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ASSESSMENT OF LEARNING DISABILITIES AND ATTENTION-DEFICIT HYPERACTIVITY/DISORDER IN ADULTS. Robert L. Mapou, Ph.D., A.B.P.P. (CN) William R. Stixrud, Ph.D. and Associates, LLC Silver Spring, MD Departments of Psychiatry and Neurology

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assessment of learning disabilities and attention deficit hyperactivity disorder in adults

ASSESSMENT OF LEARNING DISABILITIES AND ATTENTION-DEFICIT HYPERACTIVITY/DISORDER IN ADULTS

Robert L. Mapou, Ph.D., A.B.P.P. (CN)

William R. Stixrud, Ph.D. and Associates, LLC

Silver Spring, MD

Departments of Psychiatry and Neurology

Uniformed Services University of the Health Sciences, Bethesda, MD

Department of Neurology (Psychology)

Georgetown University School of Medicine, Washington, DC

R. L. Mapou, Ph.D., ABPP-CN

contact information

CONTACT INFORMATION

Robert L. Mapou, Ph.D., ABPP-CN

William Stixrud, Ph.D. and Associates, LLC

8720 Georgia Avenue

Suite 300

Silver Spring MD 20910

(301) 565-0534 x264

(301) 565-2217 FAX

E-mail: [email protected]

Web: www.stixrud.com

R. L. Mapou, Ph.D., ABPP-CN

issues to consider
ISSUES TO CONSIDER
  • Learning disabilities was a conceptual rather than a legal term.
  • Educational law did not specify degree of disability.
    • Focus on identification, often by discrepancy only
    • Focus on service delivery
  • Educational law did not apply to adults.

R. L. Mapou, Ph.D., ABPP-CN

definition of a disability under the 1990 americans with disabilities act
DEFINITION OF A DISABILITY UNDER THE 1990 AMERICANS WITH DISABILITIES ACT
  • A disability is:
    • “a physical or mental impairment that substantially limits one or more of the major life activities of [an] individual.”
  • A person is considered disabled if:
    • “the individual\'s important life activities are restricted as to the conditions, manner, or duration under which they can be performed in comparison to most people.”

R. L. Mapou, Ph.D., ABPP-CN

therefore not all disorders with impairment are disabilities

THEREFORE . . . NOT ALL DISORDERS WITH IMPAIRMENT ARE DISABILITIES!

R. L. Mapou, Ph.D., ABPP-CN

learning disabilities definitions

LEARNING DISABILITIES:DEFINITIONS

R. L. Mapou, Ph.D., ABPP-CN

current definitions
CURRENT DEFINITIONS

Individuals with Disabilities Education Improvement Act of 2002

(IDEA 2004)

National Joint Committee on Learning Disabilities (1981, 1987, 1990)

R. L. Mapou, Ph.D., ABPP-CN

problems with current definitions
PROBLEMS WITH CURRENT DEFINITIONS
  • Limit areas of impairment to language and academics
  • Does not consider the brain (IDEA 2004)
  • Does not recognize that problems occur across the lifespan (IDEA 2004)
  • Includes acquired disorders, some of which would not be considered LDs in adults (IDEA 2004)
  • Excludes difficulties related to nonverbal LDs, attention, and executive functioning (NJCLD)

R. L. Mapou, Ph.D., ABPP-CN

a neuropsychological definition

A NEUROPSYCHOLOGICAL DEFINITION?

Rehabilitation Services Administration (1985)

A specific learning disability is a disorder in one or more of the central nervous system processes involved in perceiving, understanding, and/or using concepts through verbal (spoken or written) language or nonverbal means. This disorder manifests itself with a deficit in one or more of the following areas: attention, reasoning, processing, memory, communication, reading, writing, spelling, calculation, coordination, social competence, and emotional maturity.

R. L. Mapou, Ph.D., ABPP-CN

a proposed neuropsychological definition mapou in preparation

A PROPOSED NEUROPSYCHOLOGICAL DEFINITIONMapou (In preparation)

A learning disability is a neurodevelopmental disorder affecting a specific academic and/or cognitive skill that occurs in the presence of intact skills in most other realms. The specific impairments are presumed to be due to dysfunction of the brain and to have been present since birth, although their impact may not become fully obvious until later in life.

R. L. Mapou, Ph.D., ABPP-CN

a proposed neuropsychological definition mapou in preparation1

A PROPOSED NEUROPSYCHOLOGICAL DEFINITIONMapou (In preparation)

Although most learning disabilities affect academic skills (reading, writing, mathematics) and the associated underlying neuropsychological functions needed for these skills, a learning disability can also affect specific areas of neuropsychological functioning, including attention, executive functions and problem-solving abilities, spoken language, visuospatial skills, or learning and memory.

R. L. Mapou, Ph.D., ABPP-CN

a proposed neuropsychological definition mapou in preparation2

A PROPOSED NEUROPSYCHOLOGICAL DEFINITIONMapou (In preparation)

A learning disability substantially limits functioning in one or more aspects of a person’s life (e.g., school, work, home, social). It is not better explained by an acquired neurological disorder that occurs either in childhood or later in life, mental retardation, or a pervasive developmental disorder, It is also not due primarily to cultural factors, psychosocial factors, psychiatric disorder, or lack of education, although it may co-exist with these factors.

R. L. Mapou, Ph.D., ABPP-CN

slide14

TYPES OF LEARNING DISABILITIESFletcher, et. al (2007); Tsatsanis & Rourke (2008); Wasserstein et al., (2008); Cutting & Denckla (2003); Wasserstein & Denckla (in press)

  • Reading disability
    • Word recognition (dyslexia)
    • Fluency
    • Comprehension
  • Mathematics disability (computations and/or problem-solving)
  • Written language disability (handwriting, spelling, and/or composition)
  • Nonverbal learning disability
  • Attention and executive functioning disorder

R. L. Mapou, Ph.D., ABPP-CN

research learning disabilities in adults
RESEARCH:LEARNING DISABILITIES IN ADULTS

R. L. Mapou, Ph.D., ABPP-CN

research on adult ld
RESEARCH ON ADULT LD
  • Problems with earlier (and some current) research include small samples, limited test batteries, lack of controls, inappropriate statistical methods, and conclusions based on limited data.
  • There is no “gold standard” or biological marker for LD diagnosis, and studies define LD differently.
  • Most neuropsychological research has focused on dyslexia, perhaps because of its high prevalence and being more easily defined.
  • Most research has used college students or young adults.

R. L. Mapou, Ph.D., ABPP-CN

slide17
PREVALENCE OF LEARNING DISABILITIESGeneralKatz et al. (2001); Henderson (1999); Horn et al. (1999); Sack et al. (2008)
  • 3 to 20% in the general population
  • 20 to 89% of adults enrolled in ABE or GED programs
  • 2 to 4% of college students, based on surveys in 1996 and 1998
  • 2.3% of U.S. medical students were reported to have requested accommodations, of which over 90% were for LDs or ADHD

R. L. Mapou, Ph.D., ABPP-CN

prevalence of learning disabilities specific katz et al 2001
PREVALENCE OF LEARNING DISABILITIESSpecificKatz et al. (2001)
  • 80% of all LDs are estimated to affect reading.
  • 1 to 6% of LDs are estimated to affect mathematics.
  • 1 to 10% of LDs are estimated to be nonverbal LDs.
  • 10% of children in school may have LDs affecting writing.

R. L. Mapou, Ph.D., ABPP-CN

slide19

NEUROPSYCHOLOGICAL FINDINGSREADING DISABILITIES-CORE DEFICITSBirch & Chase (2004); de Gelder & Vrooman (1996); Elbro, (1998); Hugdahl et al. (1995); Lovrich et al. (1997); Katz et al. (2001); Paulesu et al. (2001); Shaywitz & Shaywitz (2005); Shaywitz et al. (2006)

  • The core dyslexia deficit is in phonemic processing and phonological awareness, demonstrated through neuropsychological and ERP studies. This is found cross-culturally.

R. L. Mapou, Ph.D., ABPP-CN

slide20
NEUROPSYCHOLOGICAL FINDINGSREADING DISABILITIES-CORE DEFICITSBirch & Chase (2004); Cirino et al. (2005); Vukovic, et. al (2004)
  • Support for the double-deficit hypothesis of dyslexia (impairment in phonological awareness/rapid visual naming) has also been demonstrated for adults. However support is weaker, and factors including general processing speed, vocabulary, single-word reading, and reading rate may better account for speeded naming deficits.

