Attention deficit hyperactivity in accordance with Singh (2002) is a developmental disorder that is based on the brain and most often affects children. This developmental disorder can be described as a disorder that affects self-control; The main aspects are difficulty with attention, impulse control and activity levels, usually diagnosed for up to seven years (Willoughby, 2003). It is estimated that almost 4–12% of school-age children have an ADHD type (Pediatrics, 2000).
There are primarily three subtypes of ADHD. The inattentive subtype 1 is ADHD, which manifests inattention without having hyperactivity and impulsivity (Barkley, 2005). There is also ADHD subtype 2 with symptoms associated with hyperactivity and impulsivity (Barkley, 2005). Finally, there is a combined subtype of ADHD, which expresses the presence of all the main characteristics of inattention, hyperactivity and impulsivity. According to Pediatrics (2000), early diagnosis and management of these conditions can redirect these young people to achieve higher educational and psychosocial outcomes.
According to Kamphaus & Campbell (2006), the complexity and differences in the underlying symptoms regarding the nature of this disorder cause a logical assumption; that if the clinician is to test and evaluate a person for ADHD, the assessment should be dynamic using a variety of different testing scales, different methods and information that will be collected in many different environments (p. 327). Such a dynamic assessment should also take into account the presence or absence of other disorders so common in ADHD; such as disability, anxiety disorders, oppositional innocent disorders, behavioral disorders and depression (Pediatrics, 2000). The clinician in accordance with Pediatrics (2000) should understand that a thorough assessment can also take up to three visits to the patient and family.
To account for complex and dynamic variables regarding the symptoms of ADHD, there are specific processes that need to be evaluated in order to get an accurate picture for diagnosis, with particular emphasis and analysis of information received from children, parents and teachers, if possible (Barkley, 2005).
Assessment areas include several areas and data collection procedures:
1. Historical assessment (social, family, medical, prenatal / developmental and educational)
2. Using interviews, observations and exams
Figure 1.1.
Access to the full story includes several areas of assessment. According to Mercugliano, Power, & Blum (1999), a practitioner must first be aware that many of the problems that children with ADHD confrontation face will manifest themselves in areas of behavior, academies, and social interaction. Because of these problematic issues, the clinician must evaluate the history of prenatal development / development, social, familial, medical, educational, and use interviews, observation, and exams as a data collection process (Mercugliano, et al., 1999). Through data collection, DSM IV criteria should be defined and compared with patterns and consistencies that were solved by data collection (Personal Communication, Darrell Moilanen LMSW, June 21, 2007). The DSM IV criteria clearly state that 6 or more symptoms must be found either in areas of inattention or in areas of hyperactivity / impulsivity, and these symptoms must be present for at least 6 months, many before reaching 7 years of age, should create worsening and in at least two main systems, including: work, school or society (Quinn, 1997). Family, medical, educational, educational, and social histories are important for understanding whether a child’s manifestation of behavioral symptoms in several systems is the result of ADHD or a dysfunctional environment or health problems (Mercugliano, et al., 1999). ). Assessment of the educational sphere is of great importance due to the fact that many difficulties with the behavior, learning and implementation of this ADHD can be identified in the school (Barkley, 2005). As a rule, the first transition from a child’s home to spending most of his time at school is that the child is first identified as having ADHD (Barkley, 2005).
The first and main method of data collection during the interrogation of these areas includes the recommended use of semi-structured interviews (Schroeder & Gordon, 2002). When interviewing parents and children, it is important to use open-ended questions and a structured fixed format (Kamphuas & Campbell, 2006). The CAIS system or comprehensive assessment for intervention in accordance with Schroeder & Gordon (2002) is an excellent format for obtaining information in a flexible semi-structured format. For the purposes of this document, this interview is used as a guide to obtain relevant areas of information and to integrate proper assessment and testing processes in each primary area (Schroeder & Gordon, 2002). CAIS has clear and specific areas of inquiry. These include the following main areas that the clinician should consider:
1. Reason for contacting
2. Problems of social context
3. Assessment of general / specific areas
CAIS - Schroeder & Gordon, (2002)
Figure 1.2.
