Home Child & Teen Assessment Attention Deficit Disorder
Attention deficit disorder, as the name suggests, can be defined predominantly by difficulties in concentration. These difficulties may, or may not, be accompanied by hyperactivity or impulsivity.
Attention deficit disorder is identified by being:
Attention Deficit Disorder (ADD), with or without hyperactivity (ADHD), is a disorder that reduces in severity with age. Many people believe that the symptoms of hyperactivity disappear around the time of adolescence. In reality, many research reports show that it is highly unlikely that the symptoms disappear altogether. It is true that there may be fewer symptoms and they may be less intense, but in about 80% of cases, children diagnosed with ADHD will still have enough symptoms during their teenage years to receive the same diagnosis. Once they reach adulthood, the percentage remains between 50% and 65%, indicating that the difficulties do not disappear with time.
The fact that the symptoms do tend to last over time does not mean that they do not change the way in which they manifest themselves. For example, physical restlessness may become less intense, as may all of the symptoms. However, whilst the symptoms may seem to diminish, social expectations on the other hand, increase with age. This reality, unfortunately, prevents individuals with hyperactivity from behaving like their peer group. Taking the example of getting a driving licence: in some countries, the minimum age is 16, because this is considered to be the age required to have a sufficient level of concentration to be able to drive safely. Yet a hyperactive adolescent of this age will probably not yet have adequate control of his or her focus and attention to be a prudent driver.
Attention deficit disorder is complicated to diagnose. Healthcare professionals agree that a global overview of the symptoms is necessary as the attention disorder may be:
Let’s take the example of a boy with signs of an attention deficit disorder: he is struggling to concentrate in class, to do his work and is having academic difficulties. He feels like a failure. His attitude becomes defeatist regarding anything academic; he can’t motivate himself to try and disengages with his education. Medication and/or neuropsychological rehabilitation of his attention difficulties are not helping very much and so his parents decide to ask for a full psychological and neuropsychological assessment.
The results of the assessment highlight normal attentional capacities but an anxiety disorder. The parents and child therefore understand that the symptoms have a psychological rather than a neuropsychological origin. On a neurological level, the child is capable of concentrating but is being inhibited by psychological barriers. Initially everyone focussed on the symptom, but not the cause of that symptom. It’s as if we tried to treat the fever related to an infection with a painkiller. By not treating the infection and only the fever, the symptom is likely to last or even worsen.
Determining the origin of the symptom of attention difficulties enables the treatment to be correctly adapted.
In this case, the attention disorder is a secondary disorder linked to an emotional issue. The treatment suggestion would be child psychotherapy and parental guidance along with psycho-educative strategies aiming to build confidence at home and in the school environment.
In other cases, when the attention disorder is a primary disorder, the treatment suggestion might be neuropsychological rehabilitation along with psycho-educative strategies. When the symptoms are too intense, a medication can be associated (but the drug’s side effects must be considered first).
In comparison with their peers, children with ADD / ADHD have difficulty focussing and maintaining their attention, whatever the activity. It often seems like they do not integrate instructions. They may suffer from difficulties:
Children with ADHD seem restless and hyperactive both mentally and physically. They may have difficulties:
This hyperactivity is particularly noticeable during tasks requiring concentration (in the classroom for example), whilst in other contexts such as during break time, the child with AD(H)D may be hardly distinguishable from the others. They may, however, be boisterous, invasive or ready for a fight. Sometimes they are unpopular and rejected by their friends who can no longer tolerate their misbehaviour and incapacity to play by the rules.
Children with ADHD may suffer from an overwhelming need to act or speak without being able to defer the urge. They have great difficulty being patient and so may:
Hyperactivity and impulsivity may make these children, who do not think before they act, who struggle to plan and anticipate their actions, take risks and put themselves in dangerous situations. This explains the amount of accidents they have at home or at school. Sufficient supervision is necessary. Their behaviour can mean that their families restrict the amount of family outings together through fear of them endangering themselves or others. They are often perceived to be unpredictable, disruptive, rude, noisy or undisciplined.
At any one point in time, our brain is carrying out complex procedures to gather and process the information it encounters. In order to do so, it uses what are known as "cognitive functions". Cognitive functions can be defined as the cerebral activities that lead to knowledge (cognition). They include all types of mechanisms for acquiring information, namely:
It is thanks to the efficiency of our cognitive functions that we can participate in the world around us and learn. When a child has difficulties learning or being in the world, it means that there are deficits or at least difficulties with one or more of their cognitive functions.
Due to the complexity of the brain and it’s functioning, an exploration of the different capacities that may have an influence on the relationship with the world and learning, is essential. For example, children with autism often display varying difficulties that should be assessed, such as emotional, social, attention, language-based and mobility impairments.
In case of a suspected attention deficit disorder, for children from the age of 6 and above, a full psychological and neuropsychological assessment should be carried out. The full assessment links together cognitive development with emotional and affective development.
* Neuropsychological assessment examines cognitive development. It analyses the totality of the cognitive (brain) functions. By exploring the symptoms displayed by the child, it enables deficits of any of the brains functions to be identified.
* Psychological assessment examines emotional development. It allows the psychologist to identify the specificities of a child’s personality and whether or not any disorder is present. It examines the following psychological aspects of the child:
If an attention deficit disorder is suspected before the age of 6, a developmental assessment can be carried out. This involves assessment of the child’s stage of development in relation to that of other children of the same age. The following aspects are examined:
A developmental assessment enables the detection of deficits as well as helping to make diagnostic hypotheses and to orient the therapeutic care plan as well as psychoeducational strategies at school and at home.
Under the age of 6, the child is in a stage of phenomenal neuronal and psycho-affective development. The diagnostic hypotheses based on the developmental assessment should be verified around the age of 6 once the brain functions are not in such a major phase of development.
As the brain functions are still in the process of developing, we cannot expect, for example, a 3-year-old to have fully developed attentional capacities and to be able to concentrate. For this reason, this cognitive cannot be assessed. Certain cognitive functions cannot be assessed before the age of 6.
Therefore, a full psychological and neuropsychological assessment at the age of 6 allows for the diagnosis to be confirmed or otherwise and for an evaluation of the totality of the cognitive functions in depth. In the meanwhile, psychological treatment can be offered to assist the child in their development.
The assessment helps to respond to several questions.
The evaluation allows for difficulties to be identified and for a diagnosis or diagnostic hypothesis to be proposed. It enables:
The evaluation can guide the follow-up treatment and maximise the learning potential and well-being of the child. The objective is to help the child to flourish on all levels - academic, social and emotional. The evaluation helps:
Parents to better understand their child, respecting the child’s limits and providing better adapted support