room, to perform tasks more efficiently, to manage your time and/or

ADHD TESTING CPT’s Gold Standard-Physiological Measure Idiosyncratic, no consensus on how much testing and what testing is needed. [Sort of like linguine with clam sauce]-[Everyone has their own recipe]. Malingering Case of the ADHD football player Case of the ADHD/Dyspraxia/Stutter Malingering in the post secondary environment: Suhr et al. (2008) 31% of ADHD cases (N = 85) Sullivan et al. (2007) 24.5% of ADHD Alfano & Boone (2007) 31% of ADHD/LD Similar to mTBI in a medicolegal situation