Counseling Points - Family/Pediatric Nurse 11/08 - (Page 7)

symptoms listed as part of the APA’s diagnostic criteria are most commonly seen in school-age children. When preschoolers are diagnosed with ADHD, it is usually because they are exhibiting symptoms of hyperactivity and impulsivity: They have difficulty sitting still for quiet activities, following simple instructions, and waiting their turn, and often demonstrate other developmentally immature behaviors. Many preschool children with ADHD have poor social skills with their peers and may become aggressive, pushing other children or grabbing toys away. Because many toddlers or preschoolers exhibit behaviors such as inattention or impulsivity, care must be taken to differentiate whether the symptomatology is merely part of the normal developmental trajectory or diagnostic of ADHD. ADHD symptoms in adolescents differ somewhat from those seen in school-age children and may include sleep problems, restlessness, and disorganization; teens may also demonstrate heightened motor activity (e.g., foot tapping).15 Other symptoms include significant academic difficulties and school failure, anxiety disorders, poor social interaction skills with possible antisocial behavior, and illicit substance and/or alcohol use.15 Many adolescents meet less than six of the necessary designated APA symptoms within a specific category, but still have significant impairment concomitant with an ADHD diagnosis.8 The Diagnostic Process To date, there are no genetic or neuroimaging tests that clearly establish the diagnosis of ADHD. In addition, there continues to be controversy regarding the overdiagnosis of ADHD in children and adolescents. When evaluating a person for ADHD, it is important to consider the pattern, severity, and pervasiveness of symptoms, and to what extent the disorder interferes with normal daily functioning. For instance: Is this just a temporary reaction to a situation (parental divorce, family death, etc.) or is it an ongoing problem? Do the symptoms occur in more than one setting? In order to make a definitive diagnosis of ADHD, the evaluation must include a complete cognitive, psychosocial, and psychiatric assessment, as well as a review of the appropriateness of the school setting and the individual’s social and employment functioning. Although the majority of children with ADHD have an unremarkable medical history, a more comprehensive medical evaluation may be required in some children to rule out metabolic or brain dysfunction. A physical examination that includes thor7 ough vision and hearing tests as well as appropriate laboratory testing may be indicated. Unless there is strong evidence in the medical history, tests such as an electroencephalogram (EEG), magnetic resonance imaging (MRI) scan, single photo emission computed tomography (SPECT) scan, or positron emission tomography (PET) scan are not indicated.8 When appropriate, the individual should be referred to a specialist for further evaluation and testing. When examining the individual’s school, employment, and social functioning, it is critical to gather information regarding his/her overall functioning and performance; the school environment and grade placement; special education services or work modifications provided to the person; involvement in extra-curricular activities; and overall behavior at school or work. A classroom or work observation, including during social interactions with peers and employment managers and staff, will further help to assess the individual’s level of functioning. It is also important to interview the family and observe the family relationships/dynamics. A complete psychiatric assessment should include a structured diagnostic interview; clinical review of pertinent records; psychological and neuropsychological testing; family, child and teacher feedback; use of specific diagnostic tools (Table 2); review of the patient’s sleep patterns and use of substances and alcohol; and additional information from counselors, daycare workers, school nurses, and psychotherapists. Table 2. Rating Scales Utilized in ADHD • • • • • • SSQ-01 Barkley School Questionnaire ACTeRS Parent Report Form Connors Teaching Rating Scale* Connor’s Parent Rating Scale* Child Attention Profile Child Behavioral Check-List (CBCL—Teacher/Parent Report Form)* • Adult ADHD Self-Report Scale Symptom Checklist • Home/School Situations Questionnaire • Academic Performance Rating Scale ( APRS) *Most commonly used and best-normed tools. Differential Diagnosis Many conditions can produce symptoms that mimic those seen in ADHD, and may even co-exist with ADHD, making the differential diagnosis of ADHD complex NOVEMBER 2008

Table of Contents Feed for the Digital Edition of Counseling Points - Family/Pediatric Nurse 11/08

Counseling Points - Family/Pediatric Nurse 11/08

For optimal viewing of this digital publication, please enable JavaScript and then refresh the page. If you would like to try to load the digital publication without using Flash Player detection, please click here.