Screening and Assessment & Intervention Tools

Screening and Assessment of Children and Youth with ADHD is a multifaceted approach that needs the involvement of many people, both with personal and professional relationships with the child. These supports can come from a range of qualified healthcare professionals such as psychiatrists, psychologists or nurses, who have training and expertise in the diagnosis of ADHD in children, adolescents and/or adults.

Generally, there are three steps involved in the screening and assessment of children and youth with AD(H)D:

 

1 – Clinical examination

Purpose:
“Clinical examination aims to identify the presence of other illnesses with symptoms that overlap with those of ADHD.
– (ADHDInstitute,2012)

This includes screening for

“vision or hearing impairments, neuro-developmental immaturity in relation to gross and fine motor functions and motor or vocal tics, and mental delays.” – (ADHDInstitute,2012)

How This Tool Is Used:
Evidence of comorbidities are also watched for closely, as the prevalence rates of these, including but not limited to, are:
– Conduct disorders (16.5%)
– Specific developmental disorders of language, learning and motor skills (15.4%)  –   – Autism spectrum disorder (12.4%)
– Intellectual disability (7.9%) (ADHDInstitute,2012)

Through these examinations, a bigger picture can be painted of the client in order to gain a more through understanding of the symptoms, issues and factors at hand. In order to plan and carry out a proper treatment plan – one that is open and fluid to the situation as it presents itself – we must remain open and educated to all that surrounds and is withing our clients.

Sleep Studies are proving to be highly valuable as 50% of children with AD(H)D also deal with sleep disturbances, such as sleep apena (“Sleep Disorders in Children”, 2012). Lack of sleep can exacerbate symptoms in children with AD(H)D and make treatment harder (“Sleep Disorders in Children”, 2012). If a child is suffering with sleep disturbances, along side AD(H)D, we must first work towards better sleeping habits to ensure successful treatment for their conditions.

Please view the link below for more information on sleep disturbances in children:

2 – Interview

Interviews will take place, conducted by a healthcare specialist, with parents, any caregivers, teachers, family members, employers, friends, to gain insight and understanding on:

– ” Observations of symptoms/behaviours in different settings
– Developmental, medical and psychiatric history
– Associated family functional difficulties/issues
– Presence of any comorbidities
Patterns of ADHD or related comorbidities present in the family.
(ADHDInstitute,2012)

A tool that is often used within these interviews are rating scales given to family, friends, teachers, excetera. I will describe two below, including their purpose and how they can be used.

 A) The Child Behavior Checklist –

ACCESSABLE THROUGH THE LINK BELOW:
http://www.aseba.org/forms/schoolagecbcl.pdf

Purpose –
This tool offers great insight into the childrens behavioral state, consisting of 202 options. The checklist offers insight into the childs, Emotions, Self-Concept, Peers/Play, School, Language/ Thinking, Concentration/ Organization, Activity Level/Motor Control, Behavior, Values, Habits, and Health (NCTA, 2008). Its main purpose is to give practitioners a wide, and quick view of the childs issues across many fronts in their lives (NCTA, 2008).

 How The Tool Can Be Used –
I recommend using The Childrens Problem Checklist early on as it lays out a good ground base. However, as this list is done by the parent/guardian, we must remember that their view of the situation their child is going through may be swayed by love, stress, or misguidance. That being said, it can also give us an insight into the parents view of their children’s behavior and offer us ideas on how we can best process with treatment and the parental influence involved.

B) SNAP-IV-C Rating Scale –

ACCESSIBLE THROUGH THE LINK BELOW:
https://www.addrc.org/wp-content/uploads/2009/10/snap-iv-form.pdf


Purpose and How The Tool Can Be Used

The purpose of the  SNAP-IV-C Rating Scale is similar to The Children’s Problem Checklist, however it is based primarily in ADD and ADHD Symptoms. It offers 90 questions that allow insight both on the hyperactivity domain of ADHD as well as the inattentive domain (A.D.DResourceCenter, 2009). It also relates questions to Oppositional Defiant Disorder and can be conducted about youth up to sixteen years old (A.D.DResourceCenter, 2009). It allows views on their behaviors, deviations between the two sub sects; ADD and ADHD, and can highlight other behavioral concerns often associated with AD(H)D (A.D.DResourceCenter, 2009). This tool is a great resource to help diagnose, organize and treat the correct issues and symptoms within the AD(H)D universe itself, assisting in drawing clear lines between symptoms that can blur together without guidance,

3) Observations

Purpose –
Observational tools are often used to gain understanding and confirm behaviors and symptoms in the child/adolescent. The purpose is to understand how the client acts and reacts in different environments and within different relationships.
Observational procedures can take place in any nearly setting, given it is allowed.

