It’s a matter of finding out how your life resembles the diagnostic criteria for ADHD. It’s not scary.
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When a person’s getting a diagnosis about ADHD, it’s important, first of all, to find out that the person who’s going to do the evaluation for you has some expertise in ADHD. Not everybody does. There are some physicians, you know, both general practice docs and pediatricians, who are really quite good and there are a number of others who just haven’t had much training to do that specific thing. The same thing is true of psychologists and also of psychiatrists.
The critical element of an evaluation – the diagnostic evaluation for ADHD – has to do with finding out to what extent does the person’s day-to-day operation get impaired because of symptoms related to ADHD. There’s a video that I did a number of years ago which is still on YouTube and which is available for free. It’s Thomas E. Brown, Ph.D. and it’s just called “What is ADHD?” And it’s had about eight million views so far, and a number of people have said that they find that’s a good concise description of at least the way I think about ADHD.
But the thing that I’m interested in when I’m talking with anyone – the first thing I usually do is just say, “Can you tell me a little bit about how you decided to come see me?” because often there’s some very specific things that people have noticed about themselves. Sometimes it’s a matter of a parent who was there for an evaluation of their kid and was sitting there listening to the doctor and asked the questions about how their kid’s functioning. And, you know, some of them will be saying after they’ve been through the list, “You know, I’ve had exactly those same problems most of my life.”
The elements that I think are essential are first of all, find out what the presenting problem is. Secondly, get some sense of what problems the person is already aware of that they think might somehow be related to ADHD. And then I usually will ask them to do a couple of standardized measures. I’ll ask them, for example, about how they do with their ability to sort of keep things in mind when they’re reading something. Do they find often that they read it and then turn the page and find they can’t remember what they just read on the previous page? Or do they often find themselves walking into a room and then scratching their head wondering what the hell did I come in here for? And things like that which are sort of tip-offs to the fact that working memory is a problem. With people who have ADD, we don’t very often see the problems of long-term memory being difficult. The problem that’s more common is short-term working memory.
It’s the kind of thing you depend on, for example, if you’re going into the other room to get something and then you’re standing there scratching your head and wondering what the hell did I come here for? It’s the kind of thing that you find sometimes that the students complain about. They’ll be in class. The teacher asks the question and somebody else gets called on first. You have to wait while the teacher gets the answer from the other person, and then the teacher comes back and says, “What were you going to say?” “Like totally cool, it’s not like I’ve forgotten what I was going to say. What was the question again?” Or they will read something; they’ll understand it perfectly well at the moment that they read it, and then a couple of minutes later, they’ve turned onto another page and realize they haven’t got the foggiest idea of what they just read. You know, it’s memory difficulties in short-term working memory. Often people with ADD have pretty good memory for things from a long time ago, but not such good memory for things that just happened a few minutes ago.
When I do evaluations, I use standardized measurements for short-term working memory. It only takes a few minutes. I’ve got a couple of specific stories that we’ve got norms for. So I’ll say, “I’m going to read these two stories – each is just a paragraph. Please listen carefully and then after I finish reading it, I’m going to ask you if you would please tell me as close to the same words as possible. Not a summary, but as close to the same words as possible what you just heard.” And then do that for the first story, and then do it for the second story, and I do numbers forward and backwards, as well. It takes just about 10 – 15 minutes.
And then when we get to the completion of those three elements of it, I’ll say, “I’d like to take a minute now to go back to those two stories I read to you. Would you tell me now what you can still remember of each of those stories?” And there’s a scoring system for it and you can sort of see how this person stacks up relative to how other people their age stack up.
So a standardized measure of short-term working memory is one element of it. And then another thing that I think is helpful is to use one of the standardized and normed rating scales that’s appropriate for the age of the person that you’re talking to. There are, you know, rating scales for ADHD that Keith Connors has published for various age groups. I’ve published them. Russ Barkley has published them. And then you’ve got the BRIEF, which is widely used with adults and with kids. And then also there’s the BASC, which is used in a lot of school systems.
So any one of those normed rating scales that has a long list of symptoms related to ADHD. It’s not just the symptoms that are listed in the DSM criteria for ADHD – it’s a broader package – and they’re normed. So what you’re going to do is, you know…usually it’s like zero, one, two, three scoring or something like that. And then you can run it through the computer and see how the answers the person has given fit with what we know about people their age who are responding to the same scale. And that’s the benefit of the normed scale to be able to talk about it.
So, you know, the rating scale. We also certainly want to go over the DSM criteria and see item by item. And you can pick up a lot of that just by listening to the person as they tell you a little bit about what the problems were that they came in with in the first place. And then the standardized memory test, and then the standardized rating scale for ADD or ADHD and executive function, and then the DSM criteria.
So the part of the task of evaluation is education to help people understand what is this disorder that we call ADD or ADHD and how do you get it? And then the other question that I usually include when I’m talking with people is, you know, what can you do about it?
And I think it’s important for people to understand the first, most important, thing you can get out of an evaluation is a clear understanding of what ADHD is. And I feel like that teaching component is important for what I need to do. And then the other thing I want to ask about in an evaluation is what other problems do they have that might be related to it.
So those are sort of a long-winded way of saying it, but those are the elements that I usually think about as important for being able to do a decent evaluation of ADHD.
About the speaker
Thomas E. Brown earned his PhD in Clinical Psychology at Yale University and served on the Yale faculty for 25 years. He is now Director of the Brown Clinic for Attention and Related Disorders in Manhattan Beach, CA, and Clinical Professor of Psychiatry and Neuroscience at the University of California Riverside School of Medicine. He is an elected Fellow of the American Psychological Association, and has published numerous articles and seven books on ADHD. His website is www.BrownADHDclinic.com