Attention Deficit Hyperactivity Disorder (ADHD)
Assessment of ADHD
We provide comprehensive assessments for the diagnosis of ADHD in children/adolescents. This includes testing for the presence of ADHD symptoms and for co-occurring difficulties such as anxiety, learning difficulties, and emotional regulation difficulties. The assessment will include ADHD client/informant questionnaires, cognitive and neuropsychological tests, a clinical assessment, and written report with recommendations.
What is ADHD?
Attention deficit hyperactivity disorder (ADHD) is a common behavioural disorder that affects 11.2% of children/adolescents in Australia (Sawyer et al., 2000) The three main features of ADHD are:
• Difficulty paying attention (e.g., workplace tasks, conversations, or personal belongings)
• Hyperactivity (e.g., fidgeting or being unable to sit still, talking a lot)
• Impulsivity (e.g., interrupting conversations, being unable to wait in line)
Some children will display a mostly ‘inattentive subtype’, others will have a ‘hyperactive/impulsive subtype’, while many will have a ‘combined subtype’ involving inattentive, hyperactive, and impulsive behaviours.
Causes of ADHD
Despite intensive research, we do not know the exact cause of ADHD, and it is possible that a number of factors may contribute to its development. ADHD tends to run in families, so the leading theory is that ADHD is an inherited neurodevelopmental disorder. Possibly, it is caused by structural and chemical differences in the brain. The fact that some people can manage their ADHD with medication suggests that brain chemicals are at least partially involved.
Children who have symptoms of inattention may:
- Fails to give close attention to details or makes careless mistakes
- Has difficulty sustaining attention
- Does not appear to listen
- Struggles to follow through on instructions
- Has difficulty with organisation
- Avoids or dislikes tasks requiring sustained mental effort
- Loses things
- Is easily distracted
- Is forgetful in daily activities
Children who have symptoms of Hyperactivity/Impulsivity may:
- Fidgets with hands or feet or squirms in chair
- Has difficulty remaining seated
- Runs about or climbs excessively in children; extreme restlessness in adults. Difficulty engaging in activities quietly
- Acts as if driven by a motor; adults will often feel internally as if they were driven by a motor
- Talks excessively
- Blurts out answers before questions have been completed
- Difficulty waiting or taking turns
- Interrupts or intrudes upon others
ADHD also commonly affects the following areas of an individual's functioning:
Organising and planning
▪ Difficulty prioritising tasks (not knowing which one to do first)
▪ Difficulty organising complex or multi-step activities (e.g., researching and writing a report, organising a trip away)
▪ Procrastination around activities that are uninteresting or challenging (putting off phone calls, household tasks, writing an essay or report)
▪ Messy and disorganised house (e.g., drawers/cupboard doors left open, piles of clean and dirty clothing, unwashed dishes)
Motivation
▪ Difficulty getting started on activities in the absence of a deadline, or despite a deadline
▪ Taking short cuts to reduce effort resulting in sloppy work, penalties
▪ Difficulty persisting with activities that require commitment or mental effort (e.g., learning to drive, learning to use a necessary computer program)
Time management
▪ Losing track of time and regularly running late
▪ Underestimating how long things will take (e.g., travel time, getting ready)
▪ Missing appointments or turning up late
▪ Leaving things to the last minute
Quality of Life & Emotional Regulation
When ADHD is moderate to severe and left untreated, a child can experience a wide range of associated difficulties. Some researchers believe that emotional regulation difficulties such as anger outbursts are a prominent feature of ADHD. ADHD can make life difficult and therefore create secondary emotional challenges. These can include:
▪ Feeling overwhelmed
▪ Low self-esteem due to chronic feelings of underachievement
▪ Short temper / brief outbursts of anger
▪ Bouts of tearfulness or sadness with stress
▪ Feeling socially anxious
Other common life difficulties
▪ Failing to achieve life goals, or taking longer to achieve such goals (e.g., not completing a degree)
▪ Working long hours due to inefficiency
▪ Receiving warnings at work for performance issues
▪ Problems with career development due to regular job changes (e.g., constantly restarting a different career)
▪ Difficulty developing a long-term relationship due to getting bored with partners, being unreliable, not putting in adequate effort
▪ Arguments with loved ones due to disorganisation or not fulfilling expectations (partner gets fed up with acting like a “mother”)
▪ Financial difficulties due to impulsive spending
▪ Health issues due to not taking care of oneself (e.g., dental decay, cholesterol or high blood sugar from poor diet, unplanned pregnancies, STDs)
You don’t need to have all these symptoms to be diagnosed with ADHD.
ADHD & Executive Functioning
The cognitive functions required to organise, begin and complete a task can be thought of as our “executive functions”. Each day we engage in a series of goal directed tasks or activities, from simple tasks like getting dressed through to more complex activities like completing an essay or a tax return.
Getting a task done involves recognising or remembering that the task needs to be done, paying attention to the task, resisting distraction, finding the motivation to get started, making a plan, locating important tools, persisting in the face of boredom/frustration, monitoring progress, and making changes as needed until the task is complete. People with ADHD often find it difficult to execute all of these steps, and thus often have difficulty completing life activities in line with their goals and needs. ADHD can therefore be thought of as a neurodevelopmental disorder of executive functioning.
(Adapted from ADHD Australia https://www.adhdaustralia.org.au/ February 2018)