Page 40 Healthy Cells Magazine Peoria June 2014

attention deficit disorder

Diagnosis is Not as
Easy as It Seems
By Luke Dalfiume, PhD, Licensed Clinical Psychologist
I
t would seem that diagnosing attention deficit hyperactivity disorder
would be simple: if the person has a longstanding pattern of either
inattention or hyperactivity and impulsivity, or both, then they must
have ADHD, right? It is possible, but not necessarily so. There are other
factors to consider:
Did the person have symptoms before the age of 12? Many adults
come in to my office with attention problems, but no childhood history
of either inattention or hyperactivity or impulsivity. This is problem-
atic, but suggests the issue must be related to something other than
ADHD.
Do the symptoms occur in more than one setting? If not, then it is
likely more of an environmental problem (e.g., in the home, school, or
work setting) than an ADHD issue.
Is there another mental health issue contributing to the symptoms?
This is the most significant area that a professional must rule in or
rule out prior to a diagnosis. The most common problems looking
like ADHD include anxiety disorders and post-traumatic stress dis-
order, in which inattention and hyperactive, impulsive behaviors are
common. A common feature of depression is difficulty concentrat-
ing, and in this way depression mimics ADHD. Less common are
schizophrenic-spectrum disorders, in which a person frequently
experiences auditory or visual hallucinations. Hallucinations involve
a person hearing (auditory) or seeing (visual) things that are not really
there. Many who are experiencing hallucinations will appear to be dis-
tracted. This experience was once described to me as being similar
to having two TVs (real, objective reality and subjective, hallucina-
tory experience) at the same time.
Is there a physical problem? Auditory problems, such as hearing loss
or ear infections, should be ruled out. A seizure disorder, in particular
petit mal seizures, which may not be visible but can cause one to be
inattentive for periods of time, should also be ruled out.
Diagnosis of ADHD should include several sources of data. A thor-
ough history to rule in or rule out the factors noted above should be
obtained. If there are concerns about another mental health issue con-
tributing to the symptoms, an objective measure to assess for these
should be used. Behavior rating scales should be completed by the
person (if they are an adolescent or adult), parents, and teachers. A
performance-based measure, such as the Conners Continuous Per-
formance Test or the Test of Variables of Attention is useful, too, allow-
ing a live, computer-based assessment of capacity to attend. When a
younger child is being assessed, a classroom observation prior to the
evaluator meeting the child in the office can be helpful.
Ideally, all the data gathered will provide convergent data (everything
suggesting the same diagnosis). In that case, a definitive diagnosis can
be given. However, sometimes things are not that clear, and a plan of
progressive interventions needs to be developed until the symptoms
are adequately addressed.
For more information, contact John R. Day & Associates, Christian
Psychological Associates, located at 3716 West Brighton Avenue, Peo-
ria or their locations in Normal, Canton, Pekin, Princeton, or Eureka.
Call us at 309-692-7755 or visit us online: christianpsychological.org.
Photo credit: pyotr021/Thinkstock
Luke Dalfiume, PhD
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