I recently emailed a psychiatric hospital to ask about the procedure for adhd diagnosis as well as borderline personality disorder. This was their reply..."Our procedure for an ADHD diagnosis or Borderline personality Disorder is by conducting psychological assessment such as an IQ test. Treatment interventions are medications and psychotherapy."
I wasn't expecting only a IQ test. Is this standard? What should I be looking for ?
Perhaps they meant IQ test as one of the tests rather than the only one.
Once upon a time, I was in Office Assistant in a Special Ed department at a public charter school. It was within my duties to schedule testing for students with a school psychologist. (The school did not have its own psychologist, but would contract with a couple from local school districts.)
An IQ test was often paired with ADHD testing, because many students who are being assessed for ADHD are likely to also have learning disabilities.
However, what this did not do was to identify students who had ADHD but did not have learning struggles. The tests were ordered by special ed teachers, for the purpose of assessing what particular learning challenges that a student had.
For professionals who assess ADHD in children, and IQ test is probably going to be used as well. I would guess that many of those professionals might also consider an IQ test if they are assessing an adult for ADHD, simply because it is their practice to do so.
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Gifted students are likely to score very high on an IQ test, even if they have out of control ADHD.
From what I have seen, I believe the spread of IQ scores among people with ADHD follows a bell curve, just like it does for neurotypical people. I saw in a video by Dr Russell Barkley that there is a slight offset by a few points lower of average IQ for the ADHD population. I think he showed both bell curves, to show that the spread is nearly identical, but slightly offset.
• My opinion is that IQ tests, as normative tests, written and validated based on neurotypical people. For at least some IQ tests, I believe there is a time limit. If an ADHD person were given an IQ test with no time limit, and permitted to take breaks as they need them, allowed to move as their body feels like it needs to move, and maybe even allowed to snack during the test... I bet that the difference between ADHD and neurotypical IQ scores would almost completely vanish.
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[I got put in gifted and talented education in elementary school. My older brother was put in on teacher recommendation alone, and I somehow heard that he didn't pass the assessment because it was the time to test and he didn't finish the test. I know my brother well, so I know that the answers he did give we're probably all precisely correct... I don't think he knew that it was a time to test. ~ Contrary to the standard practice, I was only tested after I was already in the class. I was not told that I was putting on teacher recommendation, so I have long thought that I was put in due to a clerical error. I got to stay in the class, so I guess I scored well enough.]
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I do not think that IQ tests are a good indicator of ADHD. I do think that an IQ test might indicate them more testing is needed, in order to better determine the academic struggles of a particular individual.
However, I'm also a proponent of the multiple intelligences theory. IQ only measures a particular aspect, and does not truly represent a person's capability.
I am in the process of being evaluated for ADHD as an adult. As a child I was considered very gifted and my behavior issues and trouble getting along were attributed to being bored. I was not bored. I was fascinated by most subjects. Only did poorly in math, PE and handwriting. My problem was a strong sensitivity ri criticism to the point where being name called would result in my engaging in impulsive hitting out. My parents and the school did not realize this. I still have this sensitivity but have learned to manifest it more peacefully. As a child I did not have these skills.
My behavior was unusual for a girl and really they did not know what to do.
They would look at my IQ score and grades and say: why doesn't she figure it out? .
Too often "bright" children are presumed to be able to figure out everything on their own.
"why doesn't she figure it out?"
...the real question is, why didn't somebody have the compassion and genuine interest to help you, guide and mentor you.
School-aged children and adolescents are sometimes diagnosed as having a Conduct Disorder. Two particular conduct disorders that can be connected with ADHD are:
• Oppositional Defiant Disorder (ODD)
• Disruptive Mood Defiant Disorder (DMDD)
However, I wonder if they might be presentations of Rejection Sensitive Dysphoria (RSD).
What you mentioned about not liking to feel criticized sounds like RSD. However, actions like impulsive hitting might be likely to get a kid labelled with ODD or DMDD.
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Some kids are equally intelligent, but not interested in school, like you and I were. Those kids are more likely to be identified as troublemakers, and be presumed to have character issues.
ADHD is described by some experts as having an interest-based attention system. If a person with ADHD is interested in something, then their attention will naturally be directed towards it.
Those kids with ADHD who weren't interested in school subjects couldn't direct their attention to it well enough, and usually got a lot of attention from the school system.
Those kids (like you and me) with ADHD who were interested in school usually did not get enough attention from the school system, because our parents, teachers, and others expected that we would "figure it out" on our own.