This survey system entails primary areas of historical analysis, as described
Mercugliano, et. al., (1999). It would be helpful to use many sources of information in the interview process; such as a survey of children, parents and teachers. This interview system is understandable when analyzing the context, the reasons for the appeal and the difficulties of interaction. This survey system also highlights general and specific concerns (Schroeder & Gordon, 2002).
Social contextual inquiry is important because of the criteria for DSM IV behavior, which, if not contextualized, may be present due to other environmental circumstances and may be a sign of another disorder. Social aspects and interactions for children with ADHD should be investigated in accordance with child and parental perceptions. The study of social interactions may indicate a dysfunction of the frontal lobe, which clearly affects the ability to recognize social signals and the suppression of the correct perception of emotional expression in social situations (Circassian-Julkowski, Sharp and Stolzenberg, 1997). The clinician should also explore transitions and adaptation problems in social situations that could lead to difficulties in understanding social interactions. According to Cherkes-Julkowski, Sharp, & Stolzenberg (1997), the Vineland social adaptive scale was reliable and can be effective in assessing a child’s social adaptive abilities. This rating scale will assess for the clinician important areas related to the symptoms of ADHD, including: communication skills, daily life skills, socialization, motor skills, and inappropriate behavior (Wodrich, 1997). Standard scoring is represented by an average of 100 (Wodrich, 1997). The clinician will look for behavioral rating areas that indicate low averages to less than averages. Below average or 85 points or less, especially with deviations of 15 points or more between other adaptive points, may indicate a serious difficulty in adaptive abilities.
A general polling request within a survey system is important for many reasons, but the key point is a study with DSM IV criteria related to the need to identify most behaviors in two specific areas or systems related to work, study or society (Kamphaus & Campbell, 2006). This area of the interview will indicate the past and current status of the physician, family characteristics, environmental characteristics, consequences of behavior, medical status, and history (Schroeder & Gordon, 2002).
Initial developmental and prenatal research will take into account the presence or historical manifestations of prenatal infections, exposure to alcohol or cocaine, increased lead exposure, smoking mother cigarettes, brain defects, syndrome disorders, genetic predisposition, and prematurely (Barkley, 2005; Quinn, 1997). According to Schroeder & Gordon (2002), despite the fact that many of these factors influence the etiology of ADHD, genetic factors are a major factor that a doctor should consider. According to Faraone, Biederman, Mennin, Gershon and Tsuang (1996), almost 84% of adult patients with ADHD had at least one child with ADHD (Schroeder & Gordon, 2002), and 52% of these adults had two or more children with ADHD According to Merkulyano, et. (1999) and Schroeder and Gordon (2002), the clinician should assess the status and developmental dilemmas, the characteristics of the child’s early temperament, and learn about the early development of motor, language, intellectual, cognitive, academic, emotional and social functioning
(Quinn, 1997; Schroeder & Gordon, 2002).
Due to problems with self-regulation of young children, the doctor must learn about the mood, adaptability, sleep, and other indicators of the temperament of babies at the beginning of an interview with their parents. An effective tool that a doctor can use or request from a pediatrician for a child and allow a mother to evaluate temperament is the Carey questionnaire, a revised question about children's temperament (Quinn, 1997). This tool measures nine areas, and the results show difficult for ordinary children in five diagnostic areas (Quinn, 1997). Actual behavioral characteristics that are assessed include; activity, rhythm, approach, adaptability, intensity, mood, perseverance, distractibility and threshold (Quinn, 1997).
