CHILD STUDY:
Glenwood Psychologists have considerable experience, training and credentials as Licensed Clinical Psychologists and as a Certified School Psychologist. As such we are able to provide a broad array of psycho-educational diagnostic assessments to assist with differential diagnoses and help with educational planning (IEP's, 504 Plans, etc.). Over the past 35+ years of practice, Glenwood psychologists have developed a comprehensive psychological evaluation procedure referred to as a "Child Study". Such evaluations typically assess for the possible presence and extent of ADHD, Learning Disabilities, Communication Disorders, Pervasive Developmental Disorders (Autism, Asperger's, etc) Mental Retardation, Oppositional Defiant Disorders, Conduct Disorders and other childhood syndromes that might negatively effect a child's ability to learn. In addition, Drs. Cushing have done considerable work with childhood anxiety and depressive disorders including separation anxiety (School Phobia).
A Child Study is a complete psychological assessment of a child's intellectual, academic, developmental, emotional, personality, behavioral and social functioning. This thorough evaluation will determine the nature of the child's problems and diagnoses and will result in a formal written treatment plan. The treatment plan will outline the best way to work with the child at home and at school so as to optimize the learning abilities and treat, remediate, and compensate for or accommodate the child's disabilities.
The recommendations typically include how the parents, teachers and the child can intervene to best address the specific difficulties the child presents. In addition, the manner in which a physician, psychotherapist or counselor and other specialists (occupational therapists, speech and language clinicians, etc.) might provide services to assist the child in prospering and reaching his or her fullest potential are also outlined in the comprehensive written report. Specifics regarding the development and formulation of remedial, compensatory and accommodations plans (504 plans or Individualized Educational Plans {IEP}) are also detailed in the written report.
Additional services provided include consultation with parents to fully explain to them the nature of their child's difficulties and to help set realistic academic, behavioral and even vocational expectations in light of those difficulties. The ways in which parents can best assist educational professionals in developing and honing academic and study skills are also emphasized in the oral interpretation sessions held with parents following completion of the Child Study. Drs. Cushing also regularly attend School IEP meetings, staffings and Manifestation Determination hearings as needed.
Additionally, the Glenwood Testing Center provides access to a vast inventory of psychological assessment instruments to help assess almost any cognitive, emotional, behavioral or psycho-sexual difficulty in children ages 2-21 and adults. Specialized assessments for a variety of psychological conditions, disorders and syndromes including Autistic Spectrum disorders, neuro-psychological dysfunction, Anger Management Issues, Violence Risk Assessments, and juvenile and adult Sex Offender Risk Assessments are also available.
Such specialized services are outlined in more detail elsewhere on this website.
|
ATTENTION DEFICIT/HYPERACTIVITY DISORDER (ADHD)- DEFINITION AND DESCRIPTION:
According to the Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition (DSM-IV), the essential feature of ADHD is a persistent pattern of inattention and/or hyperactivity-impulsivity that is more frequent and severe than is typically observed in individuals at a comparable level of development. The syndrome used to be called simply "ADD", with or without Hyperactivity. Now the accepted terminology is ADHD. The psychologist must diagnose and differentiate between the types: Hyperactive, Passive-Inattentive, or Combined type (symptoms of both).
Most parents first observe excessive motor activity when the children are toddlers, frequently coinciding with the development of independent locomotion. However, because many overactive toddlers will not go on to develop ADHD, caution should be exercised in making this diagnosis in the early years without comprehensive psychological evaluation. Also, with the Passive-Inattentive type of ADHD, excessive motor activity is not seen. Rather, these children may, instead, exhibit consistent difficulty with staying on task, may be very distractive and lose focus easily and their minds may "drift" when doing classwork and homework. They may often not complete school assignments, may be disorganized and messy and may actually often finish assignments but not turn them in.
ADHD is much more frequent in males than females, with male to female ratios ranging from 4:1 to 9:1. However, many girls with predominately Passive-Inattentive type ADHD go undiagnosed because they lack the hyperactive component that often demands teacher attention and concern. The overall prevalence of ADHD is estimated at 3-5% in school age children.
ADHD is not diagnosed if the symptoms are better accounted for by another mental disorder (e.g., Oppositional Defiant Disorder, Learning Disabilities, Bipolar Disorder, Depression, Anxiety, Dissociative Disorder, etc...). Many of the above disorders cause children and adults to experience ADHD-like symptoms, when they may not be suffering from actual ADHD. Accurate diagnosis is essential for effective treatment. Therefore, it is important that such conditions be ruled out before ever making an ADHD diagnosis or prescribing medication. Only a comprehensive Psychological Evaluation or Child Study can effectively rule out other similar explanations for the neurologically based ADHD.
