Our doctors routinely assess for Autistic Spectrum Disorders, Learning Disabilities, and Attention Deficit Hyperactivity Disorder. We work with clients ages toddler through adult. The following is a brief summary of these evaluations.
Children in the autistic spectrum have significant difficulties in their social and communication skills. Their language may be slow to develop, and their speech may include peculiar patterns or a formal, monotone voice pattern. Social problems may include difficulty understanding other people’s feelings, a lack of pretend play, and an impaired ability to develop friendships. Often, eye contact with others is avoided. Additionally, children frequently demonstrate insistence on sameness and routine, have difficulty with change or transitions, and may have strong interests in a particular area. Our evaluations for Autism/Asperger’s Disorder thoroughly evaluate this array of characteristics, as well as cognitive skills, adaptive functioning (everyday independence), sensory processing (reactions to sound, touch, taste, movement), and academic performance (as relevant). Several of our clinicians have been trained in the ADOS (Autism Diagnostic Observation Schedule), the ‘gold-standard’ regarding assessments for autism spectrum disorders.
Learning disabilities are determined to exist when children have difficulty learning even though they have the cognitive capability and have been in an appropriate educational environment. Dyslexia is the term used when children have difficulty learning to read. Dysgraphia is the term used when children have difficulty with writing. Dyscalculia is the term used when children have difficulty with mathematics.
Dyslexia is the most common learning disability. Most children with dyslexia have trouble recognizing the basic sounds of speech (phonemes). They often have trouble connecting the speech sound (the /b/ sound) with the letter symbol for that sound (“b”). Difficulties with phonological processing make it hard for children with dyslexia to sound out words. Because of the time it often takes to sound out a word, the meaning of the word is often lost which can result in poor reading comprehension. Trouble with spelling is often found as well, given the difficulties in putting phonemes together to form words.
Early detection of dyslexia is key to remediation. Warning signs, beginning in preschool and kindergarten, include pronunciation problems, difficulty rhyming words, problems learning the connection between letters and sounds, letter reversals, inversions, transpositions, difficulty sounding out words, and resistance to reading activities.
Because of the importance of early detection, we have begun offering dyslexia screening evaluations in addition to our full psychoeducational evaluations for learning disabilities. Our dyslexia screener provides very basic information to determine if intervention is necessary to promote reading success. The dyslexia screener includes a brief cognitive evaluation, pre-reading and reading accomplishments, and phonological processing. A concise written statement of the results is provided to parents. Although no diagnosis may be made, the screener provides essential information for the determination of the need for intervention. It is appropriate for children who have no attentional, emotional, or other learning issues.
Attention Deficit/Hyperactivity Disorder (ADHD)
Children with attentional difficulties vary greatly and do not all have the same problems. Children who are predominantly inattentive often ignore details, make careless mistakes, have trouble sustaining attention, problems following instructions or finishing tasks, or appear forgetful or disorganized. Children who are predominantly hyperactive-impulsive are often fidgety, have trouble staying seated, are often in constant motion, tend to talk excessively, and often blurt out answers and interrupt others. Some children demonstrate difficulties in both of these areas. Overall, it is important to note that children with ADHD can pay attention. However, they have problems with what they pay attention to, how long they pay attention, and under what circumstances they stay attentive. Their difficulties pervasively affect their life, both at home and at school. Children with ADHD generally have difficulties with working memory (the ability to keep information in mind that needs to be used to make decisions and guide behavior) and executive functioning, which includes the abilities to plan, organize, multi-task, prioritize, persist, and self-monitor when completing tasks.
In order to provide a thorough evaluation of all relevant factors in a child’s situation, we offer a comprehensive ADHD assessment. This assessment evaluates a child’s history of difficulty, current cognitive functioning, academic performance, current behavior, executive functioning, computerized attention testing, and screening for social/emotional issues.
The Test of Variables Of Attention (TOVA) is a computer administered continuous performance test which has become widely used as an adjunct for the diagnosis of ADHD. It is also an objective method of assessing the effectiveness of medication for ADHD, without relying solely on parent’s/teachers reports and an interview in the clinician’s office. We offer this test as a service to doctors and parents as a diagnostic tool as well as a means of adjusting ADHD medication based on measured effectiveness. Parents and physicians may use TOVA performance on and off medication for comparison purposes, and to provide information regarding performance differences based upon medication dose. A comprehensive computer generated report is provided to the referring medical practitioner or to parents.
The task requires students to press a specially designed micro switch whenever a “target” appears on the screen, and to refrain from pressing when a “non-target” appears. The scores are compared to an age appropriate database to produce standardized scores, which gives useful, objective information on four variables of attention:
- Ability to sustain attention and mental effort
- Impulse control
- Cognitive processing speed (reaction time)
- Distractibility (variability in the response times)
Some children do not have any learning difficulties and pick up on information easily if they are provided circumstances that facilitate their learning (one-on-one teaching). These children have often had other possible causes of their inattentiveness or hyperactivity ruled out, either by school personnel or counselors. For these children, we offer an ADHD screening evaluation that specifically focuses on the difficulties with attention. An abbreviated write-up is provided to parents and diagnoses are documented as appropriate.