How The Tool Can Be Used –
Beyond observing our clients for their own treatment, these tools  can also be used for further study of the disorder itself. For example, a study was done in schools that observed children diagnosed with ADHD compared to those with out ADHD. This study, through observation and brain testing, discovered that children with ADHD seem to learn better when they are moving (Birak & Cuttler, 2017).

It is well known that children with ADHD have trouble keeping still during quiet times, causing a lot of educational and behavioral issues in school settings. This study seems to say that children who are moving when they are learning, are able to focus better than when they are being forced to sit still (Birak & Cuttler , 2017). If it weren’t for this observational study being done, many of us would still believe that children with ADHD have educational issues while both sitting still and while moving. Of course this doesn’t mean all children with ADHD learn better while moving, but it is prominent enough to study further on and work with within when improving our school systems.

Please view full article here:
http://www.cbc.ca/news/health/adhd-brain-1.4344754

Please view portion of Observational Study Video here:

Without observational tools used, we cannot aspire to improve our treatment abilities for the lives our clients, along side everyone who loves them.

__________________________

INTERVENTION TOOLS –

Here I will discus tools for Intervention in children with AD(H)D. While I know medication can be a successful form of treating the symptoms associated with AD(H)D, I am choosing to leave that tool out. That does not mean it has little value, however I prefer to focus on behavioral therapy tools in order to help clients relearn proper behaviors and calming techniques.

The three tools I will be discussing are –

1) Behavioral Therapy
2) Parental Skills Training
3) Exercise
________________________________________________

1) BEHAVIORAL THERAPY

What is this tool?
Behavioral Therapy is one of the most successful forms of therapy for children with ADHD, especially when paired with medication (S., 2017). When successful, behavioral therapy can teach children to calm themselves down and act appropriately, despite their initial urges. It addresses specific problem behaviors by structuring time, establishing predictability and routines, and increasing positive attention from parents and care givers (S., 2017).

How can it be used?

Behavioral Therapies involve minimizing anxieties and learning to recognize how moods can affect behaviors. One tool within this universe is Emotional Recognition Games. These can range from simple flash card games, story telling games that must involve a certain emotion within its plot, mirroring facial expression games – the list goes on and on (S., 2017) In younger children, these games are often most successful when played with their parents (S., 2017), adding to the building of closeness and giving parents many opportunities for positive reinforcement and confidence building with their children.

That being said, as AD(H)D is a nerodevelopmenatal disorder, older children and youth struggle with emotional and facial recognition in their peers, as it is a skill that continues to develop into late adolescence (Biomed, 2014). These games listed above, and heightened versions/increased difficulty over time, are valuable tools for ADHD intervention, no matter the age of the client.

Facial affect recognition is a major component of social behavior and might be partly responsible for social dysfunction described in children and adolescents with ADHD [5]. Singh et al. reported detailed emotion recognition pattern of children with ADHD between 5 and 13 years [7]. In this particular study, the authors did not study unaffected children but used emotion recognition data from other studies. Later reports with control subjects confirmed an impaired emotion recognition profile in children with ADHD compared to controls [8–16]. In the above studies, the children with ADHD were mainly under 13 years [7, 8, 10–14, 16], albeit with different methods, a rather general pattern of impaired emotion recognition was described.” (Biomed, 2014)


The tool of emotional and facial recognition is also considered a highly valuable resource for intervention and it helps the client tune into and better understand their own emotions. Especially with positive and loving communication and feed back from parents and caregivers, our clients can better recognize and respond to their emotions as they come up. In this, anxiety can be decrease through the development of knowledge and emotional understanding.  In turn, this helps them develop their social skills.

