Family Focused Evaluations

One of my primary values in completing evaluations, especially for children and teens, is an emphasis on family's understanding the nature of how their child works and the impact that various diagnoses have on their functioning. Given the fact that ADHD is highly heritable (approximately 90% heritability rate), I encourage all parents of a child or teen to be present for the evaluation process. Chances are, if a child or teen is diagnosed with ADHD, then at least one of the parents and likely other children in the family also have ADHD. And what is always interesting to see, is how entire families can have ADHD and each member can present entirely differently.

The initial portion of my evaluation involves an intake process. It generally lasts at least one hour, but at times goes much longer. As I gather information on a child or teen's history of functioning and symptoms in specific executive functioning domains, I also provide education to families about how that particular symptom may present differently in other family members. ADHD symptoms are often best considered as existing on a continuum, and how individuals uniquely adapt to their symptoms (often trying to conceal them from others) will also impact how symptoms are or are not visible to others (e.g., females often minimize impulsivity and hyperactivity symptoms from an early age). I routinely have other family members smiling, laughing, and identifying symptoms for themselves (or others) that they would never have previously considered being related to ADHD. Parents understanding their own ADHD symptoms is often crucial for them to effectively understand their child's symptoms and functioning.

I began taking this approach several years ago as I realized families were not receiving effective education on ADHD. And these often included families who had multiple family members on medications for 10 to 20 years. They were unable to pinpoint symptoms occurring in the room such as word retrieval and speech organization difficulties, hyperactive thought process, variable working memory, use of vocal self-stimulations and fidgeting to promote greater focus, nuances of emotional dysregulation, how impulsivity presents in females, etc.

Moments of executive functioning symptoms pointed out and discussed during the intake and later testing portion of the evaluation help to provide real world experience in identifying what is going on for an individual's executive functioning from moment to moment. These observable instances then provide anchor points to refer back to when discussing cognitive results from testing. It is extremely validating for individuals and parents to be able to see and understand the nature of variable executive functioning throughout the evaluation process. And this frequently opens a door for whole families to do this together. To understand one another, to shame others less about their symptoms, to feel less shame about having ADHD, to advocate for support when needed, and to provide support where others need it most.

During the feedback portion of the evaluation, I spend considerable time educating families on research about effective treatments for ADHD, particularly related to the often misperceived stimulant medication option. I am not a prescriber and refer out for medication management. My goal is not to pressure individuals into pursuing medication treatment for ADHD, but that they are better informed to make the right treatment options for everyone in the family.

The evaluation process I have developed is uniquely geared for families and for understanding the particular nuances of an individual's symptom presentation, compensation strategies for those symptoms, and overall functioning strengths and weaknesses. It is not for everyone. Many prefer the cheaper and faster route of seeking ADHD diagnosis via a prescriber of some form. If that is what you are looking for, I will be the first to tell you to take that route. Just be sure that you are finding a provider who truly understands the nature of ADHD, outside of the stereotypical symptom presentation, which usually only includes Inattention, Hyperactivity, and Impulsivity. This model limits who will be diagnosed with ADHD, and highly favors diagnosis of 5 to 8 year old males with a classic hyperactive/impulsive presentation. Females, older individuals, and intelligent individuals with ADHD will often not be diagnosed with those criteria alone. And if there is anything we know about ADHD, it is that it runs throughout families regardless of age, gender, or level of intelligence.