R. L. Mapou, Ph.D., ABPP-CN

slide21
NEUROPSYCHOLOGICAL FINDINGSREADING DISABILITIES-ASSOCIATED DEFICITSKatz et al. (2001); Isaki & Plante (1997); Ransby & Swanson (2003)
  • Associated deficits have been found in language skills and auditory verbal-attention.
  • More recent studies have found that naming speed, verbal working memory, vocabulary, listening comprehension, and lexical knowledge contribute independently to reading comprehension, beyond the impact of phonological processing.
    • Phonological processing may be more important for reading acquisition, rather than for reading comprehension in adults.

R. L. Mapou, Ph.D., ABPP-CN

slide22

NEUROPSYCHOLOGICAL FINDINGSREADING DISABILITIES-VISUAL DEFICITSBen-Yehudah et al. (2001); Eden & Zeffiro (1998); Graves et al. (1999); Hari et al. (2001); Iles et al. (2000); Vellutino et al. (2004)

  • Vellutino et al. (2004) have noted that the visual theory of dyslexia has been largely discounted.
  • However, some individuals with dyslexia show visual psychophysical abnormalities.
    • Magnocellular pathway deficits
    • More problems with visual target localization

R. L. Mapou, Ph.D., ABPP-CN

slide23

NEUROPSYCHOLOGICAL FINDINGSREADING DISABILITIES-QUALITY OF READINGBirch & Chase (2004); Cirino et al. (2005); Shaywitz & Shaywitz (2005); Vukovic et al. (2004)

  • Dyslexic adults are typically slow, inefficient readers, despite having average decoding and single-word reading skills.
    • Lack of fluency with words and/or text can affect comprehension.
    • Timed measures appear most sensitive to reading difficulties in adults.

R. L. Mapou, Ph.D., ABPP-CN

slide24
NEUROPSYCHOLOGICAL FINDINGSREADING DISABILITIES-QUALITY OF READINGWilson & Leseaux (2001); Simmons & Singleton (2000)
  • Wilson and Leseaux found that dyslexic college students, although average on reading and spelling measures, scored less well than normal students and showed weaknesses in accuracy and speed of phonological processing.
  • Simmons and Singleton reported that dyslexic college students have more problems with inferential than with literal reading comprehension.

R. L. Mapou, Ph.D., ABPP-CN

neuropsychological findings mathematics disabilities katz et al 2001
NEUROPSYCHOLOGICAL FINDINGSMATHEMATICS DISABILITIESKatz et al. (2001)
  • Deficits can be found in visuospatial and motor skills, similar to what is found in children.
  • Although attentional problems can contribute to mathematics disabilities, there is no research on this.

R. L. Mapou, Ph.D., ABPP-CN

neuropsychological findings mathematics disabilities greiffenstein baker 2002 cirino et al 2002
NEUROPSYCHOLOGICAL FINDINGSMATHEMATICS DISABILITIESGreiffenstein & Baker (2002); Cirino et al. (2002)
  • The first study found that adults with mathematics LDs had deficits in nonverbal reasoning and constructional skills.
  • In contrast, the second study of college students referred for LD assessment found that mathematics skills were related to semantic knowledge retrieval and executive functioning, but not to visuospatial skills.

R. L. Mapou, Ph.D., ABPP-CN

neuropsychological findings mathematics disabilities osmon et al 2006b
NEUROPSYCHOLOGICAL FINDINGSMATHEMATICS DISABILITIES Osmon et al. (2006b)
  • Evidence was found for a double deficit in college students with mathematics disorders.
    • One group showed spatial impairment.
    • A second group showed executive functioning impairment.
    • A group with impairments in both areas had the most impaired math skills.
    • Right hemisphere impairment was hypothesized.

R. L. Mapou, Ph.D., ABPP-CN

neuropsychological findings written language disabilities connelly et al 2006
NEUROPSYCHOLOGICAL FINDINGSWRITTEN LANGUAGE DISABILITIESConnelly et al. (2006)
  • College students with dyslexia wrote essays of poorer quality due to writing more slowly, making more spelling errors, and using fewer words than normal students.
  • They made more spelling errors in their essays than expected based on a separate spelling test.
  • They also had poorer decoding and shorter listening span
  • The best predictors of essay quality were handwriting speed and spelling accuracy.

R. L. Mapou, Ph.D., ABPP-CN

neuropsychological findings written language disabilities gregg et al 2007
NEUROPSYCHOLOGICAL FINDINGSWRITTEN LANGUAGE DISABILITIESGregg et al. (2007)
  • The best predictors of the quality of essay writing in college students with dyslexia were vocabulary complexity, verbosity (length of writing), spelling, and handwriting.
    • These factors were more important for those with dyslexia than for normal students.
  • The authors concluded that an inability to write fluently placed students with dyslexia at a disadvantage on timed writing tasks.

R. L. Mapou, Ph.D., ABPP-CN

slide30
NEUROPSYCHOLOGICAL FINDINGSNONVERBAL LEARNING DISABILITIESRourke et al (1986); Tsatsanis & Rourke (2008); Wasserstein et al. (2008)
  • There is limited work on adults with nonverbal LDs.
  • Early work showed neuropsychological deficits similar to those in children, along with social deficits.
  • Subsequent studies have shown deficits in visuospatial skills, motor skills, complex problem solving, and arithmetic.

R. L. Mapou, Ph.D., ABPP-CN

slide31
NEUROPSYCHOLOGICAL FINDINGSNONVERBAL LEARNING DISABILITIESKatz et al. (2001); Ahmad et al. (2002); Tsatsanis & Rourke (2008)
  • Cognitive and social deficits are worse in adults than in children, with the largest differences seen in problem-solving, concept formation, and hypothesis testing.
  • This contrasts with similar deficits in adults and children with language-based LDs.
  • Most studies have been cross sectional.

R. L. Mapou, Ph.D., ABPP-CN

neuropsychological findings nonverbal learning disabilities wasserstein et al 2008
NEUROPSYCHOLOGICAL FINDINGSNONVERBAL LEARNING DISABILITIESWasserstein et al. (2008)
  • Conclusions:
    • Some adults with nonverbal LDs show the traditional deficits, but not all do.
    • Nonverbal LD may not be a unitary entity.
    • Poor outcome is not universal.

R. L. Mapou, Ph.D., ABPP-CN

slide33
NEUROPSYCHOLOGICAL FINDINGSGIFTED ADULTS WITH LEARNING DISABILITIESFerri et al. (1997); Gregg et al. (1996)
  • There is no neuropsychological research on this issue.
  • Variability in intellectual and academic profiles have been reported, with differences between gifted and non-gifted adults with LDs.
  • Caveats:
    • Variability in test results is the rule rather than the exception (Schretlen et al. 2003).
    • Everyone has strengths and weaknesses.

R. L. Mapou, Ph.D., ABPP-CN

outcome and early intervention interaction between genes and environment shaywitz et al 2006
OUTCOME AND EARLY INTERVENTIONINTERACTION BETWEEN GENES AND ENVIRONMENTShaywitz et al. (2006)
  • Recent longitudinal follow-up studies of adults with dyslexia diagnosed as children found different brain connectivity patterns on fMRI for those who developed good reading skills and those who did not.
  • The authors concluded that despite a genetic underpinning for dyslexia, having better cognitive skills to start and access to intervention will greatly influence outcome.
  • This reinforces the need for early intervention.

R. L. Mapou, Ph.D., ABPP-CN

slide35

CO-OCCURRING DISORDERS AND COMPLICATING FACTORSPSYCHIATRIC DISORDERSCleaver & Whitman (1998); Gregg, et al (1992); Hooper & Olley (1996); Hoy & Manglitz (1996); Katz et al. (2001); Vogel & Forness (1992)

  • Adults with LDs remain at increased risk for psychosocial and psychiatric difficulties.
  • This is true for nonverbal LDs, which affect emotional processing, as well as for language-based LDs.

R. L. Mapou, Ph.D., ABPP-CN

slide36

CO-OCCURRING DISORDERS AND COMPLICATING FACTORSPSYCHIATRIC DISORDERSTsatsanis & Rourke (2008); Mesulam & Weintraub (1983); Greiffenstein & Baker (2002)

  • Adults with nonverbal LDs are especially vulnerable to internalizing disorders because of the impact on interpersonal skills and everyday functioning.
  • However, studies differ in the degree of psychosocial impairment, and some individuals have no psychosocial problems.

