Today’s post comes courtesy of a student I recently evaluated. As a current 7th grader, she was referred to me because she was having trouble paying attention in class and keeping up with her teachers’ lectures. She was originally diagnosed with ADHD by her family physician in 4th grade and put on various medications to help control it, but her mother wanted a more comprehensive evaluation to determine if something else was going on.
This particular student, like many, was given a diagnosis of ADHD with a very brief assessment of her symptoms. Since there is no single definitive test for ADHD, doctors rely on qualitative as well as quantitative data to piece together enough evidence either to confirm or rule out a diagnosis. Consequently, a brief assessment of symptoms can often times lead to an inaccurate diagnosis of ADHD.
During the initial in-take interview, this student confirmed symptoms of ADHD, including difficulty maintaining focus in class, forgetting to do certain tasks, and the appearance of “zoning out” in class. Although her grades were very good, she admitted that she does not always enjoy school because it can be difficult. On their own, these symptoms do indeed sound like those of ADHD. Let’s take a closer look.
What are symptoms of ADHD?
- Difficulty sustaining attention
- Does not always complete tasks
- Struggles with organization and time management
- Easily distracted by outside stimuli
- Does not always listen to others
According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-V), which is the manual used for psychiatric diagnoses (including ADHD), a diagnosis of ADHD requires “a persistent pattern of inattention and/or hyperactivity that interferes with functioning or development” (59), with most symptoms appearing before age 12. That means the symptoms above must be severe enough that it adversely impacts a student’s ability either inside or outside of the classroom. This certainly seems to be the case for her.
In addition to the above symptoms, however, both the student and her mother shared additional information, including the student’s sensitivity to loud noises and increased difficulty focusing in loud environments, such as concerts or presentations in large auditoriums. Hmmm, now I am hearing evidence of an auditory processing disorder (APD).
What are symptoms of auditory processing disorder?
- Appears as though student is not paying attention
- Can seem forgetful
- Has difficulty following auditory directions
- Ability to focus is impacted by loud noises
- Difficulty following conversations and formulating responses
As you can see, the symptoms of APD can look very similar to those of ADHD. It’s important to note that the DSM-V does not contain a diagnosis of APD. Instead, APD must be verified and diagnosed by an audiologist. While ADHD is a brain disorder, APD is a weakness in the pathways the connect the ear and the central nervous system that processes those sounds. Therefore, treatment of APD is much different that ADHD and does not require the use of medication.
At the conclusion of the student’s evaluation, the evidence strongly suggested a diagnosis of APD rather than ADHD. Although I cannot officially diagnose her, I did refer her to an audiologist for further testing. I also made the recommendation that she consult with her pediatrician to determine if continued medication was necessary.
The good news for her is that most adolescents who struggle with APD see their symptoms dramatically reduced by the time they are 13. This mostly has to do with the natural maturation of those pathways between the ear and the central nervous system. In the event that symptoms do not improve, however, there are many steps to take to help.
If your student is displaying signs or symptoms of ADHD or APD, I strongly recommend you see a psychologist or psychiatrist who can evaluate for both. Although as many as 50% of students have a co-diagnosis, the other 50% do not. Receiving an accurate diagnosis is imperative to your student’s success.