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You mentioned doing poorly at math. There could be various reasons for that, but sometimes a person has dyscalculia (which is to math what dyslexia is to reading).
• However, as a former math tutor, I often found that students who struggle with math might have simply not been taught foundational skills. Learning math is like building a house. You need a good foundation to support the walls and roof. If the foundation isn't complete, it won't support the rest. ~ Some people might need more support with developing arithmetic skills, but might have excellent reasoning skills that would help them flourish in higher level mathematics.
[In tutoring 6th-12th grade students, I found that I could teach most math concepts and skills in at least 3-4 different ways. Textbooks and many teachers usually only teach the concept and skills in 1 or 2 ways.]
Doing poorly in PE and in handwriting sounds like you might have coordination issues. Does that sound like the case?
Of course, there's a difference between the fine motor coordination for writing and the gross motor coordination for athletic activities. Having both together might point to other issues than coordination, like dyspraxia or Ehlers-Danlos Syndrome.
Then again, I was uncoordinated in PE as a kid, then better in my 20s, then worse again in my 30s and 40s. My handwriting has always been a bit bad (but legible). I have never been diagnosed with a motor coordination issue, or even had anyone hint that I might have a disorder causing it. (Yet, nobody thought I had ADHD, until I got diagnosed as 45...then most people who knew me didn't seem surprised, only my then-wife didn't agree with the diagnosis at first.)
I suspect I may have RSD. I think my issue with math eas simply that I was not gifted in it so was not able to or willing to put out the work in it. As you point out, the interest was not strong
I avoided physical activity recreationally until recently when due to needing to lose weight I started to walk and do water aerobics. Especially in water aerobics I found a peace and ease in moving and also in being in the water. And realize that when I am active during the day I am more relaxed and focused and at peace. Moving seems to be something i need to do. Girls were taught to be still. Realizing I was not made to be silent, still or slow paced is liberating to me b
I'm glad that you have realized that.
Schools and society try to put people into boxes. But people are so unique from one another, none of us fit into the box.
As an introverted, highly-sensitive, ADHD male, I also don't fit in the box.
BTW- I think that RSD shows up differently for me. I tend to internalize criticism, and it makes me even less likely to speak up. So, while some people act out from rejection sensitivity, I clam up instead, withdrawing into myself to avoid potential conflict.
Oh! I just learned that Ehlers Danlos happens more with people who are neurodivergent! There’s current research studies finding this out.
Ive also learned that because rsd can cause trauma we are in the fight or flight state. The people with the fight response are probably diagnosed a lot earlier than the ones with flight response like me. I was a kid always called a cry baby in school. Made the trauma worse.
And I highly agree with you in that dmdd is a presentation of rsd. My stepkid was having aggressive tendencies when he had discipline happen in class and he had to publicly pull a card (if 3 cards are pulled in a day, kids get a call home or have other consequences). He was just distracted and not doing his school work. This is how he got diagnosed.
Ive also learned as a person with adhd that I don’t have the interest to learn about why people act the way they do because we make decisions that to me are illogical. By having adhd, I think I need direct instruction on social nuances and social skills then given a specific safe place to practice those skills. I don’t just get it. I need the specific laid out with why we do things, even if we don’t know why sometimes. As an adult I’m learning to be more curious on why people do the things they do. I never felt safe enough as a kid to ask why without thinking I would be beat up for being stupid. I never really judge people for doing something illogical to me. I would lay out what I thought should have been done then ask why someone did it their way. Not as a judgement, but genuine curiosity. Again never had a safe place to do that as a kid so never really learned those skills. Luckily DBT is giving me that space to learn them.
Thank you for your reply and insight. It's very helpful and valuable as I haven't been able to get this kind of information from the hospitals here. They really haven't explained the reasoning behind anything.
adhd was diagnosed by detailed questionnaires and discussion with more questions especially about childhood. They also do a short autism questionnaire at the same time. My daughter did not have an IQ test. She did do some tests for secondary school and won an academic scholarship and had been thought as gifted at primary school
An IQ test for Borderline Personality Disorder makes absolutely no sense at all.
According to the DSM there are certain criteria one needs to meet in order to be diagnosed borderline and none of them have anything to do with IQ.
An IQ test for ADHD doesn't make much sense either.
An ADHD test for ADHD and checking to see if the person has the criteria for borderline is the only thing that makes sense to me.