R. L. Mapou, Ph.D., ABPP-CN

diagnosis discrepancy vs clinical approaches seigel 1993
DIAGNOSISDISCREPANCY VS. CLINICAL APPROACHESSeigel (1993)
  • Discrepancy approaches are still mandated by many states.
  • Yet, it is clear that such an approach is not useful and is outdated, given research on learning disabilities and, especially, dyslexia.
  • Assumptions about the usefulness of discrepancy approaches are often based on clinical lore rather than research.

R. L. Mapou, Ph.D., ABPP-CN

diagnosis discrepancy vs clinical approaches fletcher et al 2007
DIAGNOSISDISCREPANCY VS. CLINICAL APPROACHESFletcher et al. (2007)
  • Multiple factors contribute to underachievement:
    • Emotional and behavioral difficulties
    • Socioeconomic factors
    • Inadequate instruction
  • Response to instruction should be used to assess the possibility of an LD, provided that instruction is shown to be adequate.

R. L. Mapou, Ph.D., ABPP-CN

slide39
DIAGNOSISDISCREPANCY VS. CLINICAL APPROACHESMapou (in preparation: Brackett & McPherson (1996); Hoy et al. (1996)
  • Fletcher et al.’s approach has not been used with adults.
  • There is no research on response to intervention with adults.
  • Earlier, but limited research indicated that a comprehensive, clinical approach is more effective with adults than a discrepancy approach.

R. L. Mapou, Ph.D., ABPP-CN

diagnosis discrepancy vs clinical approaches mapou in preparation wolf et al 2008
DIAGNOSISDISCREPANCY VS. CLINICAL APPROACHESMapou (In preparation); Wolf et al. (2008)
  • Conclusions:
    • Discrepancy approaches should not be used as the basis for learning disability diagnosis.
    • Although selective assessment and/or response-to-intervention have empirical support with children, there is no research basis for these approaches in adults.
    • Comprehensive assessment, including a consideration of demographic, historical, emotional/behavioral, and neuropsychological factors, currently has the most support for assessment of learning disabilities in adults.

R. L. Mapou, Ph.D., ABPP-CN

assessment of motivation and effort osmon et al 2006a
ASSESSMENT OF MOTIVATION AND EFFORTOsmon et al. (2006a)
  • In an analog study, a new computerized forced-choice measure of reading/word matching, the Word Reading Test, has shown promise for identifying individuals feigning deficits of reading skill or speed.
    • A double dissociation was found between those asked to feign a reading deficit vs. a speed deficit.
    • The Word Memory Test also was sensitive, but less so.
  • Clinical studies remain to be completed.

R. L. Mapou, Ph.D., ABPP-CN

assessment of motivation and effort dombroski et al 2006 lu et al 2004
ASSESSMENT OF MOTIVATION AND EFFORTDombroski et al. (2006); Lu et al. (2004)
  • In the context of personal injury litigation, Lu et al. reported that showing a normal interference effect on the Stroop Test identified individuals faking illiteracy.
    • This could potentially be used to identify feigned reading disorders.
  • In contrast, Dombroski et al. found that the Rarely Missed Index did not show sensitivity to simulated LD, despite sensitivity to effort in those with TBI.

R. L. Mapou, Ph.D., ABPP-CN

assessment of motivation and effort alfano boone 2007
ASSESSMENT OF MOTIVATION AND EFFORTAlfano & Boone (2007)
  • Preliminary data found that individuals diagnosed with LDs did not fail symptom validity measures, based on the presence of LDs alone.

R. L. Mapou, Ph.D., ABPP-CN

assessment of motivation and effort sullivan et al 2007
ASSESSMENT OF MOTIVATION AND EFFORTSullivan et al. (2007)
  • A study of consecutive referrals for LD/ADHD evaluation in a college assessment center found that 15.4% of those seeking LD evaluation and 9.4% of those seeking LD/ADHD evaluation failed the Word Memory Test, based on Green’s (2003) cutoffs.
    • This was much lower than the failure rate for those seeking ADHD evaluation.
    • It was concluded that either secondary gain was less of an issue for LD diagnosis or else the WMT was not sensitive to this.

R. L. Mapou, Ph.D., ABPP-CN

adult intervention specific interventions shaywitz 2003 shaywitz shaywitz 2005 shaywitz et al 2006
ADULT INTERVENTIONSPECIFIC INTERVENTIONSShaywitz (2003); Shaywitz & Shaywitz, (2005); Shaywitz et al. (2006)
  • Shaywitz and colleagues have described evidence-based programs for improving reading skills in children and adults with dyslexia.
  • Nonetheless, studies with adults are still in their infancy.
  • It is clear that intervention should occur as early as possible.

R. L. Mapou, Ph.D., ABPP-CN

adult intervention specific interventions eden et al 2004 katz et al 2001
ADULT INTERVENTIONSPECIFIC INTERVENTIONSEden et al. (2004); Katz et al. (2001)
  • Eden et al. showed that improvement resulting from a phonologically-targeted training program for adults with dyslexia, which led to improvement in everyday reading skills, was associated with changes on fMRI in brain regions important for reading.
  • No research has shown efficacy of programs to remediate specific deficits in other LDs, and Katz et al. reported that little work has examined the efficacy of compensatory strategies outside the educational setting.

R. L. Mapou, Ph.D., ABPP-CN

adult intervention accommodations extended time shaywitz shaywitz 2005 ofiesh hughes 2002
ADULT INTERVENTIONACCOMMODATIONS-EXTENDED TIMEShaywitz & Shaywitz (2005); Ofiesh & Hughes (2002)
  • Extended time on classroom tests is the most common academic accommodation requested for post-secondary education students.
  • Shaywitz & Shaywitz consider it “essential.”
  • A review of seven studies by Ofiesh and Hughes showed that additional time used ranged from 50% to double time. Factors that affected the decision about how much time to use included educational setting, the student’s limitations, and the test characteristics.

R. L. Mapou, Ph.D., ABPP-CN

slide48
ADULT INTERVENTIONACCOMMODATIONS-EXTENDED TIMEAlster (1997); Leadbetter et al. (2001); Runyan (1991); Ofiesh et al. (2005)
  • Several studies have shown that extended time helps those with LDs in reading or math, but does not help normal learners.
  • Ofiesh et al. found that the best predictors of the need for extended time in college students were simple timed academic tasks (i.e., WJ3ACH Academic Fluency) rather than timed neuropsychological tasks (i.e., WAIS-III Processing Speed).

R. L. Mapou, Ph.D., ABPP-CN

adult intervention accommodations course substitution downey et al 2000
ADULT INTERVENTIONACCOMMODATIONS-COURSE SUBSTITUTIONDowney et al. (2000)
  • College students with dyslexia performed less well than normal students on measures of foreign language aptitude, single-word reading, spelling, and phonological analysis, but did not differ on timed reading comprehension or single-word repetition.
  • However, they did not differ from normal students in final grades or final scores on a translation proficiency test in a modified foreign language class.
    • Courses taught by “master instructors”
    • Slower pace of instruction
    • Highly structured and predictable course content
    • Required daily amount of study time
    • Use of tutors as needed.

R. L. Mapou, Ph.D., ABPP-CN

adult intervention accommodations course substitution sparks et al 2003
ADULT INTERVENTIONACCOMMODATIONS-COURSE SUBSTITUTION Sparks et al. (2003)
  • In contrast, these authors found that college students with LDs seeking foreign language exemption did not differ in language skills, academic skills, or GPA from those who did not seek exemption.
    • A mediating factor appeared to be overall aptitude, as measured by ACT scores.
    • Those seeking exemption had done less well in foreign language classes and often sought first time LD evaluation because of this.
    • LD documentation was often inadequate.
  • The authors concluded that requests for foreign language substitution should be carefully reviewed, especially if based on a new LD diagnosis.

R. L. Mapou, Ph.D., ABPP-CN

adult intervention accommodations course substitution sparks 2006
ADULT INTERVENTIONACCOMMODATIONS-COURSE SUBSTITUTION Sparks (2006)
  • There is no research support for a foreign language LD.
    • Students with LDs do not always have trouble learning a foreign language.
    • Students who have difficulty learning a foreign language do not differ in cognitive or academic profiles based on the presence of a learning disability.
    • IQ-achievement discrepancies have no relationship to cognitive or academic skills in these students.

R. L. Mapou, Ph.D., ABPP-CN

adult intervention accommodations course substitution sparks 20061
ADULT INTERVENTIONACCOMMODATIONS-COURSE SUBSTITUTION Sparks (2006)
  • Conclusions
    • The ability to learn a foreign language is on a continuum.
    • Variables other than a learning disability play a role.
    • Native language ability, including phonological and orthographic skills, is a strong predictor of foreign language learning.
    • More effective interventions to assist students with learning a foreign language, similar to interventions for dyslexia, should be developed.

