ADD and ADHD
What is Attention Deficit Disorder (ADD) and Attention Deficit Hyperactivity Disorder (ADHD)?
ADD/ADHD is not new. It has been in medical literature for over a hundred years, and it affects over 8 percent of the population. The ratio of male to female is 3 to 1 with the age range from young children to senior citizen. The prevalence of ADD/ADHD is worldwide, and the U.S. ranks third worldwide.
ADD ADHD is a diagnosis applied to individuals who consistently display certain behaviors over a period of time. The most common features include:
- Distractibility (poor sustained attention to tasks)
- Impulsivity (impaired impulse control and delay of gratification)
- Hyperactivity (excessive activity and physical restlessness).
In order to meet diagnostic criteria, these behaviors must be excessive, long-term, and pervasive. The behaviors must create a real handicap in at least two areas of a person’s life, such as, at school, work, home, or social settings. These criteria set ADHD apart from the “normal” distractibility and impulsive behavior of childhood, or the effects of the hectic and overstressed lifestyle prevalent in today’s society.
However, in the recent years, ADD/ADHD, through the use of SPECT scan and/or Quantitative EEG (QEEG), has shown up to seven different subtypes.
Depending upon what type of brain scan the subtypes are labeled as follows:
- Frontal Beta
- Frontal Alpha
- Frontal Theta
- SPECT Scan:
- Over focused
- Temporal Lobe
- Ring of Fire
ADD/ADHD is most likely caused by biological factors that influence neurotransmitter activity in certain parts of the brain. According to research, lower levels of activity in some parts of the brain may cause inattention and other ADD/ADHD symptoms. ADD/ADHD usually persists throughout a person’s lifetime.
While genetics, maternal alcohol or drug use, birth trauma, jaundice, brain infections and head trauma can play a causative role in ADD symptoms, the increase in ADD is most likely related to influences in our world today that negatively affect brain function, including:
- Limited physical education in school
- Excessive use of video games
- Diets filled with processed foods
- Exposure to environmental toxins (i.e. pesticides in the food supply)
An accurate assessment must be done, which Dr. Diane® and her team of Brain Health Experts do by looking at many aspects of the person through her 5 Prong approach.
Dr. Diane® and her Brain Health Experts work as a unified team, which strongly believes that regardless of the presenting problem or situation, you as a person should be seen from the five distinct views that make up our approach: physical, psychological, emotional, spiritual, and energy. Often these areas intertwine, yet Dr. Diane® looks for the core issue. Once the assessment is done, your individual treatment program is developed based on conventional, complimentary, and alternative treatment methods. These methods are often modified and customized to meet your specific needs as you progress in regaining your life.
Specialists in the Field of ADD ADHD Diagnosis
Behavioral Neurologist: A Neurologist with a sub-specialization in the branch of Neurology pertaining to changes in a person’s behavior, personality, or intellect due to brain damage. Dr. Jorge Gonzalez, M.D., is our Behavioral Neurologist on the Dr. Diane® Brain Health Team.
An in-depth Neurological evaluation has several parts. The first step is to obtain detailed information about the circumstances of the injury and resulting symptoms. This includes a thorough medical history, including family history, prior illnesses, injuries or infections, and information about developmental milestones such as walking, talking, and social skills. Also requested is information about alcohol and medication usage, as well as use of recreational substances, and any history of psychological trauma. The Neurologist also gathers information about hearing, vision, sleeping, work- or school-related interactions, and physical appearance.
Next is a test of the cranial nerves. This provides information about vision, taste, facial expression, chewing, swallowing, balance, and the ability to speak. You may be asked to smile, follow the doctor’s finger with your eyes, or listen for certain sounds during this part of the exam. Then, components of motor function will be assessed, including walking, the ability to stand on one foot, blinking, mouth movements, and eye-hand coordination. In addition, the evaluator may request specific diagnostic tests to determine the nature of the suspected brain injury. He or she may also refer you to a Neuropsychologist for an evaluation of your current level of functioning.
Neuropsychologist: A licensed Psychologist with specialized training and/or board certification in the assessment of brain function. Dr. Diane® is a Neuropsychologist and a board certified Health Psychologist.
There are two vital components to evaluating the brain: its structure and how it is functioning. Tests that evaluate the structure of the brain look at the location of injuries to the brain, such as the gray mater, white matter, or vascular system. Tests of function, on the other hand, provide information on how well the brain is able to perform any given task. The following are some of the neurodiagnostic measures most frequently used with ADD/ADHD patients. These are divided into tests based on blood flow in the brain, and tests based on the neuro-electrical system and neural connectivity. For more in-depth information, it is important to consult with your Physician or Neurologist about the diagnostic method best suited to your circumstances.
