What is ADHD?
Officially, ADHD is defined by 9 inattention criteria, and 9 agitation/hyperactivity criteria. These criteria are set out in the Diagnostic and Statistical Manual of Mental Disorders - 5th edition (DSM-5). Around 7% of children suffer from ADHD, and this proportion would be roughly the same across all countries, and probably even throughout all eras.
Neurologically, ADHD is underpinned by a delay in the maturation of the frontal areas of the brain. If we wanted to explain it simply, we could say that these areas should play a filtering role in the child's brain. A filter that enables :
- Filter out distractors around the child to enable him to concentrate on his work or on the teacher's explanations.
- Filter out intrusive and invasive thoughts that monopolize and drain attention
- Filter out the urge to get up, talk and move when sitting or being quiet is expected.
- Filter the intensity of emotional reactions such as joy, anger, pain and sadness.
Another term to explain this filtering role would be INHIBITION. The ADHD child lacks a filter, and therefore lacks inhibition. Inhibition enables self-control by blocking inappropriate reactions, or irrelevant thoughts, to make way for more appropriate and reflective behavior, as well as thoughts relevant to the task in hand.
in neuropsychology
Is ADHD for life?
Excellent news! Studies increasingly show that in more or less 50% of ADHD cases diagnosed in childhood, the disorder fades until it disappears completely, simply through brain maturation!
Thus, for one child out of two affected by ADHD, the condition will subside between adolescence and the following years, once the frontal areas of the brain have reached full maturity.
If a diagnosis is made in childhood, you'll understand the importance of reassessing whether or not ADHD is still present, and to determine whether symptoms persist or not.
The importance of a good diagnosis
Before considering prescribing a medication such as Ritalin or Concerta for a child showing symptoms of ADHD, make sure you get an accurate diagnosis. Attention disorders in the school environment can stem from a disturbed emotional state, such as anxiety, preoccupations or sadness.
Similarly, organizational problems can result from different conditions such as NVLD, while hyperactivity can be linked to Gilles-de-la-Tourette Syndrome or Oppositional-Defiant Disorder (ODD).
On the other hand, a child who has experienced developmental delays may present persistent difficulties with oral comprehension. These children, affected by a receptive language disorder, seem inattentive as they struggle to understand complex sentences and the explanations provided by their teacher.
A comprehensive neuropsychological evaluation provides a clear picture of whether or not symptoms of inattention and/or hyperactivity are present, and identifies their causes. The aim is to adapt the most appropriate intervention. It also plays a preventive role by avoiding the erroneous attribution of ADHD and the inappropriate prescription of medication.
How is ADHD assessed and diagnosed?
The diagnosis of ADHD can be established by simply observing the child according to the lists of 9 symptoms of inattention and 9 symptoms of hyperactivity.
However, in recent years, organizations such as INESS and the Institut de la Statistique du Québec have highlighted abnormally high rates of ADHD diagnosis among young people (mainly adolescents) in Quebec. More than ever, it seems crucial to use a rigorous and comprehensive assessment protocol to evaluate ADHD, in order to avoid overdiagnosis (and therefore false diagnosis) of ADHD.
At CERC, we ensure a thorough, detailed and rigorous evaluation process, carried out by a neuropsychologist. This process includes the following 6 points:
- History taking with the parents: Professionals meet with parents to establish a detailed history of the child's development. This step, essential to understanding the overall context, usually lasts 45 minutes.
- Distribution of questionnaires to parents and teachers: These tools gather information on the child's daily behaviours. They provide valuable clues, although the diagnosis of ADHD must not be based exclusively on their results.
- Administering attention tests to children: To assess attention in depth, specific tests are required. They help to formulate recommendations adapted to each situation.
- Assessment of other cognitive abilities: Through what is known as differential diagnosis, professionals seek to understand whether other disorders, such as language or learning disorders, could explain attention difficulties. Neuropsychological tests provide a complete cognitive profile.
- Exploring psycho-affective aspects: Children with affective issues or disorders sometimes show signs of inattention similar to those of ADHD. It is therefore crucial to examine these aspects in order to adjust intervention.
- Organization of one or two long assessment sessions: To grasp the extent of attentional deficits, extended sessions simulating the conditions of a school day are carried out. This enables us to observe variations in the child's attention under realistic conditions.
ADHD symptoms
Attention difficulties (according to DSM 5, 2013):
- Lack of precision and inattention to details.
- Difficulty maintaining attention when working or playing.
- Doesn't seem to listen when addressed directly.
- Does not follow instructions or does not complete tasks.
- Meets organizational challenges.
- Dislikes or avoids activities requiring prolonged concentration.
- Frequently misplaces and loses personal belongings.
- Easily distracted by environmental elements.
- Regularly forgets commitments or tasks.
Hyperactivity and Impulsivity (according to DSM 5, 2013):
- Restlessness and frequent movements in the seat.
- Rises in circumstances where sitting is expected.
- Excessive activity: inappropriate running or climbing (in adolescents or adults, this manifests as impatience).
- Difficulty remaining calm.
- Tendency to talk excessively.
- Constant feeling of being on the alert or extremely energetic.
- Interrupting questions before they have been fully asked.
- Difficulty waiting his/her turn in groups or activities.
- Often interrupts or interferes in other people's conversations or games.
10 Questions sur le TDAH
For clear, easy-to-understand answers based on scientific literature, we strongly recommend this book written (in french) by our dear General Manager!
https://www.miditrente.ca/fr/produit/10-questions-sur-le-tdah-chez-l-enfant-et-l-adolescent
ADHD in adults
Although its prevalence drops to 2-3% in the population, ADHD also exists in adulthood. Although the same diagnostic criteria are used, adult ADHD could simply be explained in 3D: Distractibility, Disinhibition, and Disorganization.
Adults with ADHD often feel under-achieved at work. Their attention span and organizational and managerial limitations often prevent them from moving up the corporate ladder and obtaining promotions. At home, the arrival of children in the couple can create tensions between spouses, when one of them finds it difficult to meet the new demands on time and tasks imposed by the children.
At CERC, our neuropsychologists also carry out ADHD assessments, offering tests and questionnaires specifically designed for adults.
ADHD and medication
For children, adolescents and adults alike, there are now several pharmacological treatment options available to stimulate attention and improve the efficiency of the brain's "filter". This filter inhibits hyperactivity and impulsivity. The neuropsychologist cannot prescribe medication, but based on his/her report, the physician will be better equipped and informed to establish a treatment plan. In our Laval office, CERC collaborates with Dr. Anne-Marie Landry, general practitioner, for prescriptions and medical follow-up in ADHD and mental health issues.
You may have heard of Ritalin more often, but there are many alternatives available to reduce side effects and improve therapeutic effectiveness. Medications fall into three categories:
- Methylphenidate-based medicines (Ritalin, Concerta, Biphentin and Foquest)
- Amphetamine-based medicines (Adderall, Vyvanse and Dexedrine)
- Non-stimulant drugs (Strattera and Intuniv)
For more information on the various medications available to treat ADHD, we invite you to consult this chart produced by the Canadian ADHD Resource Alliance (CADDRA):
https://www.caddra.ca/wp-content/uploads/Nov-2022-Medication-laminate-1.pdf
To make an appointment or for any questions about ADHD assessment
Our neuropsychologists
Our team of neuropsychologists in Montreal, Laval and Brossard, made up of accredited professionals, offers specialized support to individuals with neurological disorders. We develop personalized intervention plans and support families in promoting well-being and cognitive success.