R. L. Mapou, Ph.D., ABPP-CN

research adhd in adults
RESEARCH:ADHD IN ADULTS

R. L. Mapou, Ph.D., ABPP-CN

research on adult adhd
RESEARCH ON ADULT ADHD
  • Research on ADHD has seemed more advanced and well developed than research on LDs, perhaps because of a “gold standard.”
  • Similarly it appeared that more studies had been published on etiology, neuropsychology, and outcome, and that they were more rigorous than those on LDs.
  • However, research on LDs has “caught up.”
  • As with LDs, we are still early in the research process.

R. L. Mapou, Ph.D., ABPP-CN

slide55
PREVALENCE OF ADHDMurphy & Barkley (2006); Prince et al. (2006); Wender et al. (2001); Kessler et al. (2006); Barkley et al (2008)
  • 3 to 10 percent of school age children have been estimated to have ADHD.
  • 50 to 80 percent of children continue to have symptoms as adults.
  • Therefore, we can estimate that between 1 and 8 percent of adults have been estimated as meeting criteria for diagnosis of ADHD.
  • However, Murphy and Barkley gave a lower estimate of 4 to 5 percent.
  • A recent population study reported a prevalence of 4.4%, but the authors cautioned that this was conservative, due to using standard DSM-IV criteria
  • Barkley et al. (2008) estimated that ADHD affects at least 5% of adults.

R. L. Mapou, Ph.D., ABPP-CN

slide56

NEUROPSYCHOLOGICAL FINDINGSCORE DEFICITSBarkley (2006a); Epstein et al. (1997, 1998); Jenkins et al. (1998); Johnson et al., (2001); Seidman et al. (1997, 1998); Schreiber et al. (1999)

  • Findings are similar to those in children.
  • Individual studies have reported impairment on measures of attention, information processing speed, executive functioning, learning, and memory.

R. L. Mapou, Ph.D., ABPP-CN

neuropsychological findings core deficits hervey et al 2004 schoechlin engel 2005 woods et al 2002a
NEUROPSYCHOLOGICAL FINDINGSCORE DEFICITSHervey et al. (2004); Schoechlin & Engel (2005); Woods et al. (2002a)
  • Three reviews, including two meta-analyses have reported that:
    • Impairments are evident in divided and sustained attention, timed word generation, auditory-verbal list learning, planning, organization, impulsivity/response inhibition, cognitive flexibility, problem solving with working memory, and information processing speed.
    • Impairments are selective rather than global, showing the need for multiple measures of attention and executive functioning.
    • Deficits are more likely on complex measures than on simpler measures.

R. L. Mapou, Ph.D., ABPP-CN

neuropsychological findings core deficits boonstra oosterlaan et al 2005
NEUROPSYCHOLOGICAL FINDINGSCORE DEFICITSBoonstra, Oosterlaan et al. (2005)
  • A fourth meta analysis focusing on executive functioning, found impairment in executive functioning on measures of verbal fluency, response inhibition, and set shifting, but also found impairment in other non-executive domains.
  • However, the non-executive domains mainly reflected attention and processing speed.

R. L. Mapou, Ph.D., ABPP-CN

neuropsychological findings attentional impairment barkley et al 2008
NEUROPSYCHOLOGICAL FINDINGSATTENTIONAL IMPAIRMENTBarkley et al. (2008)
  • Reaction time variability and errors of commission were best for discriminating between adults with ADHD and clinical or community controls.
  • A high level of response variability may be specific to ADHD.

R. L. Mapou, Ph.D., ABPP-CN

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NEUROPSYCHOLOGICAL FINDINGSBARKLEY’S THEORYBarkley et al. (2001); Epstein et al. (2001); Murphy et al. (2001); Rapport et al., (2001); Wodushek & Neumann (2003); Young et al. (2007)

  • Studies have supported Barkley’s (2006c) model, showing deficits in response inhibition, time estimation, interference control, and nonverbal working memory and the impact of response inhibition on emotion processing.
  • All deficits hypothesized to be linked to frontal lobe system dysfunction.

R. L. Mapou, Ph.D., ABPP-CN

neuropsychological findings barkley s theory carr et al 2006 wiersema et al 2006
NEUROPSYCHOLOGICAL FINDINGSBARKLEY’S THEORYCarr et al. (2006); Wiersema et al. (2006)
  • More recent studies on response inhibition are mixed.
    • Carr et al. found a deficit in motoric inhibition, but not attentional inhibition.
    • Wiersema et al. failed to find any deficit in response inhibition.

R. L. Mapou, Ph.D., ABPP-CN

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PSYCHOSOCIAL FUNCTIONINGEMOTIONAL PROCESSING/INTERPERSONAL SKILLSFriedman et al. (2003); Rapport et al. (2002)
  • Heightened emotional responsiveness has been linked to deficits in affect perception in adults with ADHD providing additional support for Barkley’s (2006c) theory.
  • Adults with ADHD have also been found to have lower social-emotional competence. Although aware of their deficits, impulsivity prevented them from using their knowledge effectively.

R. L. Mapou, Ph.D., ABPP-CN

psychosocial functioning impact on driving fischer et al 2007
PSYCHOSOCIAL FUNCTIONINGIMPACT ON DRIVINGFischer et al. (2007)
  • In a longitudinal study, young adults with ADHD had higher rate of traffic citations, license suspensions, and crashes, based on both self-report and parent report, as well as driving records, in comparison with community controls.
  • However, the rate of adverse events was lower than in the clinic-referred group.
  • Driving simulator performance showed a range of deficits, reflecting inattention and impulsivity.
  • Ratings by driving instructors showed more impulsive errors in an on-the-road test.

R. L. Mapou, Ph.D., ABPP-CN

psychosocial functioning impact on driving barkley et al 2008
PSYCHOSOCIAL FUNCTIONINGIMPACT ON DRIVINGBarkley et al. (2008)
  • Treatment with psychostimulant medication or atomoxetine (Strattera) can improve driving performance.

R. L. Mapou, Ph.D., ABPP-CN

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OUTCOME AND CO-OCCURRING DISORDERSCHANGES IN SYMPTOM PRESENTATIONBarkley (2006a, c); Barkley et al. (2008); Murphy & Barkley (2006); Prince et al. (2006)

  • Symptoms of motor hyperactivity tend to diminish with age, while problems with inattention and impulsivity continue and affect self-regulation, planning, organization, and time management in everyday life.

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OUTCOME AND CO-OCCURRING DISORDERSCHANGES IN SYMPTOM PRESENTATIONBarkley et al. (2002a); Barkley et al. (2008)
  • However, prevalence can be a function of the respondent and age at the time of assessment.
    • Prevalence of ADHD at age 21 using DSM criteria was 12% based on reports of the young adults, but 66% based on reports of their parents.
    • In contrast, prevalence of ADHD at age 27 was no longer found to differ as a function of the respondent.
      • Roughly 50% of young adults and observers both reported persisting symptoms that met ADHD DSM diagnostic criteria.
      • An additional 20% had residual symptoms.

R. L. Mapou, Ph.D., ABPP-CN

outcome and co occurring disorders predictors of outcome barkley 2006a barkley et al 2008
OUTCOME AND CO-OCCURRING DISORDERSPREDICTORS OF OUTCOMEBarkley (2006a);Barkley et al. (2008)
  • No single variable from childhood has been found to predict adult outcome in longitudinal studies, although several have shown relationships.
  • However, co-occurrence of conduct disorder has been found to predict anti-social behavior, drug use, school dropout, and teen pregnancy and leads to more negative outcomes.
  • Predicting outcome is complex, as different variables predict different aspects of outcome.

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OUTCOME AND CO-OCCURRING DISORDERSIMPACT ON ADULT LIFEBarkley (2006a); Barkley, Fischer, et al (2002); Biederman et al., (1993); Fischer et al. (1990); Manuzza et al. (1993); Seidman et al. (1998)

  • Longitudinal studies have shown lower academic achievement, more cognitive impairment, lower occupational attainment, and poorer social functioning in those diagnosed with ADHD as children.

R. L. Mapou, Ph.D., ABPP-CN

outcome and co occurring disorders impact on adult life barkley et al 2008 murphy barkley 2006
OUTCOME AND CO-OCCURRING DISORDERSIMPACT ON ADULT LIFEBarkley et al. (2008); Murphy & Barkley (2006)
  • Those followed longitudinally from childhood tend to be more impaired than adults seeking evaluation in a clinic.

