Archive for Tuesday, August 29, 2006

Reader wants to be tested for AD/HD

August 29, 2006


Q: Dear Dr. Wes and John: I would like to inquire about AD/HD testing. While my father was in the military, I was diagnosed at the age of 6 with AD/HD and put on medication around 11 or 12. After my father was discharged from the military, my medical records were lost. I am now seeking to re-establish the proper medical documentation of the diagnosis. What are the costs involved and time commitment to be retested? Any information you may provide would be greatly appreciated.

A: John: AD/HD is thought to be a neurological disorder with symptoms of hyperactivity, poor impulse control, distractibility, or forgetfulness affecting about 3 percent to 5 percent of the people, though these numbers are debated.

An AD/HD diagnosis can't be made on a blood test or heart rate. Instead, you and those around you will be asked about your behavior, and the doctor will analyze the responses. Do you have difficulty paying attention in class? Do you often feel restless throughout the day? These are the types of questions a physician or mental health provider will ask to try and make his diagnosis. Of course, some kids don't pay attention during class because they are bored. And if you feel restless, you might just need more exercise. Because there are so many factors that could be mistaken for AD/HD, diagnosis is very controversial.

One of the major questions involved in AD/HD is why it is being diagnosed far more frequently then before. Some say this is because AD/HD is being overdiagnosed, while others claim it was always present but simply went unnoticed. Still others argue that it becoming more common because of environmental or social changes.

Treatment for AD/HD is generally stimulant drugs, such as Ritalin, Focalin, Mythelin, Automoxetine or Medadate. These work by stimulating the areas of the brain responsible for focus, attention and impulse control. Most research suggests that counseling for the child and family are beneficial and changes in exercise or diet may also help.

My best advice for you would be to simply ask your doctor or school nurse about your options. Pay attention to your own behavior and try to outline your problem, if any. About 40 percent of children diagnosed with AD/HD outgrow it by adulthood. Keep an open an open mind and be honest with your doctor. Whatever the diagnosis, know that improved treatment is allowing AD/HD to become easier to live with, and it doesn't have to put a serious roadblock in your path to success.

Wes: John's right. AD/HD can't be diagnosed with any physical exam. While there is ongoing experimentation with PET scan technology, psychological testing the is easiest and least expensive method. Fortunately, we have fairly precise paper and pencil tests that improve the accuracy of diagnosis far beyond a doctor, teacher or psychologist "eyeballing it." Check with area psychologists and see which specialize in assessing AD/HD in teens. They should provide a two-page test for you to fill out, along with several others for your parents, friends, teachers or other observes to complete. The use of multiple tests allows us to assess how you perceive yourself, AND how others see you as well. There also is a computer test that I refer to as the "World's Most Boring Video Game." If you take it you'll know why. While it's fairly good at finding people who are obviously AD/HD, it's not so good at proving someone doesn't have the diagnosis. Using these tests along with a trained therapist's interview raises the likelihood of a correct diagnosis. From that point on the question becomes one of whether and which medications may work, and what sort of therapy will help you learn to organize yourself to be successful.

Don't allow psychologists to overdo the testing or tell you they have a special battery of tests for AD/HD. There are no other tests beyond what I've outlined above that can assist in the diagnosis of AD/HD. If someone wants to give the MMPI, an IQ test or a neurological exam, be very cautious. These are rarely needed unless the psychologist sees something more serious going on - like frontal lobe damage or serious memory impairment. On the other hand, I would not accept a diagnosis for AD/HD unless I had taken these tests AND HAD THEM SCORED. These tests are not designed to be looked over by a physician or psychologist. Your scores have to be compared to the "standardization sample" (the group of people who took the test and with whom you are being compared) before they can be interpreted. I've seen many unscored tests being used to diagnose people.

The entire cost for an AD/HD evaluation should run about $150 for the initial session, between $50 and $150 for the testing itself, and about $100 for a follow-up session for diagnosis and referral. Your insurance company will usually pay for the two sessions. Some will pay for the testing. You or your family can call your particular insurance carrier to find out. You should be looking at a total bill of no more than $500. Good luck!

Next week: Is your child really at risk from sexual predators while logged into MySpace and other social networking sites? Double Take reviews personal safety awareness versus media hype.

- Dr. Wes Crenshaw is a board-certified family psychologist and director of the Family Therapy Institute Midwest. John Murray is a Free State High School senior. Opinions and advice given here are not meant as a substitute for psychological evaluation or therapy services. Send your questions about adolescent issues to All correspondence is strictly confidential.


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