You have probably seen many recent articles, books, and television programs about Attention Deficit Disorder (ADD) and Attention Deficit Hyperactivity Disorder (ADHD). One might get the impression that these problems have just been discovered. Psychologists have, in fact recognized and have been addressing these problems for many years. In the 60’s there was a great flurry of attention to these problems in children. Diagnostic procedures    were not well developed at that time and some physicians were prescribing Ritalin to children in an almost indiscriminate manner. Since that time much research has been done on these disorders as they affect both children and  adults. Great progress has been made both in the diagnosis and treatment of ADD and ADHD.

My approach involves the following steps:
        
(1) I take a careful history to evaluate the nature and the development of the symptoms. (2) I make use of appropriate, well validated behavior-rating scales to compare the patient’s behavior patterns against norms based upon the gender and age of the patient. (3) I do direct testing of the patient’s ability to focus his or her attention on a well designed and standardized psychological test. (4) I evaluate or test for the presence of any emotional problems which could be an alternative cause of the symptoms. (There are other psychological problems that could cause symptoms similar to ADHD or ADD, including anxiety, agitated depression, a thought disorder or mood disorder with manic components.)

It is essential to arrive at an accurate and proper diagnosis 

because inappropriate treatment based on an incorrect diagnosis could have negative consequences. In arriving at a proper diagnosis I always start by taking a history during the initial visit. Then, for adults, I use the Conners’ Adult ADHD Rating Scale (CAARS). Sometimes I also use the Wender Utah Rating Scale. The Conner’s generates a profile with measures of various patterns of inattentiveness, restlessness, impulsivity and hyperactivity as well as cognitive problems, perfectionism, social problems and other relevant dimensions of psychological functioning.  The results are evaluated in terms of normative data. This provides a comparison of the results with a normative group, which helps to establish an objective measure of the presence and pattern of problems that may be interfering with the patient’s psychological functioning. In addition to having the patient complete this behavioral rating scale, I request that the patient have a relative or close friend complete the Conners’ Adult ADHD Rating Scale Observer form. The comparison of the self-rating and observer rating profiles often provides important validating information.

  The IVA is a test of attentiveness to both visual and to auditory stimulation. The patient’s pattern of responsiveness to visual images presented on a computer screen, and spoken words presented by the computer audio is measured. The results provide measures of speed, accuracy, perseverance, reliability, impulsivity and consistency of response. All scores are evaluated in terms of normative age-controlled data. The results represent an objective measure of important aspects of attentiveness and impulsivity.

Finally, in order to rule out the possibility that emotional factors may be creating symptoms similar to those caused by attention deficit disorder or attention deficit hyperactivity disorder (ADD or ADHD), I usually administer a Minnesota Multiphasic Personality Inventory-2 (MMPI-2). The MMPI-2 is arguably the best researched and validated psychological personality test available. It provides a wide range of information, which can be useful in gaining insight into a person’s feelings, behavior and psychological functioning.

A similar method is used to diagnose ADD and ADHD problems in children. The history is taken from the parents, and the Conner’s' Parent Rating Scale and the Conner’s Teacher Rating Scale are used to get objective behavioral ratings as observed both in the home and in the school situation. The Integrated Visual and Auditory Continuous Performance Test (IVA) can be administered to most children who are 6 years of age or older. It is scored based on gender and age related norms and provides information similar to that provided in testing adults.

The results of a thorough psychodiagnostic evaluation helps to determine the most appropriate form of treatment: psychological/behavioral, medication or a combination of both treatment modalities.