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OUTCOME AND CO-OCCURRING DISORDERSPSYCHIATRIC AND OTHER DISORDERSKessler et al (2006); Barkley et al (2008); Katz et al. (2001)
  • Over 80% of adults with ADHD in a population-based study had at least one co-occurring psychiatric disorder.
  • “Pure” ADHD is rare in adults.
  • Multiple medications may be more necessary in treatment of adults with ADHD than in children.

R. L. Mapou, Ph.D., ABPP-CN

outcome and co occurring disorders neuropsychological functioning fischer et al 2005
OUTCOME AND CO-OCCURRING DISORDERSNEUROPSYCHOLOGICAL FUNCTIONINGFischer et al. (2005)
  • Longitudinal follow-up of an adult cohort diagnosed with ADHD in childhood showed that those who still met diagnostic criteria had more evidence of impairment in attention, disinhibition, slowed processing speed, and observed ADHD behavior during testing.
    • Co-existing anxiety added to problems, while co-existing depression did not.
    • Those with a history of conduct disorder also showed evidence of response perseveration.

R. L. Mapou, Ph.D., ABPP-CN

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OUTCOME AND CO-OCCURRING DISORDERSLACK OF GENDER EFFECTSBarkley (2006a); Barkley et al (2008); Biederman et al. (2004)
  • There is a higher proportion of women in clinic samples, perhaps because they are diagnosed later than men.
  • Women show cognitive impairment and psychosocial difficulties that are similar to those of men.
  • Gender differences, when present, are similar to gender differences in normal adults.
  • Women with ADHD do not appear to have problems that are different from those of men.

R. L. Mapou, Ph.D., ABPP-CN

outcome and co occurring disorders adhd as a disabling condtion barkley et al 2008
OUTCOME AND CO-OCCURRING DISORDERSADHD AS A DISABLING CONDTIONBarkley et al (2008)
  • The effects of ADHD are not benign, but, rather, lead to substantial impairment in functioning.
  • ADHD does not confer any special gifts, such as creativity.

R. L. Mapou, Ph.D., ABPP-CN

diagnosis diagnostic criteria barkley 2006a barkley et al 2008
DIAGNOSISDIAGNOSTIC CRITERIABarkley (2006a); Barkley et al. (2008)
  • The DSM-IV diagnostic criteria are too conservative and can miss adults who have the disorder.
  • Diagnostic criteria should be adjusted for age.
  • For adults, four symptoms rather than six appear to be developmentally abnormal.

R. L. Mapou, Ph.D., ABPP-CN

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DIAGNOSISDIAGNOSTIC CRITERIABarkley & Murphy (2006); Barkley et al. (2008); Conners et al. (1998); Riccio et al., (2005); Wender (1995)
  • Diagnostic criteria also need to be altered to reflect the behavioral manifestations of ADHD in adults, which differ from those of children.
  • Barkley and colleagues have recently proposed a new set of diagnostic criteria, based on initial research.

R. L. Mapou, Ph.D., ABPP-CN

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DIAGNOSISNEUROPSYCHOLOGICAL TESTINGLovejoy et al. (1999); Woods, Lovejoy, & Ball (2002); Woods, Lovejoy, Stutts et al. (2002)
  • Neuropsychological tests are modestly reliable in detecting ADHD in adults.
    • Although an abnormal finding can correctly predict ADHD, a normal finding does not indicate its absence.
    • Therefore, definitive diagnosis still requires the presence of specified symptoms and a history of the same.
  • Tests most sensitive to ADHD include measures of response inhibition, timed word generation, auditory-verbal list learning, and sustained attention (continuous performance tests; CPTs).

R. L. Mapou, Ph.D., ABPP-CN

diagnosis neuropsychological testing katz et al 1998 walker et al 2000 woods lovejoy ball 2002
DIAGNOSISNEUROPSYCHOLOGICAL TESTINGKatz et al. (1998); Walker et al. (2000); Woods, Lovejoy & Ball (2002)
  • Neuropsychological measures are sensitive, but not specific.
  • Individuals with psychiatric disorders can show similar neuropsychological deficits to those with ADHD, with poor predictive power when discriminating between psychiatric disorders and ADHD.

R. L. Mapou, Ph.D., ABPP-CN

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DIAGNOSISSELF-REPORT MEASURESHill et al. (2006); McCann et al. (2000); Murphy & Barkley (2006); Murphy & Schachar, (2002); Zucker et al. (2002); Barkley et al (2008)

  • Similarly, rating scales may be sensitive to problems due to other psychiatric disorders or to demographic factors.
  • Caution must be taken with retrospective rating scales of ADHD symptoms, although modest relationships between ratings from adults with ADHD and their parents have been reported.
  • A multi-dimensional assessment is essential.

R. L. Mapou, Ph.D., ABPP-CN

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ASSESSMENT OF MOTIVATION AND EFFORTAlfano & Boone (2007); Harrison et al. (2007); Sullivan et al. (2007); Harrison (2006)
  • Faking ADHD may be done to provide access to psychostimulant medication and accommodations.
  • Harrison (2006) found that 20% of students seeking evaluation for ADHD showed evidence of poor effort based on typical criteria established for other disorders.

R. L. Mapou, Ph.D., ABPP-CN

assessment of motivation and effort leark et al 2002 henry 2005 quinn 2003
ASSESSMENT OF MOTIVATION AND EFFORTLeark et al. (2002); Henry (2005); Quinn (2003)
  • CPTs can be useful to detect faking of ADHD, particularly when results on symptom rating scales are positive for ADHD.
    • Instructions to “fake bad” on the Test of Variables of Attention led to much poorer performances than did standard instructions.
    • Probable malingers in a group of mild TBI patients performed less well on the Test of Variables of Attention.
    • A study of college students by Quinn using the Integrated Visual and Auditory CPT found that those instructed to fake ADHD showed poorer performance than did those who were actually diagnosed with ADHD.
      • Both groups endorsed a similar number of ADHD symptoms, however.

R. L. Mapou, Ph.D., ABPP-CN

assessment of motivation and effort harrison et al 2007
ASSESSMENT OF MOTIVATION AND EFFORTHarrison et al. (2007)
  • Simple timed academic and processing speed measures (WJ3) may also be sensitive, as shown by slower speed and more errors in students instructed to fake ADHD, in comparison with normal controls and those with ADHD.
  • These same students also reported more ADHD symptoms on the Conners Adult ADHD Rating Scale than those with ADHD.

R. L. Mapou, Ph.D., ABPP-CN

assessment of motivation and effort sullivan et al 2007 fisher and watkins 2008
ASSESSMENT OF MOTIVATION AND EFFORTSullivan et al. (2007); Fisher and Watkins (2008)
  • Using Green’s (2003) cutoffs, Sullivan et al. found a failure rate of 47.6% on the WMT among those seeking evaluation for ADHD.
    • Poorer performance on the WMT also correlated with lower Performance IQ, poorer memory skills, and endorsement of more symptoms on the CAARS.
  • Fisher et al. found that five minutes of studying information on ADHD enabled 77% to 93% of students to produce a credible ADHD symptom profile.

R. L. Mapou, Ph.D., ABPP-CN

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PSYCHOPHARMACOLOGICAL TREATMENTHorrigan & Barnhill (2000); Maidment (2003); Prince et al. (2006); Saffren, Otto et al. (2005); Spencer, Biederman, Wilens et al. (2001)

  • Psychostimulants are the most effective treatment, with a response rate 25% to 78%.
    • Studies have examined Ritalin, Dexedrine, Adderall, Focalin, and the extended release versions in adults.
    • Response rates are lower than in children.
    • Differences across studies reflect study differences in diagnostic criteria, stimulant dosage levels, high levels of co-occurring disorders, and different methods of measure response.
    • Up to 50% of adults may not respond or have side-effects that prevent use of psychostimulants.
    • Medications do not treat co-occurring psychiatric disorders.
    • More data are needed to confirm long-term efficacy.

R. L. Mapou, Ph.D., ABPP-CN

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PSYCHOPHARMACOLOGICAL TREATMENTSpencer et al. (1998); Michelson et al. (2003); Prince et al. (2006); Barkley et al. (2008)
  • Strattera (atomoxetine), a noradrenergic agonist, has been added to the list of effective treatments, although anecdotal reports suggest that it is more effective for depression than for ADHD.
  • It may be a better choice than psychostimulants for adults with co-occurring mood, anxiety, tic, or substance abuse disorders.

