Attention Deficit/Hyperactivity Disorder

 

Both health care professionals and lay people have become increasingly aware of the prevalence of ADHD (formerly called ADD) in children and adults. However, the assessment tools that have been available have had certain limitations. Symptom checklists (i.e. The Conners and The Vanderbilt) are very helpful as screening instruments but one should not arrive at a diagnosis based on this type of information alone. This is because so many other disorders have shared symptoms with ADHD (i.e. depression, anxiety, oppositional defiant disorder, learning disabilities and some medical disorders).  Further, 80% of individuals with ADHD have at least one other coexisting disorder.  Consequently, a thorough diagnostic evaluation is essential.

 

Psychometric testing has been a common method of assessment for ADHD.  However, most of the tests which have been available, until recently, are time consuming to administer and therefore costly.  In addition, almost all of these tests were designed to measure other mental functions such as immediate memory, fine motor speed, visual perception and mental calculation skills. While these tests can be affected by concentration problems, they are not directly assessing attention and concentration.  Therefore, these tests are not very accurate.

 

In the last several years, much more sophisticated tests have been developed which are very sensitive and specifically measure concentration and impulse control without requiring other cognitive processing.  The two with the highest diagnostic accuracy are the Test of Variables of Attention (TOVA) and the IVA Continuous Performance Test.  These instruments have a 92% accuracy rate in identifying adults and children with ADHD. 

 

Further,  the TOVA and the IVA are designed for serial administrations in order to assess response to medication.  Research with these instruments has shown that either too little or too much medication will result in less than optimal symptom control and poor test perfromance.  By performing drug challenge administrations, it is possible to objectively assess the patient's response to medication and make adjustments accordingly.  Because these tests take less than an hour to administer, it is very cost effective.

 

Generally, the initial interview with Dr. Schuyler can identify whether there are any other possible disorders which might account for the patient’s presenting problems and an additional evaluation is performed if necessary. Otherwise, either the IVA or the TOVA are quite accurate in identifying ADHD in children and adults.