Tuesday, October 27, 2009

"How Can Parents Identify ADD or ADHD?"

The question to be answered is; "Who can identify and remediate ADD - ADHD to help parents"? Is it a physician, a school psychologist, a brain scientist, universities’ special education or psychology departments, the school, the teacher, the parent, or a special education specialist?

Unfortunately, each has a small piece of the puzzle, and often, many of the pieces do not interface.

The author's qualifications: I am the parent of three children of whom I conducted auxiliary home schooling as I developed The Bridge To Achievement cognitive skills brain building program. They were: an ADD - ADHD student, an average grade school student, and a gifted student (all who later excelled remarkably and who are now VPs of major national companies (two of them), the third, a finance Director of an Irvine, CA company. They, and 2500 others seeking information processing acceleration, propelled to upper limits through cognitive skills retraining, which is applicable for all of us.

I have been a special education specialist/clinician heavily trained in measurement, assessment, and evaluation; a teacher with years of experience in 7 school districts, including a special education classroom, an Itinerant Learning Disability teacher, a researcher and private program administrator who set up 14 national testing sites observing that most people have deficient cognitive areas of their brain, and who conducted small group and school investigations for many years without funding support. I also set up a nonprofit parent-teacher literacy organization in 1980 to help all individuals learn more efficiently and be more productive.

According to J. R. Ramsay, "ADHD management usually involves some combination of medications, behavior modifications, lifestyle changes, and counseling. Its symptoms can be difficult to differentiate from other psychiatric or other disorders, increasing the likelihood that the diagnosis of ADHD will be missed. Additionally, most clinicians have not received formal training in the assessment and treatment of ADHD, particularly in adult patients." (Ramsay, J. Russell. Cognitive Behavioral Therapy for Adult ADHD. Routledge, 2007).

Brain scientists can verify that there is a physical problem with a lack of dopamine, and that with ADHD, the receptors and transporters are significantly less abundant in mid-brain "reward" structures. (Arias-Carrión O, Pöppel E (2007). "Dopamine, learning and reward-seeking behavior". Act Neurobiol Exp 67 (4): 481–488. A recent (October 2009) Dana Foundation's Brain in the News p. 6 article, "Brain Scans Link ADHD to Biological Flaw Tied to Motivation" offers some contemplative thought. The article reveals 4.5 million U.S. Children have received diagnosis for the disorder, and more than half of these children take prescription drugs. There is much controversy on medication (the long-range effects on the brain and behavior) and remediation, and "how to remediate" approaches. (National Institutes of Health (NIH) "Diagnosis and Treatment of Attention Deficit Hyperactivity Disorder (ADHD)". NIH Consensus Statement 1998 Nov 16(2): Reason R (1999). "ADHD: a psychological response to an evolving concept. Report of a Working Party of the British Psychological Society". Journal of learning disabilities 32 (1): 85–91.

The Dana Foundation continues (October 2009, p.6) that these scientists are "years away" from a biological test for the disorder, but their studies are a step in the right direction. In the frontal lobes, dopamine controls the flow of information from other areas of the brain. "Dopamine disorders in this region of the brain can cause a decline in neurocognitive functions, especially memory, attention, and problem-solving. Reduced dopamine concentrations in the prefrontal cortex are thought to contribute to attention deficit disorder and ADHD" (Biederman J (1998). "Attention-deficit/hyperactivity disorder: a life-span perspective." Journal of clinical psychiatry 59, (Suppl. 7): 4–16.)

Waiting for a biological measurement is not necessary, as there are many high ranking psychological batteries, which will determine cognitive weaknesses. These include: The Wechsler Intelligence Scale for Children - Revised (WISC-R) and the Woodcock-Johnson Psycho Educational Battery (WJ); Test 1 Cognitive Skills Test Battery and Test 2 measures Academic Achievement among others. In the 1970s- to 1980s, these tests were widely used by schools to identify learning disabled students in accordance to Public Law 94-142 in 1975. (the first predecessor was PL 89-750, 1966). Gradually, these tests gave way to simpler measurements, if any. Students were placed in remedial classrooms to receive tutoring. Abilities were not changed. The the learning deficient status quo was maintained, and often test scores stagnated. Lives became limited.

Who can administer these tests and how is it diagnosed? Tests can be given by any professional trained and certified at the master's or doctoral level having educational and psychological testing and measurement proficiency. This includes physicians, psychologists, special education clinicians, and university experts. Evaluators look for high and deficient or low cognitive areas, which can be improved through a specific therapy regimen.

What do they charge for a full battery? The fees usually run $2,500-$4,000 depending on how many subtests are given, and how many hours it takes to administer them. Since many object to these measurement fees, they prefer amphetamine medication.

However, you can request some of these tests from your school at no cost. Unfortunately, they are backed up with measurement requests, and are reluctant to do the WISC-R and in depth Woodcock Johnson Psycho Educational Batteries as they are labor intensive and time consuming, let alone the time it takes to score, evaluate, and report the complete results in special meetings.

Yet, according to the 2004 Individuals with Disabilities Education Improvement (PL 108-446) schools are required to furnish independent evaluations and evidenced-based management techniques (Turnbull, H. R., Stowe, M.J., and Huerta, N.E. 2007, Free Appropriate Public Education 7th edition, Denver, Co: Love Publishing Co. p. 362).

It was most unusual that I was conducting scientific inquiry testing since 1980, for overly nominal fees or for pro bono, in order to gather important data for thousands of individuals. For twenty years, a series of publications documented the progress. With the fortitude to continue the investigations, additional scientific reports are in publication process. Testing and reporting a specific protocol with various ages, abilities, and demographic groups for nearly three decades was deemed landmark in 2001 (International Alliance for Learning publication, June 2001). How can you find a program that will "actually work?" That will take research.

Examine the program’s research, and how long they have been practicing and collecting results that show academic achievement gains longitudinally. Longitudinal results are difficult to come by, as it takes roughly 7-8 years for any experiment to be administered, evaluated, concluded, and published. The good news is that everyone can step forward whether there are minimal or more serious cognitive skill deficits. Plus the consideration that behavioral remediation is possible as an alternative to medication!

No comments: