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ADHD and executive function assessment

 

Attention Deficit Hyperactivity Disorder  (ADHD)  Assessment

 

I provide thorough assessments for adolescents suspected of having ADHD using the Conner-3 computer scored scales (parent + teacher rating and a comparative report). Usually, insurance companies DO NOT pay for ADHD evaluations. The fee for an ADHD assessment, including reports from the most current Conners-3 scales and summary consultation is $150.00. Please call me to discuss my assessment service.


Executive Function Assessment

A central element of Attention Deficit Disorder is increasingly understood to involve (particularly adults) “executive function”. Executive function (EF) is a set of mental skills that help you get things done. In adults, the hyperactivity is almost unnoticable but the EF functions are particularly problematic. The EF skills are controlled by an area of the brain called the frontal lobe.

Executive functions help:

  • Manage time
  • Pay attention
  • Switch focus
  • Plan and organize
  • Remember details
  • Avoid saying or doing the wrong thing
  • Do things based on your experience

Russell Barkley, PhD was one of the first neuropsychologists to descibed EF - particularly as is relates to ADHD. He developed a scale to measure deficits in EF. Barkley describes five main categories of executive function. The Barkley Deficits of Executive Function Scale (BDEFS) measures a patient's report of behaviors that address the five primary components of EF as they manifest in activities of daily living (ADL). It measures an individual's capacity to engage in self-regulation across time for the attainment of future goals, particularly in social contexts. The five sub-scales are:

  1. SELF-MANAGEMENT to TIME: This describes a patient’s ability to sense of time, time management, planning, preparing for deadlines and other goal-directed behavior. Often those with deficits in this EF are described as having “time-blindness”.
  2. SELF-ORGANIZATION/PROBLEM SOLVING: This element of EF mediates the ability to organize one's thoughts, actions and writing; the ability to think quickly when encountering novel events, constructing solutions to problems in the pursuit of goals.
  3. SELF-RESTRAINT/INHIBITION: This aspect of EF regulates impulsivity of speech, poor inhibition of reactions to events, impulsive decision making, acting without appreciating painful consequences, not thinking about relative past or future before acting. Four items indicate the ability to appreciate the perspective of others.
  4. SELF-MOTIVATION: This element mediates the ability to persevere with tasks that are not interesting to the patient. The ability to resist impatience, and boredom often leading to taking ‘shortcuts’ to quickly (though incarefully) finish a task or not completing all of an assigned task; often requiring more supervision than most others would.
  5. SELF-ACTIVATION/CONCENTRATION: This executive function limits distractibility by one's own cognitions when required to do boring tasks, remaining alert while completing tasks, the ability to sustain concentration in reading, paperwork, meetings and other activities that are not subjectively stimulating - often experienced as commonly daydreaming or having to reread uninteresting material in order to comprehend it.

EF deficit assessmets are provided using the BDEFS. Insurance does not pay for EF deficit assessment. The fee for EF deficit assessment usising the BDEFS is $150.00. Please call me to discuss this assessment.