Hi MorningDanceTrece, I think that there might be a big difference on what is done by big institutions (hospital, school district, etc.) versus individual MDs, thearpists, etc., in giving a diagnostic test(s) for ADHD. It seems to me that IQ testing would be appropriate for large institutions that are largely impersonal and would not know the individual being tested, but IQ tests might be less appropriate for ADHD diagnosis by individuals. I see that giving someone who comes in for diagnosis of ADHD an IQ test is done mainly to rule out other possible reasons for that person's behavior. What came to mind was that this would be like going to see your MD about back pain but before seeing your doc the nurse takes your temperature and measures your blood pressure; a normal temperature and BP would rule out a great many less common causes for, or associated with, back pain.
Yes, for my teen an IQ test was only one part of many components like parent and child questionnaires, computer testing programs, etc. It did show a wide range, or 'spiky profile' as they said, like above average visual/spatial skills, a couple average things, but borderline impaired working memory and processing speed, which supported the ADHD diagnosis. This was a child who was in the gifted program in the lower grades but then struggled greatly and got way derailed by the pandemic.
trillium42, Great explanation about why an IQ test might be given as part of assessment for ADHD. I hope that the situation with your teen is at a better place than during and after the pandemic. Your teen was not alone in having difficulties during the pandemic. I taught science in college during the pandemic and when we went to remote teaching, fully a third of the students in every class had extreme difficulties and were what I referred to as "lost".
A study which was published this year confirmed that certain factors can much delay being diagnosed with ADHD. This article talks about the study:psypost.org/intelligence-so...
Having a higher IQ can delay getting diagnosed with ADHD by years (or as many of us have experienced, by decades).
I think that going forward, the professionals who diagnose ADHD ought to look more closely if the subject they are evaluating has a higher IQ. That's because highly intelligent people often figure out ways to self-accommodate their ADHD.
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Other factors that the article mentions can delay getting diagnosed with ADHD include:
• Being female
• Being in a higher socioeconomic clas
• Having a mother who is of any racial minority
It's a shame that people aren't getting the diagnosis and treatment that they need due to factors that they have no control over. Especially since it is well known that the earlier treatment begins, the higher likelihood that someone with ADHD will do succeed in life (or at least struggle less).
Hi, I have a question: How do you or anyone with an ADHD teenager, have a conversation with their teen regarding their successes or failures in a normal conversation? Do you say, "oh, that's because you have ADHD, and forgot to take your meds." or "How was your focus during the test today?" or, "I know you have plans tonight, did you confirm the time the movie starts". We just are confused about not acknowledging the ADHD in normal conversation because it's such a glaring reminder that you are "not normal". He doesn't ever refer to it; I don't think he ever thinks in those terms. I would love your insight or anyones' ideas of how to converse with this kind of "spacy" teen (17). Thanks.
ps He's now a new driver and I am on edge every time he drives away. For himself and others on the road. I want to say something about focusing on driving and not the conversation next to you or in the backseat. It's icy tonight, turn the radio down etc etc. Is there a conversation for these kids where you say, "because you have ADHD, your reflexes might be too aggressive, like putting your foot on the brake to quickly, and sliding off the road. OR, is that something he would have probably known. I would have said that to my other kids, and a lot more, but I'm stuck with how to impart knowledge to this smart but quirky ADHD kid without reinforcing that he is "different". Am I overthinking this? Thanks again.
I have Inattentive ADHD. So, before I got diagnosed and started on ADHD medication, I had a slower reaction time when driving.
My mom was aware of my inattentiveness when I was a kid, even though I didn't get diagnosed until I was 45. When I started driving, she was worried that I wouldn't notice other cars around me. Because she shared her concerns with me, I got in a habit of checking my mirrors more often and adjusted them to minimize blind spots, as my dad and older brother had taught me to do.
Also, because I'm very nearsighted, I don't have great peripheral vision. So, I have to turn my head farther when checking my blind spots on both sides, because I have to be able to look through my eyeglasses. (For my first year of solo driving, my mom insisted that I wear contact lenses. I wore them for two years, then switched back to glasses, but the contacts were definitely a good help.)
As for how to bring things up, to address concerns and give helpful instructions:
Don't make a habit of mentioning ADHD by name.
Instead, address the specific trait, symptom, behavior, or concern.
There's a saying that, "if you've met one person with ADHD, then you've met one person with ADHD." We are each unique, with collections of traits and severity of symptoms varying a kid from individual to individual. Yeah, there are similarities, but my ADHD is different from your son's.
Your son is a teen, no longer a young child and developing into an adult. ADHD might make him a bit less mature in some ways. If he's like many people with ADHD, he is likely about 2-3 years socially, emotionally, and rationally behind what would be considered "normal" for his age. At the same time, he might be more advanced or adept at creative problem solving, diversity of interests, or other markers of intelligence.