Below I will post some simple, yet effective examples of emotional and facial recognition games/educational videos on emotions that we can use with our clients:

2) PARENTAL SKILLS TRAINING:

What is this tool?
Parental Skills training is a necessity when parental coping methods are proving to be waning (ChildrensHospitalofPA, 2016). Raising a child with AD(H)D can add a heavier burden to the already lofty load many parents must carry. Considering that parental styles such as coldness, lack of attention giving, frustration based communication and “refrigerator mother” behaviors, can further develop AD(H)D symptoms, we as practitioners must work with the parents to ensure they are as well equipped with support and knowledge as their children are.

How can it be used? –
Teaching parents how to respond to their childrens behavior/symptoms with love and openness, calmness and reassuring responses, helps children learn how to regulate their emotional responses (Miller). Positive Reinforcement Behavioral Intervention is a key strategy for behavioral change in children with ADHD and there are many programs available to parents to help teach them these strategies. I will post a video below that is highly educational and effective in teaching parents how to respond and treat their children, including information on the importance of follow through in calm but sure discipline (ChildrensHospitalofPA, 2016).
“There are several kinds of parent training that have been shown to be effective, including Parent-Child Interaction Therapy (PCIT), Parent Management Training (PMT), Positive Parenting Program (Triple P). They all teach parents how to use praise, or positive reinforcement, more effectively, as well as consistent consequences when kids don’t comply with instructions. They result in better behavior on the part of children, decreased arguing and tantrums, better parent-child interactions, and reduced parental stress”  – (Miller.)

 

3) EXERCISE

What is this tool?

Regular exercise is growing awareness of importance in the world of ADHA treatment in Children, Youth and Adolescents. Regular and structured exercise as part of a treatment plan for AD(H)D is  proving to be highly successful.

How can this tool be used?
A trained Children’s Fitness Professional would first access fitness level, motor skills, behaviors, and cognitive functions with standardized tests before and after a structured fitness program (Varret, Guay , & Gardener , 2010). These tools has proven to improve motor skills, information processing, muscular capacities and behavioral reports from both teachers and parents  (Varret, Guay , & Gardener , 2010). The exercise routines can be done at home with proper guidance  and a good dose of regular cardio, such as joining a soccer team, is also highly beneficial.

This tool is a great way to reduce anxiety, improve confidence and self-belief by transforming inner self dialogue. It can be used to allow growth in these areas, as well and physical, mental and emotional capacity for challenging ones self.

_________________________________________________________________________________
REFERENCES

S., N. (2017, October 20). A Pragmatic Parent’s Guide to Behavior Therapy. Retrieved October 30, 2017, from https://www.additudemag.com/behavior-therapy-it-works/

H, Biomed (2014, July 08). Emotion Recognition Pattern in Adolescent Boys with Attention-Deficit/Hyperactivity Disorder. Retrieved October 13, 2017, from https://www.hindawi.com/journals/bmri/2014/761340/

Miller, C. (n.d.). ADHD Behavioral Treatment | Therapy for ADHD. Retrieved October 9, 2017, from https://childmind.org/article/behavioral-treatments-kids-adhd/

ChildrensHospitalofPA. (2016, June 27). Retrieved October 17, 2017, from https://www.youtube.com/watch?v=jRkNm_XayXI

Varret, C., Guay, M., & Gardener, P. (n.d.). A Physical Activity Program Improves Behavior and Cognitive Functions in Children With ADHD. Retrieved October 30, 2017, from http://journals.sagepub.com/doi/abs/10.1177/1087054710379735?ssource=mfr&rss=1

REFERENCES:

Review of Mental Health Screening & Assessment Tools (NCTA, 2008). Retrieved from https://humanservices.ucdavis.edu/sites/default/files/104056-MentalHealthLR.pdf

L. (2012, January 31). Sleep Disorders in Children. Retrieved October 31, 2017, from https://www.youtube.com/watch?v=OL-DmUrfD9o

Vanderbilt ADHD Rating Scales . (A.D.DResourceCenter, 2009). Retrieved from https://www.addrc.org/child-adolescent-screening-tests/

Assessment, ADHD Institute (2012, January). Retrieved from http://adhd-institute.com/assessment-diagnosis/assessment/

Birak , C., & Cuttler, M. (2017, October). Let them fidget: Children with ADHD seem to learn better when they’re moving. Retrieved from http://www.cbc.ca/news/health/adhd-brain-1.4344754

 

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