R. L. Mapou, Ph.D., ABPP-CN

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PSYCHOPHARMACOLOGICAL TREATMENTNEUROPSYCHOLOGICAL EFFECTSBoonstra, Kooij et al. (2005); Wilson et al. (2006)
  • Two studies have shown improvement in neuropsychological functioning with stimulant treatment (Ritalin, Concerta, Adderall XR) in late adolescents and adults.
  • The effects of Adderall were seen as long as 15 hours after administration.

R. L. Mapou, Ph.D., ABPP-CN

slide86
PSYCHOPHARMACOLOGICAL TREATMENTSUBSTANCE ABUSEWilens (2004); Barkley et al. (2008); Wilens et al. (2003); Levin et al. (1998)
  • Substance abuse frequently co-occurs with ADHD.
  • Psychostimulant treatment in childhood may be protective against substance abuse.
  • Psychostimulants may be effective when treating adults with substance abuse.
  • However, it may be better to begin with non-psychostimulant medication, such as Wellbutrin or Strattera.
  • Treatment of ADHD is crucial when treating substance abusers, because of the impact ADHD on self-regulation.

R. L. Mapou, Ph.D., ABPP-CN

adult intervention nadeau 1995 saffren perlman et al 2005 wender et al 2001 wasserstein lynn 2001
ADULT INTERVENTIONNadeau (1995); Saffren, Perlman et al. (2005); Wender et al. (2001); Wasserstein & Lynn (2001)
  • Medication does not address educational issues, problematic social interactions, nor ways to compensate for difficulties.
  • Also, many adults do not respond well to medication.
  • Unfortunately, there is little research showing efficacy for methods to treat these problems in adults with ADHD, despite a large popular literature and several scholarly works.

R. L. Mapou, Ph.D., ABPP-CN

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ADULT INTERVENTIONCOGNITIVE BEHAVIORAL THERAPYRostain & Ramsay (2006); Ramsay & Rostain (2008)Saffren, Otto et al. (2005); Saffren, Perlman et al. (2005) Stevenson et al. (2002)

  • Group-based and individually based CBT has been used effectively in these studies to treat problems associated with ADHD.
  • Programs included psychoeducation and modules to address problems with organization and planning, distractibility, motivation, concentration, listening, impulsivity, stress management, anger control, and communication.
  • Participants remained on medication.
  • A reduction in ADHD symptoms, anxiety, depression, and other problems were reported by participants and independent raters.
  • Books to guide treatment have been published.

R. L. Mapou, Ph.D., ABPP-CN

adult intervention neurofeedback riccio french 2004
ADULT INTERVENTIONNEUROFEEDBACKRiccio & French (2004)
  • In a review of empirical support for treatment of attention deficits, Riccio and French concluded that there was tentative support for EEG biofeedback treatment of adults with ADHD.

R. L. Mapou, Ph.D., ABPP-CN

adult intervention assistive technology hecker et al 2002
ADULT INTERVENTIONASSISTIVE TECHNOLOGYHecker et al. (2002)
  • Use of the Kurzweil 3000 assistive reading software program helped college students with ADHD better attend to reading more effectively for longer periods and helped reduce stress and fatigue from reading, but did not improve comprehension.

R. L. Mapou, Ph.D., ABPP-CN

adult intervention accommodations extended time leadbetter et al 2001
ADULT INTERVENTIONACCOMMODATIONS-EXTENDED TIMELeadbetter et al. (2001)
  • Extended time on reading comprehension tests improved scores of college students with ADHD/depression or with a reading disability, but resulted in far less improvement for those with ADHD alone.

R. L. Mapou, Ph.D., ABPP-CN

adult intervention accommodations course substitution sparks et al 2004
ADULT INTERVENTIONACCOMMODATIONS-COURSE SUBSTITUTIONSparks et al. (2004)
  • College students with ADHD had little difficulty passing both lower and upper level foreign language courses.
  • ADHD alone should not be grounds for foreign language substitution.

R. L. Mapou, Ph.D., ABPP-CN

assessment components mapou 2004 2008
ASSESSMENT COMPONENTSMapou (2004, 2008)
  • History interview
  • Record review
  • Interview focused on ADHD symptoms
  • Behavioral rating scales (self and other report)
  • Intellectual/academic/cognitive evaluation, including behavioral observations
  • Personality/emotional assessment

R. L. Mapou, Ph.D., ABPP-CN

history
HISTORY
  • Early Development
    • Pregnancy, labor, and delivery
    • Problems immediately following birth
    • Developmental milestones
    • Serious illnesses or injuries
    • Frequent ear infections and drainage tube placement
    • Febrile or other types of seizures
    • Primary language

R. L. Mapou, Ph.D., ABPP-CN

history1
HISTORY
  • Education
    • Early subject-specific difficulties
    • Attentional problems and hyperactivity
    • Diagnosed LD or ADHD
    • Special education, accommodations, tutoring, and other assistance in primary and secondary education (e.g. Individualized Education Program or 504 Plan)
    • Repeated grades and reasons
    • Results of standardized testing (e.g., psychoeducational, yearly, entrance examinations)

R. L. Mapou, Ph.D., ABPP-CN

history2
HISTORY
  • Education
    • Total number of years in school
    • Grades in high school, college, and beyond
    • Specific problems in high school and college
      • Paying attention and taking notes in class
      • Paying attention when studying
      • Retaining studied material
      • Completing tests in the allotted time

R. L. Mapou, Ph.D., ABPP-CN

history3
HISTORY
  • Education (Continued)
    • Specific problems in high school and college
      • Retrieving studied information when tested
      • Problems with specific test formats
      • Time management and procrastination
      • Not turning in work
      • Failed or incomplete courses
      • Selecting college classes to maximize grades
    • Accommodations and support in post-secondary education
    • Degrees received

R. L. Mapou, Ph.D., ABPP-CN

record review
RECORD REVIEW
  • Report cards with teacher comments
  • Standardized academic testing (e.g. CTBS, CTP III, CAT, Otis-Lennon, Iowa, Stanford)
  • Secondary School Admission Test
  • College entrance examinations (e.g., SAT, ACT)
  • Graduate/professional school entrance examinations (e.g., GRE, GMAT, LSAT, MCAT)
  • Transcripts from college and postgraduate study
  • Letters documenting accommodations from testing agencies and university disability support services
  • Reports from previous evaluations
  • Medical records

R. L. Mapou, Ph.D., ABPP-CN

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TAKE HOME POINT:A DETAILED HISTORY ISKEYTO UNDERSTANDING A CLIENTAND ESSENTIALFOR GETTING ACCOMMODATIONS

R. L. Mapou, Ph.D., ABPP-CN

behavioral rating scales
BEHAVIORAL RATING SCALES
  • Wender Utah Rating Scale and Parents’ Rating Scale (WURS and PRS; Ward et al., 1993)
  • Childhood and Current ADHD Symptoms Scales (DuPaul et al., 1998; Murphy & Barkley, 1996)
  • Brown Attention Deficit Disorder Scales (BADDS; Brown, 1996)
  • Conners’ Adult ADHD Rating Scales (CAARS; Conners et al., 1998)
  • Behavior Rating Inventory of Executive Functioning-Adult Version (BRIEF-A; Roth et al., 2005)

R. L. Mapou, Ph.D., ABPP-CN

interview focused on adhd symptoms wender 1995 mapou 2006 in preparation
INTERVIEW FOCUSED ON ADHD SYMPTOMSWender (1995); Mapou (2006, in preparation)
  • Physical or cognitive restlessness
  • Problems with attention and concentration when listening to others
  • Difficulty remembering things told to you
  • Problems with attention and concentration when reading or studying
  • Difficulty comprehending and remembering written material

R. L. Mapou, Ph.D., ABPP-CN

interview focused on adhd symptoms
INTERVIEW FOCUSED ON ADHD SYMPTOMS
  • Forgetfulness
  • Organizational difficulties (School, work, home)
  • Time management difficulties and procrastination
  • Problems with initiation and follow-through
  • Impulsivity in speaking or acting
  • Risk-taking
  • Emotional lability, temper, stress management

R. L. Mapou, Ph.D., ABPP-CN

interview focused on adhd symptoms barkley et al 2008 barkley 2007
INTERVIEW FOCUSED ON ADHD SYMPTOMSBarkley et al. (2008); Barkley (2007)
  • New criteria proposed for adults with ADHD, which have empirical support, can be used to guide an interview.
  • Barkley’s Quick Check for Adult ADHD Diagnosis can be used to guide an interview for past and current symptoms

R. L. Mapou, Ph.D., ABPP-CN

assessment procedures mapou 2004 2008
ASSESSMENT PROCEDURESMapou (2004, 2008)
  • Items with an asterisk make up my core battery.
  • Additional measures from the group are selected, based on the referral question.
  • This not a definitive nor comprehensive test list.
    • There are other measures that can be chosen
    • These can be used as part of a psychoeducational or neuropsychological assessment.

