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ADHD, 2.06 (V) Aligning Assessment with Treatment

So now we're gonna talk about diagnosing ADHD with an emphasis on identifying areas of impaired functioning. And then we'll move to how can we take this diagnostic information and begin to align it with treatment planning. Really our key goal. Because impairment is a critical part of diagnostic criteria, its important to assess for as a standard part of our work with families where we're try to find out is in the ADHD present. This is because impairments integrate into every aspect of the ADHD diagnosis. We know that parents don't bring kids to treatment because of the ADHD symptoms. No parent comes in and says, yes I think my child is often easily distracted by extraneous stimuli and that's why I want them treated for ADHD. They say instead, my child can't ride the bus anymore, because the bus driver kicked them off because they wouldn't sit in one seat and kept hopping around while the driver was trying to be driving. Or you know what, my child hasn't been invited to a play date all year. Or my child is failing math and social studies and English. And it's not because she's not smart it's because she hasn't handed in one homework assignment this whole entire semester and you know what I know the homework was done, because we took hours to get it done. She's just so disorganized that she can't figure out how to get it from home, to her backpack, to her locker, to her class. Those areas of impairment are really what's causing the person to seek treatment. And so, if we're gonna do a good job as treatment providers we have to be addressing those. Finally, it's those areas of impaired functioning, academic functioning, peer relationships, that predict longterm outcomes. So if we're really interested in helping this child develop into a stronger individual with more skills and tools to cope with the things that happen every day to them, we really have to be addressing the areas of impairment if we really wanna mediate the important long term outcomes. Now, there are measures of impairment available. So the Columbia Impairment Rating, the Global Assessment of Functioning, an Impairment Rating Scale. And then, lots of other scales that focus on one particular domain of impairment, say peer relationships, academic progress, family functioning, all of those could be part of a comprehensive assessment battery that a clinician uses to determine the levels of impairment for the child. Our Impairment Ratings Scale was developed by Bill Pelham and I, and others within the centers for children and families. It's short and only includes six or seven items and it's easy to fill out. The teacher or parent just puts an x on the line from not a problem at all definitely does not need treatment or special services to extreme problem definitely needs treatment or special services. And there's also a space for the parent or teacher to write in. What they were thinking when they answer that question? This becomes a very clinically rich tool for treatment providers cuz it tells them exactly what it was that the parent or teacher wants to see addressed to see improvement in a treatment effort. By the way it's available online and free to use. Any clinician can use it in any clinic or any school across the country if they wanted to. Once we have identified that the child has ADHD, really our diagnostic decision-making process is over, but our assessment process is not over. We should now immediately move to figuring out how we can inform treatment, progress monitor, and evaluate treatment efforts through our assessments. So that means we have to identify the impaired areas of function. We have to operationalize target behaviors now. What is it that we're hoping our treatment is going to tackle? We conduct functional assessments of the antecedents and the consequences of targeted behaviors so that we can better figure out the best way to help the child. So for example, if we're thinking about problem being non-compliance, and to that might include the commands that are being given by the parents or teachers, we can change those in a way to make a more likely to child exhibit compliance instead of non-compliance. And we also have to think about the consequences of non-compliance. Is the child sometimes allow to avoid the task they dislike because they just don't do it? If that's the case, we have to figure out a way to help the parent and teacher promote the child's completion of that task so that they don't get a secondary benefit of escape or avoidance by the negative behavior. We have some examples in this slideshow of outlines that can be used for helping a clinician determine the child's impair behaviors, helps them operationalize the targets, and then figure out what might be triggering or resulting from the negative behaviors. [COUGH] Another tool that we use successfully in our treatment is a daily report card. A daily report card is simply a list of the operationalized target behaviors. It's evaluated by a teacher and or could be a parent each day where they circle whether the child met or did not meet a behavioral goal. And this is given every day, so it's a clean slate every morning, it's filled out again. It becomes a running record of the child's performance in the school setting or the home setting, and it helps a clinician identify areas that are being successfully treated as well as areas that are not being successfully treated and need more attention and different intervention. So in summary, there's considerable psychometric information available that supports ADHD assessments for diagnosis. We can do diagnosis relatively easily using a procedure where we have parent and teacher rating scales, a parent interview, and perhaps a child evaluation with the parent to rule out other comorbid reasons for the symptoms that are present. Once we figure out the diagnoses we should move immediately to focusing on treatment planning. We don't need to do more diagnostic procedures like computer based tests or costly observations to simply continue to admire the problem that the child has ADHD related behaviors. We should be moving towards assessments that help us change the environment to support the child and help them be more successful. Therefore, the focus of assessment activity should be weighted toward those that facilitate our treatment planning, our treatment modification, and our treatment evaluation. In a moment we're gonna move to module three where we start to discuss how we might best treat ADHD in a school setting.



