People often ask, “What’s the difference between ADD and ADHD? There have been several names for the same disorder, but ADHD, which stands for attention-deficit/hyperactivity disorder, is the current accurate medical term. There are three subtypes of the disorder: inattentive, hyperactive-impulsive and combined. For example, ADHD Inattentive Type replaced the former term ADD. A diagnosis of ADHD means that the problem behavior is beyond the normal limit for the individual’s age and gender. It is easy to err on one side of the spectrum or the other—friends and relatives may tell you, “All children act like that—that’s not ADHD” or alternatively, just because a child does have symptoms of inattention, impulsivity, or hyperactivity does not mean that he or she has ADHD. Many other things can cause symptoms that are identical to the symptoms of ADHD. Before an accurate diagnosis of ADD / ADHD can be made, it is important that a professional explore and rule out the following possible causes of the ADHD-like symptoms:
	Major life events or traumatic experiences that have caused stress (e.g. a recent move, death of a loved one, bullying, illness, divorce). Learning disabilities or problems with reading, writing, motor skills, or language. Psychological problems including anxiety, depression, and bipolar disorder. Behavioral disorders such as conduct disorder and oppositional defiant disorder. Medical conditions, including thyroid problems, neurological conditions, epilepsy, and sleep disorders. A neuropsychological evaluation is a comprehensive evaluation that directly measures an individual’s attention skills and capabilities in addition to other cognitive skills. Neuropsychological assessment may also uncover problems in other areas that masquerade as attention problems but are not primarily attention problems (i.e., anxiety, learning disability, etc.).  A neuropsychological evaluation is preferred when an individual presents with problematic symptoms in order to prevent missing other disorders that commonly co-occur with ADHD symptoms.  However, an ADHD evaluation is an abbreviated neuropsychological evaluation that can diagnose or rule-out ADHD or attention problems.

You’ve reasoned, pleaded, and even bribed your child. You’ve taken away everything in his room—even the carpet. You’ve read up on the Top 10 Strategies to Get Your Child To Complete Homework and complied with all the advice—created a specific place to complete homework, , removed distractions, made yourself available for assistance, made use of a timer, etc. You were embarrassed to read the comments on your child’s last report card: Timmy will learn best if he actually completes his own homework. Thank you for your understanding. You even made a recording of yourself saying, “Finish your homework”, which you play back in 30 second intervals during homework time to avoid losing your voice.  None of these things have worked consistently, so you finally blurt out the unimaginable to your child…”I hate homework!” Oops. But we understand. Consider a few other possibilities:

1. Timing is everything. Although your eldest son, who is now at Harvard, used to come home and complete his homework right away, what works for one child may not work for the other child.  Avoid comparisons and experiment with the best time for homework, which also may change weekly or daily: right after school while his mind is still “on”, after a snack, after some “down time”, after dinner, etc.
2. “Some things are just hard” versus Learning Disability or ADD/ADHD. Your child may fall on a continuum of having homework that is too difficult for them to complete or having a learning disability.  Some thing to rule out is whether your child received adequate instruction on how to complete the homework or if this subject matter is an outright challenging topic. Other considerations are whether your child consistently has problems in a specific subject despite adequate instruction, or is she distracted during homework regardless of the subject matter.
3. Occasional forgetfulness versus Executive Dysfunction. Your child may also fall on a continuum of forgetting homework occasionally to clinical chronic disorganization.  Executive dysfunction is a fancy word to describe a deficit with the set of brain processes that help us plan, organize, self-monitor, and follow-through on thoughts and behaviors. If your child occasional forgets to write down his homework or bring home the necessary supplies, he may simply need a strategy to help avoid those mishaps in the future.  Other children will chronically forget to write down homework assignments, write down assignments incompletely or incorrectly, forget books or supplies, or even complete the homework but forget to turn it in!  This is frustrating to the child, the teacher, and the parent.  Poor grades are earned that do not reflect the true ability of the child.
4. Typical emotions versus Emotional Dysregulation . The cognitive resources your child needs to focus on her homework are being used to “work through” or manage a negative emotional state she is experiencing, which makes it difficult to concentrate. These typical emotions may require your child to talk about her day or sort through a social or personal problem on her mind before she tries to tackle homework.  A teenager may prefer to do this with a close friend (No offense, mom and dad!). Other kids may experience more intense emotions such as a level of anxiety that stems from needing their homework to be perfect—they may procrastinate in order avoid the frustration of not meeting a specific standard.  Bright students may even complete their homework, but then neglect to turn it in because they aren’t satisfied with it, don’t feel that it reflects their true ability, or don’t want their teacher to evaluate it.

Call and schedule a complimentary consultation. We’ll help you determine if you simply need some strategies to help your child be successful, or if your child needs a formal evaluation to uncover a deficit in the way the brain processes information or emotion, which may require a different approach. Either way, we’re here to help.

Neuropsychological assessment uses non-invasive tests to measure specific brain functioning such as attention and concentration, memory and learning, visual-perceptual and visual-construction abilities, executive functions, and other specific domains that may be selectively impaired by brain injury. Neuropsychologists may use some of the same tests used by a clinical or school psychologist, but interpret the results in light of their special expertise in brain-behavior relationships. Neuropsychological assessment was originally designed to diagnose specific types of brain damage after an individual sustained some type of brain injury. Lately, neuropsychological assessment has expanded from the hospital setting into the community because it adds invaluable insights into how to help the students with learning problems, as well as cognitive identify strengths and weaknesses. A neuropsychological assessment saves valuable time by helping to determine what will help students reach their full learning potential.

Sometimes parents will hire a tutor, which is just what some students need.  Other times, tutoring does not seem to help, or lots of time is wasted while the tutor uses a process of elimination approach to determine which method of instruction will actually help the student learn. Neuropsychological assessment removes any guess work and provides critical information to assist decisions about teaching approaches, remediation of deficits or compensation for deficits, and other decisions about intervention and support strategies.

Identifying a student with a learning disability is not a simple task—learning disabilities can be difficult to identify.  A student’s ability to learn and acquire academic skills can be affected by several factors.  It is possible that Jill can not read well because she has difficulty paying attention, missed too much school in kindergarten and first grade, suffers from anxiety that interferes with learning, or has some brain dysfunction that makes learning through traditional methods completely overwhelming if not impossible.  A neuropsychologist designs a battery of test to administer that separates the many overlapping factors in order to provide the most accurate diagnosis possible. Through the use of tests, the neuropsychologist is able to differentiate whether or not a behavior is more likely caused by a biological defect in the brain or by an emotional or learned process.

Students who are having difficulty with learning or thinking obviously will benefit from neuropsychological assessment. Surprisingly, students with more subtle problems benefit most from neuropsychological assessment because they do not have severe disabilities with obvious symptoms; yet, these students do not function best within the typical learning environment.  Also, some students may not need a full neuropsychological assessment—a partial assessment helps students understand how they learn best, determine if they have an attention problem or ADD/ADHD, or establish the need for extra time during important exams such as the SAT, GRE, or LSAT.