For those of you who don’t know what a school psychologist does, a big part of our job is to assess children for disabilities. A popular referral question is: “Does my child have Attention Deficit Disorder?” An assessment for ADD is often the most complex of all assessments because there is no “test” for ADD. It is a process where you assemble of tons of data, including psychoeducational assessment, executive functioning tasks, observations, interviews, and rating scales to see if signs point toward other disabilities, or if it is a true disorder of attention.
You have to show there are severe behavioral symptoms such as lack of focus, disorganization, memory difficulties, difficulties with sustained attention, distractibility, and the like, that are unusual for the age (a 3 year old is distracted all the time and that's normal). The symptoms need to have started before school entry, and need to be pervasive (meaning you can’t have ADD only during math class, or only in school and not at home). Sounds pretty straightforward until you think of all the other reasons you could have symptoms of inattention:
-A learning disability that makes it difficult to concentrate, organize, or learn -Emotional or social problems that deflect your focus (ever try to do work when you’re really upset?) -Situational factors such as being in a disorganized environment - Auditory processing/language deficits that make it hard to focus (just think of having to be in a foreign language class all day when you don’t know what the heck anyone is saying. Hard to stay focused.) -Anxiety (you are preoccupied with worry thoughts, and thus can’t focus) -Depression (you don’t have the energy to focus) -Being gifted (you get bored easily!)
And the list goes on. But testing for ADD is one of my favorite assessments to do, because it is like being a detective.
One time, I was asked by my school district to assess a student for ADD during my spring break. At first, I resisted. I mean, it’s called a “break” for a reason, right? Then, I found out that the child was not enrolled in the public school, but was in Circus School, and happened to live in our district. There was a time crunch, and it would have to be done ASAP. I thought about saying I couldn’t do it, but c’mon, it was Circus School!
Now, you’re probably thinking (as was I), “How on earth do you test a kid for symptoms of inattention in Circus School?” What would that write up look like?
Caroline appeared distracted by the TIGERS JUMPING THROUGH FLAMING HOOPS.
I couldn’t wait to see what this Circus School was all about. It was worth sacrificing my spring break. Caroline was a 9-year old girl, specializing in contortionism.* She was indeed quite flexible, but she did kind of seem like she wasn’t listening to her trainer. But seriously, what child could focus in this environment?
I ended up testing her and she came up fine on every test, with some difficulties in visual-motor planning and impulsive answering. No anxiety or social-emotional problems. Her focus was fine one-on-one, but that’s not too unusual, even for kids with ADD. Her circus teachers* rated her “at-risk” for attention difficulties, and her mom rated her as the most unfocused child on the planet. Ug. I didn’t have enough data to say for sure what was going on.
Then I hit the jackpot. I found her cumulative folder that included teacher comments from preschool through 2nd grade, prior to enrolling in Circus School. And there were comments all over the report cards about her lack of focus, distractibility, and not meeting her potential. There was enough data to tentatively diagnose her with ADD, with ongoing monitoring of symptoms.
So for all you teachers out there, who are spending this week writing a zillion report cards, seek comfort that years from now, you will be helping some school psychologist make better diagnoses! Here’s where I normally would pull this posting together with a lovely metaphor about contortionism and circus arts, but it’s Sunday and I haven’t had my coffee yet. I guess there would be something about “disentangling” symptoms or "jumping through assessment hoops."
Please excuse me, I’m going to need to go to Peet’s Coffee now.
*I feel like I’m making this up as I write, but I swear I am not.