My best advice is what is:
• Be a mentor to your son. He is developing into an adult. Give him heartfelt guidance, but give him the liberty to figure things out on his own.
• Foster trust and acceptance. Make sure he knows that he can come to you about anything.
• Have a genuine curiosity about him, get to know him in a new way...his interests, his thoughts and feelings on things, his goals, and his direction in life.
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I've raised two kids into adulthood already (ages 31 and 22), and I'm raising two more (12 and almost-10). They all seem a bit "neuro-spicy", each displaying some definite ADHD-like traits, but none of them have been diagnosed with ADHD (yet).
I know how hard it is to watch your kids struggle with things. You can give them advice and direction, but they are the ones who have to decide what they're going to do.
If your son responds well to ADHD medication, then that's one of the most impactful aids he can have on a daily basis.
However, many people with ADHD struggle with self-doubt and/or "imposter syndrome". He might not feel as capable as he really is. Many people with ADHD see their faults and shortcomings maximized, while they minimize their strengths and talents.
If he struggles with anxiety, depression, or self-image issues, he might need therapy (or even medication).
ADHD coaching or even life skills coaching might be helpful, too. The earlier he learns essential skills like budgeting, the more it will help him in life.
Treatment guidelines are published by The American Academy of Pediatrics and by The Society of Developmental and Behavioral Pediatrics. They have been developed over many years and updated in 2019 and 2020 respectively.
I think that IQ tests is one of them. They want to see how smart you are. There are people with learning issues that have a very high IQ level. Psychologists are good for getting the medicine that you may need (depending on how severe you learning issues are). Psychologist (the one that can't prescribe medicine) are pretty good also. They're the ones that ask your thoughts and feelings about things. They should know all about learning issues and how they affect your mental health and how to deal with it.
That's because they don't truly understand it one a lot of us have a hard time realizing things and once you've realized some things it's better to just stay in your head cuz it tends to be a sad fucking reality I have learned that my ADHD BPD anxiety PTSD depression stems from a lack of people giving a shit it stems from everybody acting like I'm the problem when I just didn't understand and needing a couple extra questions or having somebody put a limit of questions on you demand you as a person or forcing a 7-year-old to sit there and take your fucking assessments and then only put them in a category, because your tests took too long and I was a 7 year old who was getting bored so I got to see what they said about a board 7 year old that I wouldn't I put my 7 year old in but he's not add he's gifted he's smart and if people would have just had a little patience with us trust would have been just fine the problem is is when they think they're right that doesn't mean they're right and I don't need to go to school to tell you that I am none of the things except for post-traumatic stress disorder I stem from a childhood of trauma and yeah I guess it seems normal you look in and you're like oh a teen takes care of themselves not if a teen has never been treated like an adult and left to fend for themselves I have learned a lot more about me and these diagnosis that it's just a way for people to make money sitting around not doing a goddamn thing about people that are hurting they wanted to make money off us so they slap a label on US stick us in a system so they all have jobs cuz they don't want to do it a different way they don't want to work hard, the opinions of a learning mind pissed off one at that but learning nonetheless something nobody had patience to do when I was a child except for throw medicine at me and tell me to no actually force me to sit down and shut up literally in a month ago that wouldn't have sounded as intelligent as I felt it sounded this time. Oh also want to add kind of funny IQ test is it that I scored too high that you're going to put me on medication now because I might be smarter than you and realize that you guys are trying to fucking make us all stupid or think that we're stupid when in reality we're not it's called they stick Us in the system so they can keep tabs on us and not do an actually thing. Cuz I just my therapist had a really hard time even wanting to diagnose me with BPD because she's like Bethany you're just so sweet well that's because you were going to give me a disorder that doesn't have a cure and there's no medication for it and you're going to tell me that there's something wrong with me but everything can be cured and everybody's got medication oh so now I'm so fucked up that there's not even medications and nobody knows how to fix me it's one learning how to fix yourself and break every piece of societies expectations off of you and go I don't fit in your little fucking box that's what's wrong with me sorry for the words but from somebody who just wanted people that loved her to teach her how to use her intelligence for good that I had to struggle for 31 years actually 37 years of my life to in less than one year figured out all my fucking problems started to heal myself oh and creating a system that is going to give back to the people who are just like me. So to everyone who reads this I apologize for the no apostrophes or periods that is because I talk to text a lot cuz there's a lot going on and I can't keep up with my mouth also just a little fun joke what did one skeleton say to the other skeleton I'll pause for dramatic effect
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