According to Schroeder & Gordon (2002), if for school-age children there is a suspicion of developmental deficiencies, then psycho-educational assessment can be used to identify problem areas. The primary tools, usually associated with psychological educational assessment, in which the clinician could request results from the local school system, are the test for success in Vechsler and the Wechsler intelligence scale for children. Also important are Achenbach rating scales (CBCL) for a child, parent and teacher. Other tools used include information from the CA60's educational history and classroom information. WISC-III for measuring a child's IQ may be useful in assessing possible deviations indicating deficits in areas that may cause ADHD problems. According to Mercugliano et. al., (1999), areas that a physician should investigate regarding inattention in the results of WISC-III include areas of processing speed and freedom from distraction. Huge deviations in these areas may indicate inattention problems. Other deviations from 15 to 20 points or more between categories such as; Verbal and qualitative IQ may indicate strengths or weaknesses in working on visopathy or language (Mercugliano et al., 1999). The test of achievement of VIAT is aimed at assessing many areas in the field of educational functioning (Wodrich, 1997).
The physician should conduct a study by comparing the differences between the IQ scores and the scores in the analysis. According to Mercugliano et. (1999) a significant deviation of 12 points or more between the scale of the IQ scale and any of the subtests (basic reading, mathematical reasoning, spelling, reading comprehension, numerical operations, speech perception, oral expression and written expression) WIAT may indicate deficiencies in ability subtest limits (Wodrich, 1997). Then, it can be expected that when assessing ADHD on WIAT, it will be possible to estimate a child with a lower score (below 85 with an SD of at least 15) from their full IQ in subtesting areas, possibly indicating a learning disability. This will be consistent with current research with Barkley (2005), in which he claims that up to 25–30 percent of patients with ADHD also have learning disabilities.
The CBCL or Achenbach Behavior Rating Scale is a large-scale rating scale that should be used or results should be requested from the local school system. The CBCL can assist the clinician in assessing areas prone to DSM-IV criteria, including; understanding of behavior based on different environments (school / home), based on who is witnessing or experiencing behavior (child, parent, teacher), as well as social competence / behavior analysis based on normalized criteria of age and sex, which aims to the definition of normal Egypt is abnormal behavior (Mercugliano, et al., 1999). This rating scale is very useful in that the clinician can evaluate the associated DSM-IV problems on two broad scales of internalization and externalization (Kamphaus & Campbell, 2006). The rating scale also included eight subnets in (somatic problems, care, anxiety / depression, social problems, mental problems, attention problems, delinquent behavior and aggressive behavior) that would help the clinician determine the likely existence of any type of ADHD or some type of concomitant mental disorders
Using a CA60 review and child observation will make a big difference. Through a qualitative analysis of child observation and review of the CA60, or, despite the child’s discipline record, many behaviors could be associated with attention or hyperactive / impulsive problems, or both. The clinician may detect excessive disorganization, lack of follow-up, a child who is easily distracted, and other factors that contribute to inattention (Schroeder & Gordon, 2002). A clinician may also discover a child who is overly nervous in a classroom, acts in destructive manners, and seems to have problems waiting to turn around and presenting hyperactivity / impulsivity factors (Schroeder & Gordon, 2002). Regardless of such results, the use of psycho-educational evaluation in the course of behavioral analysis, social interactions, and clinical achievements is a priority and should be directed by a clinician or obtained from schools for testing before any likely conclusion that ADHD is present.
Identify family characteristics, environmental conditions, and behavioral consequences that help the clinician determine family structure, boundaries, expectations, and the roles of members. During this analysis, it may be useful in accordance with Mercugliano, et. (1999) to better understand the dynamics of the family and get a complete picture of how parents understand the behavioral problems of their child in perception and to the extent that they comprehend it. This will give the clinician a better understanding of the potential conflict in the family system and give a more complete picture of the behavior, and if the behavior meets the criteria of the DSM IV. Thorough research is important for many families with children with ADHD who experience very dysfunctional, chaotic, and inconsistent family systems (Circassian-Yulkowski, Sharp and Stolzenberg, 1997). Among other important issues that were reviewed by the clinician during the interview; parenting styles, genetic influences and coexisting disorders of other family members that could be identified using genealogical evaluation (McGoldrick & Gerson, 1985; Mercugliano, et al., 1999).