R. L. Mapou, Ph.D., ABPP-CN

assessment procedures mapou 2008
Intellectual Functioning WAIS-III*

Academic Skills

Reading

Decoding WJ3ACH Word Attack*

WIAT-II Pseudoword Decoding

Recognition WJ3ACH Letter-Word Identification*

WIAT-II Word Reading

Automaticity Test of Word Reading Efficiency

ASSESSMENT PROCEDURES(Mapou, 2008)

Global Functioning Measures Used

R. L. Mapou, Ph.D., ABPP-CN

assessment procedures
Academic Skills

Reading

Comprehension WJ3ACH Reading Fluency*

Nelson-Denny Reading Test*

SATA Reading Comprehension

Gates-MacGinitie Reading Test – Level AR

WIAT-II Reading Comprehension

WJ3ACH Passage Comprehension

ASSESSMENT PROCEDURES

Global Functioning Measures Used

R. L. Mapou, Ph.D., ABPP-CN

assessment procedures1
Academic Skills

Writing

Encoding WJ3ACH Spelling of Sounds

Spelling/Writing Mech. WJ3ACH Spelling*

SATA Writing Mechanics

WIAT-II Spelling

Expressive WJ3ACH Writing Fluency*

WIAT-II Written Expression*

SATA Writing Composition

WJ3ACH Writing Samples

ASSESSMENT PROCEDURES

Global Functioning Measures Used

R. L. Mapou, Ph.D., ABPP-CN

assessment procedures2
Academic Skills

Arithmetic

Calculational Skills WJ3ACH Math Fluency*

WJ3ACH Calculation*

WRAT-4 Arithmetic

SATA Math Calculation

WIAT-II Numerical Operations

Problem-Solving WJ3ACH Applied Problems

SATA Math Application

WIAT-II Math Reasoning

Knowledge/Concepts WJ3ACH Quantitative Concepts

ASSESSMENT PROCEDURES

Global Functioning Measures Used

R. L. Mapou, Ph.D., ABPP-CN

assessment procedures3
Attention

Deployment

Alertness Observation

Focused attention WAIS-II Digit Symbol*

WAIS-III Symbol Search*

WAIS-III Processing Speed Index*

WJ3COG Visual Matching, Decision Speed, and Processing Speed score or Trail Making Test and Digit Vigilance Test*

Sustained attention IVA Continuous Performance Test or

Test of Variables of Attention*

ASSESSMENT PROCEDURES

Foundation Skills Measures Used

R. L. Mapou, Ph.D., ABPP-CN

assessment procedures4
Attention

Encoding

Span of attention WAIS-III or WMS-III Digit Span

Forwards*

California Verbal Learning Test-II,

Trial 1*

WJ3COG Memory for Sentences*

WMS-III Logical Memory I, 1st

Recall Total*

ASSESSMENT PROCEDURES

Foundation Skills Measures Used

R. L. Mapou, Ph.D., ABPP-CN

assessment procedures5
Attention

Encoding

Resistance to Consonant Trigrams

interference

Mental manipulation/ WAIS-III or WMS-III Digit Span

divided attention Backwards*

WAIS-III Arithmetic*

WAIS-III Letter-Number Sequencing* WAIS-III Working Memory Index*

Paced Auditory Serial Addition Test

ASSESSMENT PROCEDURES

Foundation Skills Measures Used

R. L. Mapou, Ph.D., ABPP-CN

assessment procedures6
Motor Skills

Strength Grip Strength

Speed Finger Tapping

Dexterity Grooved Pegboard

Executive Functions, Problem-Solving Skills, & Reasoning Abilities

Planning and Problem- Tower of LondonDX-2nd Edition*

Solving D-KEFS 20 Questions*

D-KEFS Tower Test

Porteus Maze Test

ASSESSMENT PROCEDURES

Foundation Skills Measures Used

R. L. Mapou, Ph.D., ABPP-CN

assessment procedures7
Executive Functions, Problem-Solving Skills, & Reasoning Abilities

Flexibility of Thinking Wisconsin Card Sorting Test

Organization California Verbal Learning Test-II,

Semantic vs. Serial Clustering*

Rey-Osterrieth Complex Figure Test,

Copy*

ASSESSMENT PROCEDURES

Foundation Skills Measures Used

R. L. Mapou, Ph.D., ABPP-CN

assessment procedures8
Executive Functions, Problem-Solving Skills, & Reasoning Abilities

Reasoning WAIS-III Similarities, Comprehension,

Picture Completion, Picture

Arrangement, and Matrix

Reasoning*

ASSESSMENT PROCEDURES

Foundation Skills Measures Used

R. L. Mapou, Ph.D., ABPP-CN

assessment procedures9
Language Skills

Phonological Awareness Comprehensive Test of Phonological

Processing

WJ3COG Sound Blending,

Incomplete Words, and Phonemic

Awareness Cluster score

WJ3ACH Sound Awareness (with

above, gives Phonemic Awareness 3 Cluster score)

ASSESSMENT PROCEDURES

Modality-Specific Skills Measures Used

R. L. Mapou, Ph.D., ABPP-CN

assessment procedures10
Language Skills

Comprehension

Single Word WAIS-III Vocabulary*

Peabody Picture Vocabulary Test-III

Complex WJ3ACH Understanding Directions*

OWLS Listening Comprehension or

WJ3ACH Oral Comprehension and

Listening Comprehension Cluster*

ASSESSMENT PROCEDURES

Modality-Specific Skills Measures Used

R. L. Mapou, Ph.D., ABPP-CN

assessment procedures11
Language Skills

Production

Naming Boston Naming Test or WJ3ACH Picture Vocabulary*

Speeded Naming WJ3COG Rapid Picture Naming

Single Word Controlled Oral Word Association Test

(Letters F,A,S and animals) or

D-KEFS Verbal Fluency Sentence and Discourse Observation*

TLC-E Level 2 Oral Expression

OWLS Oral Expression

ASSESSMENT PROCEDURES

Modality-Specific Skills Measures Used

R. L. Mapou, Ph.D., ABPP-CN

assessment procedures12
Language Skills

Foreign Language Modern Language Aptitude Test

Aptitude

ASSESSMENT PROCEDURES

Modality-Specific Skills Measures Used

R. L. Mapou, Ph.D., ABPP-CN

assessment procedures13
Visuospatial Skills

Perception Boston Naming Test-visual errors*

Rey-Osterrieth Complex Figure

Test*

WJ3COG Spatial Relations and

Visual Closure

Construction WAIS-III Block Design*

Rey-Osterrieth Complex Figure Test,

Copy*

WAIS-III Object Assembly

ASSESSMENT PROCEDURES

Modality-Specific Skills Measures Used

R. L. Mapou, Ph.D., ABPP-CN

assessment procedures14
Learning and Memory

Verbal California Verbal Learning Test-II*

WMS-III Logical Memory*

Visual Rey-Osterrieth Complex Figure Test, Immediate and Delayed Recall*

WMS-III Family Pictures or Faces*

WAIS-III Digit Symbol-Incidental Learning*

ASSESSMENT PROCEDURES

Integrated Skills Measures Used

R. L. Mapou, Ph.D., ABPP-CN

assessment procedures15
ASSESSMENT PROCEDURES

Personality and Emotional Assessment

MMPI-2

Symptom Checklists (For those with reading difficulties)

Beck Depression Inventory

Beck Hopelessness Scale

Beck Anxiety Inventory

SCL-90-R

Projective testing not routinely used (see Smith et al., 2007 for cautions against using the Rorschach

R. L. Mapou, Ph.D., ABPP-CN

assessment of motivation and effort should we use symptom validity measures
ASSESSMENT OF MOTIVATION AND EFFORT: SHOULD WE USE SYMPTOM VALIDITY MEASURES?
  • ADHD and LD are developmental disorders.
    • There must be some evidence of problems dating to childhood.
    • These disorders do not suddenly appear in college or beyond.
  • There are established cognitive profiles for LDs.
    • Data should be consistent with expectations.
  • Results should be consistent with prior testing.

