ADHD assessment

What is ADHD? Signs and symptoms to watch out for

This neurodevelopmental disorder affects cognitive functions related to attention, self-control and organization. Often referred to as hyperactive or inattentive children, this profile can also manifest itself in different forms in adolescence and adulthood.

Some common signs

These manifestations are often described as attention or concentration disorders :

• Difficulty concentrating, inattentive errors, frequent forgetfulness ;
• Impression that the child "doesn't listen", doesn't follow instructions;
• Disorganization, repeated loss of school materials ;
• Motor restlessness, difficulty sitting still, need to move or talk;
• Impulsivity (cutting off speech, acting without thinking).

Attention, brain and maturation

Neurologically, this disorder is linked, in many people, to delayed maturation of the frontal areas of the brain involved in inhibition , self-control and emotion regulation.

To explain it simply, we can say that these areas should play a "filtering" role in the child's brain, making it possible to better manage :

• Distractors around the child to enable him to concentrate on his work or on the teacher giving explanations.

• Intrusive, invasive thoughts that monopolize attention
• The desire to get up, to talk, to move when there's no time
• The intensity of emotional reactions such as joy, anger, pain and sadness.

This clinical picture also has a strong genetic component: ADHD is often inherited within the same family, in children and adults who also have attention or organization difficulties.

This disorder is for life?

Excellent news! Studies increasingly show that in more or less 50% of cases of ADD or ADHD diagnosed in childhood, the disorder fades until it disappears completely , simply through brain maturation!

Thus, for one in two affected children, the condition will diminish between adolescence and the following years, once the frontal areas of the brain have reached full maturity.

If a diagnosis of ADHD is made in childhood, you'll understand the importance of reassessing the presence of this disorder later, to determine whether symptoms persist.

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The importance of accurate diagnosis before taking medication

Before considering prescribing medications such as Ritalin, Vyvanse, Biphentin or Concerta for a child showing symptoms similar to attention deficit disorder, be sure to obtain a precise clinical conclusion. Attention disorders in the school setting may stem from a disturbed emotional state, such as anxiety, preoccupation or sadness, rather than from a true attention deficit disorder.

Disorders that can mimic ADHD

Organizational problems can result from different conditions such as VNS, while hyperactivity can be linked to Gilles-de-la-Tourette Syndrome or oppositional disorders.

On the other hand, a child with developmental delays may have persistent difficulties with oral comprehension. These children, affected by receptive language disorders, seem inattentive, as they struggle to understand complex sentences and the explanations provided by their teacher.

The role of neuropsychological assessment in diagnosis

A thorough neuropsychological assessment provides a clear picture of the presence or absence of symptoms of inattention and/or hyperactivity, 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 this disorder and the inappropriate prescription of medication.

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How does an ADHD assessment at CERC work?

We know that this process can raise questions. That's why our evaluation process is designed to be humane, transparent and rigorous.

Even if the diagnosis can, in theory, be made on the basis of the DSM-5 list of 9 symptoms of inattention and 9 symptoms of hyperactivity , we feel that this is not enough.

In recent years, organizations such as INESSS and the Institut de la statistique du Québec have highlighted abnormally high rates of ADHD diagnosis among young people (especially adolescents) in Quebec. It is therefore more necessary than ever to use a rigorous and comprehensive assessment protocol , to avoid over-diagnosis and false diagnosis.

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Here's how we proceed, step by step, to give you a clear and complete picture of the situation.

Steps in a neuropsychological assessment

At CERC, we ensure a thorough, detailed and rigorous evaluation process, carried out by a neuropsychologist. This process includes the following 6 points:

1. Taking a history with the parents

Professionals meet with parents to establish a detailed history of the child's development, school environment, strengths and challenges, and medical history. This step, essential to understanding the overall context, usually lasts 45 minutes.

2. Distribution of questionnaires to parents and teachers

Parents and teachers fill in standardized questionnaires on the child's daily behaviour. They provide valuable clues, although the diagnosis is not based exclusively on their results.

3. Administration of attention tests to the child

To assess attention in depth, specific tests are administered: sustained attention, vigilance in children, impulsivity, etc. These help to formulate recommendations adapted to each situation. They help us to formulate recommendations adapted to each situation.

4. Assessment of other cognitive abilities

Through what is known as a 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.

5. Exploring psycho-affective aspects :

Children with emotional disorders sometimes show signs of inattention similar to ADHD. It is therefore crucial to examine these aspects in order to adjust intervention.

6. Organization of one or two long evaluation sessions :

To understand the extent of attentional deficits, prolonged 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.

Tools used for differential diagnosis

The assessment is based on standardized tools :

• cognitive testing ;
• clinical assessments and observations;
• recognized questionnaires ;
• tasks assessing attentional and executive functions.

These instruments are essential for confirming or refuting a diagnosis according to DSM-5 criteria, and for distinguishing ADHD from other difficulties.

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The Real and the Fake Podcast: Demystifying ADHD

To better understand attention deficit disorder with or without hyperactivity, Dr. Benoît Hammarrenger participated in the podcast"Le vrai du faux" hosted by Marie-Christine Proulx, in an episode devoted entirely to ADHD.

In this discussion, he answers a number of questions frequently asked by parents and concerned adults:

• How to distinguish a "lack of concentration" from true ADHD ;
• Why this disorder is sometimes overdiagnosed or misunderstood;
• What are the repercussions in everyday life, at school, at work and in the family?
• What support and intervention options are available?
  

You can listen to the full podcast here:

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The main events to know

These manifestations are varied and can be confused with other issues. For reference:

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.

To find out more: 10 Questions about ADHD

For clear, easy-to-understand answers based on scientific literature, we strongly recommend this book written by our dear General Manager! 

10 questions about ADHD in children and adolescents

ADHD in adults

How is attention deficit disorder diagnosed in adulthood? The process is similar to that for children. Although its prevalence falls to 2-3% of the population, ADHD also exists in adulthood. The challenges are particular: career difficulties, relationship tensions, low self-esteem. The adult profile could simply be explained in 3D: Distractibility, Disinhibitionand Disorganization.
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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 assess adult ADHD, using tests and questionnaires specifically designed for this age group.

ADHD and medication

Medication is one of the possible options in the ADHD treatment plan. For children, adolescents and adults, there are now several pharmacological treatment options 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.

All decisions regarding pharmacological treatment are made in consultation with a physician, following a clear diagnosis. In our Laval office, CERC collaborates with Dr. Anne-Marie Landry, general practitioner, for prescriptions and medical follow-up in ADHD and mental health. 

Alternatives to Ritalin to improve therapeutic efficacy

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:

1. Methylphenidate-based medicines (Ritalin, Concerta, Biphentin and Foquest)
2. Amphetamine-based medicines (Adderall, Vyvanse and Dexedrine)
3. Non-stimulant drugs (Strattera and Intuniv)

For more information on the various medications available to treat ADHD, we invite you to consult the chart produced by the Canadian ADHD Resource Alliance (CADDRA).