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You will be reading about assessment, use of the DSM-IV-TR and 5 and diagnosis. Diagnosis is a complex undertaking. Over-diagnosis occurs all the time. A prime example of this is the diagnosis of ADHD in children and often, with that, initiation of a prescription for medication. I have parents bring their children in to see me for assessment and evaluation, often, after their child has already been diagnosed by their pediatrician or family doc. Often, a diagnosis of ADHD that happens in the context of a pediatrician's office involves the doctor having the parent(s) and sometimes the teacher each complete a Vanderbuilt ADHD rating scale. If a child meets the criterion cut-off, a diagnosis of ADHD is made. FYI, some may be confused about the ADHD label. In the general public you will often see "ADD" referenced when there is thought to be primarily an attention deficit and "ADHD" when hyperactivity/impulsivity are prominent. In the DSM-5, the diagnosis occurs in one of three ways: Attention-Deficit/Hyperactivity Disorder: Predominantly Inattentive Type, Attention-Deficit/Hyperactivity Disorder: Predominantly Hyperactive/Impulsive Type or Attention-Deficit/Hyperactivity: Combined Type.
Getting back to the discussion: I will often see a child in my office carrying with them an ADHD diagnosis, sometimes also on medication. The problem is (generally if they are in to see me) that parents, teachers, etc. are failing to see significant improvements in behavior, ability to be successful at school, learn and retain new information, etc. More startling, there may also be troubling side effects present such as failures to make appropriate weight gains, sleep disturbance, tummyaches, and/or significant changes in personality. What I generally tell parents is that, to make a diagnosis solely off of the completion of a objective report measure is inadequate. As your book notes, consideration of a number of factors are required: developmental history, family predispositions, school functioning, ruling in/out physical causes to symptoms, ruling in/out environmental stressors/big changes, etc. to name but a few. I also conduct neuropyschological testing: I generally will do an examination of IQ/cognitive functioning, an assessment of achievement functioning, assessment of executive functions (such as sustained and selective attention abilities, cognitive flexibility, planning and organizational abilities, etc.-deficits in executive functions are thought to manifest as symptoms of ADHD, so obviously this would be an important piece of an evaluation), memory, and learning style, and emotional and behavioral functioning.
I also often tell parents that what looks like ADHD, can in fact be thirty different things (or perhaps difficulties that do not meet clinical criteria at all). At times when I conduct an evaluation, I find adequate evidence to support diagnosis. Other times, I uncover something completely different that necessitates a whole other treatment approach. Examples of factors/issues that may manifest as ADHD? Speech/language difficulties, anxiety, low cognitive functioning (either Borderline Intellectual Functioning, or in some cases, Intellectual Disability) and sensory processing issues, to name just a few.
Ok, so this week is not meant to be a discussion about ADHD, rather a discussion regarding assessment and diagnosis. I want you to try and think openly and flexibily about this topic. There is a lot out there about the negatives of diagnosis. To be certain, while inappropriate or inaccurate diagnosis can be made, and does happen, all of the time, identification of an issue if there is in fact one present, can be pivotal in then identifying appropriate intervention or treatment (and this does not mean just identifying the appropriate medication but the appropriate treatment, medication or not) and improving a person's life. I want you to consider both sides of this. The reliance on medication to the proportion that it is is troubling no doubt, but in some cases can be an important part of a treatment plan. My point is that there are often pros and cons to any aspect of an issue when are considering an important topic such as this, and I want you to think about this as you consider this week's material.
You will be reading about assessment, use of the DSM-IV-TR and 5 and diagnosis. Diagnosis is a complex undertaking. Over-diagnosis occurs all the time. A prime example of this is the diagnosis of ADHD in children and often, with that, initiation of a prescription for medication.