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So now we're gonna talk about diagnosing ADHD with an emphasis on identifying areas of impaired functioning. And then we'll move to how can we take this diagnostic information and begin to align it with treatment planning. Really our key goal. Because impairment is a critical part of diagnostic criteria, its important to assess for as a standard part of our work with families where we're try to find out is in the ADHD present. This is because impairments integrate into every aspect of the ADHD diagnosis. We know that parents don't bring kids to treatment because of the ADHD symptoms. No parent comes in and says, yes I think my child is often easily distracted by extraneous stimuli and that's why I want them treated for ADHD. They say instead, my child can't ride the bus anymore, because the bus driver kicked them off because they wouldn't sit in one seat and kept hopping around while the driver was trying to be driving. Or you know what, my child hasn't been invited to a play date all year. Or my child is failing math and social studies and English. And it's not because she's not smart it's because she hasn't handed in one homework assignment this whole entire semester and you know what I know the homework was done, because we took hours to get it done. She's just so disorganized that she can't figure out how to get it from home, to her backpack, to her locker, to her class. Those areas of impairment are really what's causing the person to seek treatment. And so, if we're gonna do a good job as treatment providers we have to be addressing those. Finally, it's those areas of impaired functioning, academic functioning, peer relationships, that predict longterm outcomes. So if we're really interested in helping this child develop into a stronger individual with more skills and tools to cope with the things that happen every day to them, we really have to be addressing the areas of impairment if we really wanna mediate the important long term outcomes. Now, there are measures of impairment available. So the Columbia Impairment Rating, the Global Assessment of Functioning, an Impairment Rating Scale. And then, lots of other scales that focus on one particular domain of impairment, say peer relationships, academic progress, family functioning, all of those could be part of a comprehensive assessment battery that a clinician uses to determine the levels of impairment for the child. Our Impairment Ratings Scale was developed by Bill Pelham and I, and others within the centers for children and families. It's short and only includes six or seven items and it's easy to fill out. The teacher or parent just puts an x on the line from not a problem at all definitely does not need treatment or special services to extreme problem definitely needs treatment or special services. And there's also a space for the parent or teacher to write in. What they were thinking when they answer that question? This becomes a very clinically rich tool for treatment providers cuz it tells them exactly what it was that the parent or teacher wants to see addressed to see improvement in a treatment effort. By the way it's available online and free to use. Any clinician can use it in any clinic or any school across the country if they wanted to. Once we have identified that the child has ADHD, really our diagnostic decision-making process is over, but our assessment process is not over. We should now immediately move to figuring out how we can inform treatment, progress monitor, and evaluate treatment efforts through our assessments. So that means we have to identify the impaired areas of function. We have to operationalize target behaviors now. What is it that we're hoping our treatment is going to tackle? We conduct functional assessments of the antecedents and the consequences of targeted behaviors so that we can better figure out the best way to help the child. So for example, if we're thinking about problem being non-compliance, and to that might include the commands that are being given by the parents or teachers, we can change those in a way to make a more likely to child exhibit compliance instead of non-compliance. And we also have to think about the consequences of non-compliance. Is the child sometimes allow to avoid the task they dislike because they just don't do it? If that's the case, we have to figure out a way to help the parent and teacher promote the child's completion of that task so that they don't get a secondary benefit of escape or avoidance by the negative behavior. We have some examples in this slideshow of outlines that can be used for helping a clinician determine the child's impair behaviors, helps them operationalize the targets, and then figure out what might be triggering or resulting from the negative behaviors. [COUGH] Another tool that we use successfully in our treatment is a daily report card. A daily report card is simply a list of the operationalized target behaviors. It's evaluated by a teacher and or could be a parent each day where they circle whether the child met or did not meet a behavioral goal. And this is given every day, so it's a clean slate every morning, it's filled out again. It becomes a running record of the child's performance in the school setting or the home setting, and it helps a clinician identify areas that are being successfully treated as well as areas that are not being successfully treated and need more attention and different intervention. So in summary, there's considerable psychometric information available that supports ADHD assessments for diagnosis. We can do diagnosis relatively easily using a procedure where we have parent and teacher rating scales, a parent interview, and perhaps a child evaluation with the parent to rule out other comorbid reasons for the symptoms that are present. Once we figure out the diagnoses we should move immediately to focusing on treatment planning. We don't need to do more diagnostic procedures like computer based tests or costly observations to simply continue to admire the problem that the child has ADHD related behaviors. We should be moving towards assessments that help us change the environment to support the child and help them be more successful. Therefore, the focus of assessment activity should be weighted toward those that facilitate our treatment planning, our treatment modification, and our treatment evaluation. In a moment we're gonna move to module three where we start to discuss how we might best treat ADHD in a school setting.


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