ASSESSMENT PROCEDURES FOR DIFFERENTIAL DIAGNOSIS:
To insure accurate diagnosis, a comprehensive psychological evaluation should be completed by a Licensed Clinical Psychologist. Such an evaluation ordinarily involves thorough clinical interviewing of both parents and the child as well as obtaining teacher input, behavior rating scales data, face to face clinical observation, and psychometric testing including I.Q. testing and academic achievement testing. In addition, Glenwood Psychologist utilize a Continuous Performance Test that is a computer based measure (like a computer game) that will measure, to the mili-second, the child's attention span, distractibility and impulsivity factors, concentration and focusing abilities and ADHD risk factors.
Once such a comprehensive assessment had been completed, parents and teachers will have a better understanding of the child's behavioral, emotional, and cognitive functioning (i.e., intelligence, working memory, academic knowledge, processing strengths and weaknesses, auditory vs. visual attention levels). As a result, a more accurate and definitive differential diagnoses can then be offered and very specific treatment recommendations are made for parents, teachers, and physicians.
|
ADHD DIAGNOSTIC CRITERIA (DSM-IV):
A. Either (1) or (2):
(1) six (or more) of the following symptoms of inattention have persisted for at least six months to a degree that is maladaptive and inconsistent with developmental level:
Inattention:
a) often fails to give close attention to details or makes careless mistakes in schoolwork, work, or other activities
b) often has difficulty sustaining attention in tasks or play activities
(c) often does not seem to listen when spoken to directly
(d) often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (not due to oppositional behavior or failure to understand instructions)
(e) often has difficulty organizing tasks and activities
(f) often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (such as schoolwork or homework)
(g) often loses things necessary for tasks or activities (e.g., toys, school assignments, pencils, books or tools)
(h) is often easily distracted by extraneous stimuli
(i) is often forgetful in daily activities
(2) six (or more) of the following symptoms of hyperactivity-impulsivity have persisted for at least six months to a degree that is maladaptive and inconsistent with developmental level:
Hyperactivity
(a) often fidgets with hands or feet or squirms in seat
(b) often leaves seat in classroom or in other situations in which remaining seated is expected
(c) often runs about or climbs excessively in situations in which it is inappropriate (in adolescents or adults may be limited to subjective feelings of restlessness)
(d) often has difficulty playing or engaging in leisure activities quietly
(e) is often "on the go" or often acts as if "driven by a motor"
(f) often talks excessively
Impulsivity
(g) often blurts out answers before questions have been completed
(h) often has difficulty awaiting turn
(i) often interrupts or intrudes on others (e.g., butts into conversations or games)
B. Some hyperactive-impulsive or inattentive symptoms that caused impairment were present before age 7 years.
C. Some impairment from the symptoms is present in two or more settings (e.g., at school/work and at home).
D. There must be clear evidence of clinically significant impairment in social, academic, or occupational functioning.
|
ADULT ADD/ADHD:
Attention-deficit/hyperactivity disorder (ADHD) affects 30 to 50 percent of adults who had ADHD in childhood. Accurate diagnosis of ADHD in adults is challenging and requires attention to early development and symptoms of inattention, distractibility, impulsivity and emotional lability. Diagnosis is further complicated by the overlap between the symptoms of adult ADHD and the symptoms of other common psychiatric conditions such as depression and substance abuse.
Drs. Cushing perform comprehensive psychological evaluations on Adults suspected of having Adult ADHD in order to ensure proper diagnosis and to facilitate appropriate treatment. Once the client has been differentially and objectively diagnosed through the use of standardized tests, a referral to a primary care physician might well be appropriate. Because,while stimulants are a common treatment for adult patients with ADHD, antidepressants or anti-anxiety medication may also be effective depending upon the correct diagnosis. Anxiety disorder patients can have significantly negative reactions and side effects to stimulant medications. This makes a thorough assessment most important.
For patients diagnosed with Adult ADHD, cognitive-behavioral skills training and psychotherapy are useful adjuncts to pharmacotherapy. If other emotional issues are at the root of the client's problem, a treatment plan tailored to the persons specific needs will be developed based upon the test results.
If interested in being assessed for possible Adult ADHD, please contact Dr. Frank Cushing or Dr. Kyle Cushing to arrange for an initial consultation. During that initial session, a comprehensive history of bothersome symptoms will be gathered and the proper battery of tests will be selected. The results of the testing will be shared directly with the client in an interpretive session. Formal written reports of findings can be made available to physicians or others at the request of the client.
|
|
READINGS AND RESOURCES AVAILABLE UPON REQUEST
|
GENERAL RECOMMENDATIONS:
|
|
