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Publish Date: 9/22/2005

Nomita Chhabildas — a licensed clinical psychologist at the University of Colorado Center for Attention, Behavior and Learning — tests children for ADHD. Times-Call/Erin McCracken
Health News Headlines

ADHD Testing Techniques
Identifying ADHD with non-traditional methods

BOULDER — It’s not quite an arcade.

But the University of Colorado’s Center for Attention, Behavior and Learning uses some game room-like testing to diagnose attention deficit/hyperactivity disorder.

One evaluation, for instance, tests a student’s ability to withstand boredom by randomly flashing three digital numbers on a screen.

In one test version, the child needs to focus on the middle column and hit the blue button beneath the screen when a nine follows a one.

Another test challenges the student to concentrate on the two outer columns and ignore the center one. When the left and right columns display a one and nine respectively, it’s time to hit the button.

It may sound challenging, but the test is not tough — but it is boring. So boring, in fact, that some kids start using their forehead or their foot to hit the button or they drop out, research associate Nomita Chhabildas said.

Measuring attention span isn’t easy, she added. But she opened the center within the psychology department last fall with associate professor Erik Willcutt to conduct comprehensive assessments on a sliding-fee scale and research potential treatments for ADHD.

All tests — from the red-and-white visual-spacial orientation block puzzles to standardized intelligence tests — ultimately help center assessors determine what disorder or disability drives a client’s behavioral problems.

In-depth interviews, though tricky, also help.

“In general, it’s very hard for a child to talk about difficulties and their weaknesses,” Chhabildas said. “They want to present the view that ‘I’m not having trouble.’”

So, she asks all sorts of questions, from the true-false variety — such as “Even when I really try hard at something I fail” — to more open-ended queries that can be revealing.

Asking clients what they would want if they could have three wishes granted fits in this category, Chhabildas said.

A combination of standardized and creative comprehensive testing still leaves too much gray for some, according to Willcutt.

“A lot of parents want a blood test or a computer test to say definitely whether the child has ADHD or not,” he said. “We all wish we had that, but we don’t have it now.”

Information revolution

Still, since physician and poet Dr. Heinrich Hoffman first described the syndrome in 1845 and later wrote a children’s book based on this type of character — “The Story of Fidgety Philip” — scientific inquiry has passed many milestones.

For instance, we now know that the inattention, hyperactivity and impulsivity that define ADHD don’t stem from poor parenting.

Though environment plays a role, the National Institute of Mental Health in Bethesda, Md., considers this disorder biologically based.

NIMH has reported studies that show 25 percent of close relatives in the families of those with ADHD also have the disorder, which shows up in about 5 percent — about 2 million American kids — of the general population.

Also, ADHD now encompasses three distinct behavior subtypes, which require more sophisticated assessments to determine the most effective treatments.

A predominantly hyperactive-impulsive person does not show significant inattention; a predominantly inattentive type does not show significant hyperactive-impulsive behavior and was once referred to as attention deficit disorder; others exhibit both behaviors.

Since most children display inattention, hyperactivity and impulsivity, diagnosis hinges on the affect of symptoms on daily life.

If symptoms show up by age 7, persist six months or more and interfere with a child’s performance at school, on the playground and at home, a comprehensive assessment is in order, according to the Washington, D.C.-based American Academy of Child & Adolescent Behavior’s Web site.

Chhabildas tests over several days in many ways because so many factors, including the nature of the testing environment, can blur assessments.

For example, testing at the center happens in a mostly distraction-free quiet room with one-on-one instruction. The highly structured environment represents an ideal setting for someone struggling to sit still and pay attention.

Still, thorough assessments will slowly but surely rule out red herrings that could skew results, such as the death of a parent or grandparent, undetected seizures, hearing problems, anxiety or depression and other undiagnosed learning disabilities.

On target?

Getting an accurate diagnosis, especially since NIMH reports between 20 and 30 percent of people with ADHD also have a learning disability, is critical to ensure the best chance at successful living.

Many parents go straight to a family doctor when a child’s behavior becomes worrisome. “But the medical profession is so far behind the eight ball in understanding ADHD,” Pat Tomlan of PST Educational Consultants in Highlands Ranch, said. “They go with parental frustration, checklists and subjective observations.”

Part of that trend reflects practicality. Only a doctor can prescribe the stimulants or antidepressants used to treat ADHD.

“If you go to a pediatrician, they are able to look at some pieces of the puzzle, but may not be able to assess a child’s learning in-depth,” Chhabildas explained.

So Tomlan, like CU’s center assessors, uses comprehensive testing to assess symptoms and information processing. Predominantly inattentive ADHD types, for instance, struggle mightily with short- and long-term memory. So, Tomlan uses standardized tests to measure the extent of that impairment. One test assigns different values to symbols — say the color green to a star and orange to a triangle. A week later, she can determine something meaningful about visual and language-based retention by counting how many of those association’s a client remembers.

In another test, the client listens to a story and then immediately recaps the events, which indicates the quality of language-based short-term memory. Another story recap a week later helps Tomlan determine long-term memory retention.

Ultimately, accurate assessments help parents and teachers become more proactive in helping children succeed, said Jeanie Margheim, a special education teacher at Westview Middle School in Longmont.

She said she has taught students with ADHD who would be distracted by the sound of their own pencil on paper.

But knowing they are in her room with ADHD, not just a learning disability, helps her and fellow special education teacher Liz Christian get creative to minimize distractions and maximize learning.

One student wore ear plugs. Another played with Silly Putty in one hand while writing with the other.

They’ve provided special notebooks labeled “Work to be Done” and “Work Completed” to help students with ADHD stay organized and recommended accordion versus zip folders for the same reason.

“Why would a group of teachers go to a shoe store and all get a size 7?” Margheim said. “Modifications are good for all kids.”

ADHD symptoms

• Trouble paying attention

• Inattention to details and makes careless mistakes

• Easily distracted

• Loses school supplies, forgets to turn in homework

• Trouble finishing classwork and homework

• Trouble listening

• Trouble following multiple adult commands

• Blurts out answers

• Impatience

• Fidgets or squirms

• Leaves seat and runs about or climbs excessively

• Seems “on the go”

• Talks too much and has difficulty playing quietly

• Interrupts or intrudes on others

Source: American Aced. of Child & Adolescent Psychiatry For more info. Call the Univ. of Colorado’s Center for Attention, Behavior & Learning at 303-492-6351.

Pam Mellskog can be reached at 303-684-5224, or by e-mail at pmellskog@times-call.com.


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