Single Photon Emission Computed Tomography (SPECT) Scan:
The procedure is similar to the PET scan in that it produces a three-dimensional image of the brain, but it is not as expensive or precise. However, the SPECT scan does provide ready information about abnormalities and circulation within the brain. It creates an image whose color and intensity reflect the amount of circulation activity present in that area of the brain, which can be compared to scans of other brain regions. Areas of damage show less or abnormal activity compared with that in the corresponding area of the opposite hemisphere. The SPECT scan can also be used to correlate the results of other procedures, including neuropsychological tests. Together with the neuropsychological testing, the SPECT scan is one of the procedures most frequently used to evaluate people with suspected ADD/ADHD.
Quantitative Electroencephalogram (qEEG):
This diagnostic test is a computerized EEG that can detect not only dysregulation of neuroconnectivity, but can also determine the brain’s level of communication and function between the hubs. This technique involves recording brain waves as signals played into a computer. The technician measures the time delay between nerve impulses, as well as the time it takes for signals to be transmitted from one region to another. By comparing this information to certain standards, a specialist can often detect and diagnose a neurological basis for mTBI symptoms, linking brain injury to brain behavior.
One of the fascinating applications of qEEG data is the Loreta program, which configures the data into a deep image of the brain and reveals the area of dysfunction. It displays damage due to shearing and tearing of individual neurons, as well as the changes in timing and disorganization of brain rhythms that do not show up on x-ray and are not detected by visual examination of a standard MRI. The procedure takes about two hours and is painless.
A neuropsychological workup evaluates the effect of brain dysfunction on your emotional state, behavior, and mental functioning, and assesses discrepancies between your current and former skills and behavior. This evaluation provides a great deal of information about specific neurological deficits and the prognosis for recovery. The testing is done by a Neuropsychologist who specializes in the emotional, behavioral, and cognitive problems that stem from ADD/ADHD, and involves a careful review of your medical history and school and employment records. This is followed by a series of tests that measure a variety of cognitive and other skills, as well as various aspects of your personality and social behavior, under conditions that mimic those of normal living. A comprehensive neuropsychological examination takes between six and eight hours.
Some of the tests that may be included:
Intelligence Tests: These tests measure verbal and nonverbal abstract reasoning and general intellectual capability. Examples include the Wechsler Adult Intelligence Scale (WAIS) and the Wechsler Intelligence Scale for Children (WISC-R).
Sensory Perceptual Function test: The ability to perceive sensory information can be assessed by the Halstead-Reitan Neuropsychological Battery (HRNB), the Tactual Performance Test, and the Sensory Perceptual Examination.
Academic Skills Tests: These survey basic academic skills and reading comprehension. Examples include the Nelson Denny Reading Comprehension Test and the Wide Range Achievement Test.
Language Skills Test: These tests are designed to measure your ability to understand and use language. Examples include the Peabody Picture Vocabulary Test and the Boston Naming Test.
Non Verbal Reasoning Test: This test measures the ability to establish, shift, and maintain thought processes. An example is the Wisconsin Card Sorting Test.
Visual Perception Skills Tests: These are done to evaluate the ability to perceive visual information. An example is the Hooper Visual Organization Test.
Memory Tests: These tests assess verbal and nonverbal memory skills. Examples include the Wechsler Memory Scale and the California Verbal Learning Test.
Personality Tests: These assess personality issues related to depression and anxiety. Examples include the Beck Depression Inventory and the Minnesota Multiphasic Personality Inventory.
The results of these tests are compared with your estimated level of functioning before injury and matched with your reported neurological symptoms. The relationships among the various deficits revealed during testing are also examined. This helps the Psychologist to separate the effects of secondary problems from symptoms that are a direct result of brain trauma. This kind of evaluation can also lead to specific suggestions about the treatment of symptoms. Neuropsychologists are perhaps the best source of information about rehabilitation and coping techniques, and can suggest approaches to recovery that are tailored to your particular needs.
Cognitive Remediation Therapy
Cognitive Remediation Therapy (CRT), also called Cognitive Enhancement Therapy (CET), is the assessment and treatment of cognitive skills, including memory, attention, and executive functioning. Cognitive remediation is used for those experiencing cognitive deficiencies like ADD/ADHD that interfere with day-to-day functioning. Amy Karas MS, CCC-SLP Speech-Language Pathologist is our Cognitive Therapist. She can assess and evaluate the specific needs and areas of attention. She specializes in cognitive, social pragmatics and language treatment, with an emphasis on providing functional therapy strategies/systems and restoring skills when able. Amy’s approach emphasizes understanding what someone needs to improve quality of life, task efficiency and effectiveness, and maximizing independence. Language treatment includes, but is not limited to, addressing receptive and expressive language skills, developing AAC systems, and advocating for needs.