Minnesota Adult Basic Education Disabilities

To date, many children and adults with AD/HD are diagnosed by physicians. Some are diagnosed by psychologists or counselors. Training in specific diagnostic procedures is not well controlled and practices vary considerably.

The predominant practice at this time—whether a diagnosis is prepared by a physician, psychologist, or counselor—is to conduct an interview with parents and/or the individual and collect behavior checklists from at least two sources—typically parents, caseworkers, coworkers, and/or teachers. Many clinicians assess adults based on current symptoms without investigating childhood behavior. Both of these practices are regarded as insufficient for establishing a valid diagnosis of AD/HD.

Among persons who can demonstrate their expertise in this area, the following sets of criteria do represent a relative consensus:

1. Complete physical examination to include neurologic exam and vision and hearing tests.  Specific complaints may also justify an endocrine panel (lab tests to rule out a hormonal disorder such as hypoactive thyroid), audiology exam (to rule out a Central Auditory Processing Disorder, CAPD), a visual processing exam typically conducted by a specially-trained occupational therapist or neuro-optometrist (to rule out a visual processing disorder) and examination for sleep disorder.
2. Detailed behavioral descriptions from early childhood to the present. These are collected in face-to-face interviews, by observation, and via standardized behavior checklists designed to measure executive functions (See Resources listed below).
3. Psychological screening for co-morbid or other conditions that may mimic AD/HD—including but not limited to learning disorders, depression, anxiety, and Autism Spectrum Disorders. Physical screening is essential for addressing possible information processing disorders that appear behaviorally as AD/HD.
4. Assessment of intelligence and achievement are required to rule out learning disability, and intellectual assessment will establish whether low ability and/or certain other information processing deficits may account for behavior.
5. Neuropsychological assessment is useful for identifying impairments in executive functioning and complex attention systems. However, in Minnesota there are few people fully trained in this discipline.

An expert in AD/HD assessment is one who stays current with new research and incorporates it into his or her practice.

Behavioral Rating Scales

There are many behavioral rating scales used in diagnosing AD/HD. Keep in mind that symptoms observed in adolescence and adulthood must have been obvious to others by age seven under current diagnostic guidelines.

Conners’ Adult ADHD Rating Scales (CAARSÔ). C. Keith Conners, PhD, Drew Erhardt, PhD & Elizabeth Sparrow, PhD. MHS Publishers, 1999.  Observer and Self-Report versions and short and long formats available. Other forms available for children and adolescents in English and Spanish.

Adult Attention Deficit Disorders Evaluation Scale (A-ADDES). Stephen B. McCarney, EdD & Paul D. Anderson, SPsyS, Hawthorne Educational Services, 2007. Forms for self, home, and work available.

Conditions That May Mimic AD/HD

Information Processing Disorders

These arise from impairments in the brain’s ability to interpret incoming stimuli and make efficient mental associations between sensory data and stored information.  Symptoms associated with common disorders include:

Working Memory Deficit

• Forgetful
• Disorganized
• Anxious
• Difficulty following oral instructions
• Reduced carryover from one lesson to the next; needs rehearsal
• May be a slow reader
• Low reading comprehension and retention
• Learns better in smaller increments

Central Auditory Processing Disorder

• Poor “listening” skills—does not always receive information accurately
• Difficulty hearing in a noisy environment – seeks quiet place
• Difficulty following oral instructions – asks for repetition
• Difficulty acquiring a foreign language
• May have poor reading comprehension and spelling
• May lack organization and planning skills
• Frustrated in a classroom setting; restless
• Favors hands-on approach to learning

Slow Processing Speed

• Low academic fluency
• Poor reading rate and comprehension
• Memory improves following a delay (e.g. 15-20 minutes)
• Needs to slow down to perform accurately
• Impulsiveness due to impatience with slow processing speed
• Dreads timed tests and deadlines; may become anxious
• Marked procrastination and discouragement
• Prefers to learn one step at a time

Developmental Disorders

These also arise from neurobiological abnormalities present at birth. Symptoms appear early in development and persist into adulthood.  Symptoms associated with common disorders include:

Specific Learning Disability

• Frustration, procrastination and avoidance of difficult tasks
• Emotional displays
• Low self esteem
• Low concentration when distracted by anxiety due to fear of failure
• Fatigue due to increased effort in Learning Disability area

Nonverbal Learning Disability

• Tends to think concretely
• Struggles with map reading, charts and graphs, math, science
• Spatially disoriented; gets lost
• Frequently late
• Disorganized
• Blurts things out, insensitive to how he/she may insult or hurt others
• Tends to be clumsy, both physically and socially
  -Impairment in social interaction; i.e. does not understand non-verbal social sues such as eye contact, boundarie, speaking out of turn, poor peer relationships, etc.
  -Perseverative interests where appears to be in own world; i.e. being overly interested in one particular topic and difficulty changing topics
  -Communication impairment; i.e. delay in language development and inability to sustain conversation
• May talk too much
• Prefers rote learning mode

More information is available in the Mental Health Chapter.

Autism Spectrum Disorder

• Inattentive to environment, physical or social
• Distractible
• Poor impulse control
• Careless
• Emotional displays, irritability
• Tends to be clumsy, both physically and socially
• No real fear of danger
• Strong preference for own interests and opinions, resistant to change
• Prefers to work alone

More information is available in the Mental Health Chapter.

Borderline Intellectual Functioning

• Thinks concretely
• Easily frustrated in academic setting; gives up
• Poor retention of new information; requires much practice, slow gains
• Low reading comprehension, poor vocabulary
• Poor achievement across all academic areas
• Prefers to learn one step at a time
• Prefers hands-on learning with practical applications

Following an acquired brain injury, executive functions affecting self-management, impulsivity, attention and concentration, initiation, and organization are often impaired. Thus, a post-concussive (post-concussion) syndrome may also resemble AD/HD.

This subject is addressed in the Brain Injury Chapter.