An assessment of health and history can help determine past medical appointments and concerns. A query can contribute to understanding whether some health problems can impede attention (Mercugliano, et al., 1999). Pharmacological considerations, comorbidities, recurring medical conditions and other problems that may contribute to DSM IV criteria and / or symptomatology of ADHD can also be identified (Mercugliano, et al., 1999; Schroeder & Gordon, 2002). Much of this information can be obtained in spite of interrogation and questioning at the first visit (Quinn, 1997; Schroeder & Gordon, 2002). For further research, a clinician would be advisable to send a child with a family for a medical evaluation; including physical and neurological examination (Mercugliano, et al., 1999). The clinician must register his interview with the child and ask the doctor if any physical abnormalities are found in the child. According to Quinn (1997), anomalies predominate, especially among children associated with hyperactivity.
Physical abnormalities that a clinician can observe in a session or through a medical survey of infants and toddlers include; fourth finger is longer than the middle; the third finger is longer than the second; the ears are set lower on the head; other anomalies of the mouth, face, and head (Barkley, 2005; Quinn, 1997). The clinician should also investigate a low birth weight history; according to Quinn (1997), low birth weight was also associated with hyperactivity, poor language skills and other difficulties. The doctor should also find out if the child has problems with the ear and / or vision. According to Schroeder & Gordon (2002), children who had problems with attention in elementary school were associated with problems of the inner ear in early childhood. Other related medical assessments that a doctor might find in confirming a diagnosis of ADHD are the use of modern technology. Хотя Barkley (2005) и Applegate and Shapiro (2005) не поддерживают последовательное использование позитронно-эмиссионной томографии (ПЭТ) или магнитно-резонансной томографии (МРТ), они утверждают, что эти процессы очень эффективны при определении структуры и функции мозга, которая связывает к наличию СДВГ. Клиницист мог использовать такие медицинские записи или предлагать родителям, рассматривая процесс, который включает в себя эти виды обследований для подтверждения физических аномалий; учитывая, что диагноз СДВГ является поведенческим образом. Согласно Barkley (2005), показания, что ADHD может присутствовать, будут включать подтверждение меньшего кровотока в области передних лобных коры головного мозга, меньшую активность мозга из лобной коры, а также меньший размер областей коры.
Конкретные области поведения, включая; постоянство поведения, изменения в поведении, тяжесть и частота относительно критериев DSM IV в отношении критериев вопроса, которые DSM использует со словами «чрезмерно» и «легко» при оценке поведения ребенка (Schroeder & Gordon, 2002) , Kamphaus & Campbell, 2006). Понимание того, было ли поведение последовательным в течение как минимум 6 месяцев и до 7 лет. будет фундаментальным (Kamphaus & Campbell, 2006). Указание поведения, конечно, поможет указать, является ли ребенок испытывает невнимательность или гиперактивность / импульсивность типов поведения, чтобы категорически идентифицировать тип присутствующего ADHD. DSM также указывает на необходимость эффективного понимания того, как происходит «часто» поведение, и именно эта частота и персистентность в определенных областях части интервью настолько важны для диагностики (Центры по контролю заболеваний, 2007; Schroeder & Gordon, 2002).
Он ясно видит, что, если клиницисты должны помочь с диагнозом детей, страдающих СДВГ, они должны использовать ряд инструментов оценки в зависимости от предпочтений и обстоятельств. Клиницист должен определить существенные особенности поведения и сравнить поведение ребенка с другими учащимися и детьми по возрасту и полу при принятии решений относительно поведения. Клиницисты должны продолжать проводить стратегии, которые отражают результаты в нескольких средах, а также от нескольких участников, которые стали свидетелями поведения. Это использование разных перспектив и получение знаний от других субъективных опытов позволило бы клиницисту получить более точный портрет обстоятельств. Большее количество характерных характеристик и согласованных взаимодействий, которые врач может извлечь из соответствующих областей жизни ребенка, а также с использованием интервью, инструментов и наблюдений, может быть получено более надежное и достоверное окончательное подтверждение диагноза. Однако, как терапевт и клиницист, моя информация и оценка могут выражать столько доверия. Что касается СДВГ, то правильный и окончательный диагноз был бы сделан врачом.
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