R. L. Mapou, Ph.D., ABPP-CN

assessment of motivation and effort should we use symptom validity measures1
ASSESSMENT OF MOTIVATION AND EFFORT: SHOULD WE USE SYMPTOM VALIDITY MEASURES?
  • Test data should be consistent with everyday difficulties.
    • Exceptionally poor performances are suspicious.
  • Use embedded neuropsychological measures.
  • The WMT may be sensitive to feigned ADHD.
    • There are no studies of other measures.
  • The Stroop test may be sensitive to feigned reading disability.

R. L. Mapou, Ph.D., ABPP-CN

abbreviated batteries
ABBREVIATED BATTERIES
  • Linked to documentation requirements
  • WAIS-III
  • WJ3ACH Word Attack, Letter-Word Identification, Reading Fluency, Spelling, Writing Fluency (Math Fluency and Calculation if math is an issue)
  • Nelson-Denny Reading Test, Comprehension section, with standard and extended time
  • WIAT-II Written Expression (if writing or speed when writing is an issue)
  • Sampling of core neuropsychological measures that are marked with an asterisk, based on the referral question

R. L. Mapou, Ph.D., ABPP-CN

diagnostic issues
DIAGNOSTIC ISSUES

R. L. Mapou, Ph.D., ABPP-CN

diagnosis of learning disabilities
DIAGNOSIS OF LEARNING DISABILITIES
  • No one accepted method
  • Aptitude-achievement discrepancy models
  • Regression models
  • Simple cutoff score
  • Research-based clinical model (Matarazzo, 1990), which is supported by legal precedent.

R. L. Mapou, Ph.D., ABPP-CN

diagnosis of learning disabilities1
DIAGNOSIS OF LEARNING DISABILITIES
  • Clear weakness in a specific academic skill or cognitive realm
  • Neuropsychological profile is consistent with research findings about the disorder
  • Difficulties are consistent with the person’s everyday functioning
  • The problem is disabling

R. L. Mapou, Ph.D., ABPP-CN

reading disabilities
READING DISABILITIES
  • Phonological awareness
  • Spoken language comprehension
    • Single word (vocabulary)
    • Sentence and discourse level
  • General knowledge
  • Span for auditory-verbal information

R. L. Mapou, Ph.D., ABPP-CN

reading disabilities1
READING DISABILITIES
  • Word retrieval
    • Confrontation naming
    • Rapid visual naming
    • Timed word generation (verbal fluency)
  • Phonological and orthographic skills
    • Decoding when reading
    • Single-word reading
    • Encoding when spelling
    • Spelling

R. L. Mapou, Ph.D., ABPP-CN

reading disabilities2
READING DISABILITIES
  • Automaticity when reading single words
  • Fluency when reading text
  • Timed vs. extended time reading comprehension

R. L. Mapou, Ph.D., ABPP-CN

mathematics disabilities
MATHEMATICS DISABILITIES
  • Attention
  • Planning, organization, and problem-solving
  • Visuospatial skills
  • Semantic knowledge
  • Fluency when completing simple math facts
  • Written calculation
  • Word problem solving (written and mental)
  • Mathematical knowledge and concepts

R. L. Mapou, Ph.D., ABPP-CN

written language disabilities
WRITTEN LANGUAGE DISABILITIES
  • Fine motor speed and dexterity
  • Handwriting quality
  • Fluency when writing words and sentences
  • Phonological and orthographic skills
    • Encoding when spelling
    • Spelling

R. L. Mapou, Ph.D., ABPP-CN

written language disabilities1
WRITTEN LANGUAGE DISABILITIES
  • Oral sentence formulation
  • Verbal organization
  • Essay writing

R. L. Mapou, Ph.D., ABPP-CN

nonverbal learning disabilities
NONVERBAL LEARNING DISABILITIES
  • Interpersonal skills
  • Visuospatial skills
  • Attention
  • Fine motor skills
  • Executive functioning, problem-solving, and reasoning abilities
  • Mathematics

R. L. Mapou, Ph.D., ABPP-CN

adhd diagnostic criteria american psychiatric association 2000
ADHD DIAGNOSTIC CRITERIAAmerican Psychiatric Association (2000)
  • DSM-IV Criteria
    • 6/9 inattention symptoms
    • 6/9 hyperactive/impulsive symptoms
    • Childhood onset
    • Impairment in two or more settings, noted in social, academic, or occupational functioning

R. L. Mapou, Ph.D., ABPP-CN

adhd diagnostic criteria wender 1995
ADHD DIAGNOSTIC CRITERIAWender (1995)
  • Utah Criteria (Use Wender-Reimherr Attention Deficit Disorder Scale to assess)
    • Specifically designed for adults
    • Childhood onset, meeting DSM criteria
    • Attentional difficulties and motor hyperactivity, together with two of the following five symptoms: affective lability; disorganization, inability to complete tasks; hot temper, explosive short-lived outbursts; impulsivity; emotional over-reactivity
    • Exclusion of other disorders that better account for symptoms

R. L. Mapou, Ph.D., ABPP-CN

adhd diagnostic criteria barkley et al 2008
ADHD DIAGNOSTIC CRITERIABarkley et al. (2008)
  • Has six (or more) of the following symptoms that have persisted for at least 6 months to a degree that is maladaptive and developmentally inappropriate:
    • Often is easily distracted by extraneous stimuli
    • Often makes decisions impulsively
    • Often has difficulty stopping activities or behavior when he or she should do so

R. L. Mapou, Ph.D., ABPP-CN

adhd diagnostic criteria barkley et al 20081
ADHD DIAGNOSTIC CRITERIABarkley et al. (2008)
  • Criteria continued
    • Often starts a project or task without reading or listening to directions carefully
    • Often shows poor follow-through on promises or commitments he or she may make to others
    • Often has trouble doing things in their proper order or sequence

R. L. Mapou, Ph.D., ABPP-CN

adhd diagnostic criteria barkley et al 20082
ADHD DIAGNOSTIC CRITERIABarkley et al. (2008)
  • Criteria continued
    • Often more likely to drive a motor vehicle much faster than others (excessive speeding) [Alternate symptom for those adults with no driving experience: Often has difficulty engaging in leisure activities or doing fun things quietly]
    • Often has difficulty sustaining attention in tasks or leisure activities
    • Often has difficulty organizing tasks and activities

R. L. Mapou, Ph.D., ABPP-CN

adhd diagnostic criteria barkley et al 20083
ADHD DIAGNOSTIC CRITERIABarkley et al. (2008)
  • Some symptoms that caused impairment were present in childhood to adolescence (before age 16 years).
  • Some impairment from the symptoms is present in two or more settings (e.g., work, educational activities, home life, community functioning, social relationships).

R. L. Mapou, Ph.D., ABPP-CN

adhd diagnostic criteria barkley et al 20084
ADHD DIAGNOSTIC CRITERIABarkley et al. (2008)
  • There must be clear evidence of clinically significant impairment in social, educational, domestic (dating, marriage or cohabiting, financial, driving, child-rearing, etc.), occupational, or community functioning.
  • The symptoms do not occur exclusively during the course of a Pervasive Developmental Disorder, Schizophrenia, or other Psychotic Disorder and are not better accounted for by another mental disorder (e.g., Mood Disorder, Anxiety Disorder, Dissociative Disorder or a Personality Disorder).

R. L. Mapou, Ph.D., ABPP-CN

adhd diagnostic criteria barkley 2007
ADHD DIAGNOSTIC CRITERIABarkley (2007)
  • For adults reporting six of the adult symptoms and four of the DSM-IV childhood symptoms
    • 87% likelihood of having ADHD
    • 13% likelihood of having another psychiatric disorder
    • 0% likelihood of being normal

R. L. Mapou, Ph.D., ABPP-CN

value and importance of neuropsychological assessment
VALUE AND IMPORTANCE OF NEUROPSYCHOLOGICAL ASSESSMENT
  • Establish the presence of a co-occurring learning disability
  • Determine whether a learning disability or other neuropsychological disorder better explains symptoms
  • Provide information for developing interventions and compensatory strategies
    • Special educators and college counselors note that an ADHD diagnosis alone is insufficient for designing an intervention program for students

R. L. Mapou, Ph.D., ABPP-CN

adhd and similar disorders
ADHD AND SIMILAR DISORDERS
  • WAIS-III IQ and Indices profile
  • Attention
  • Executive functions, problem-solving skills, and reasoning abilities
  • Learning and memory

R. L. Mapou, Ph.D., ABPP-CN

differential diagnosis
DIFFERENTIAL DIAGNOSIS
  • A history dating to childhood must be established.
  • Diagnosis cannot be based solely on test results.
  • Co-occurring disorders are common.
    • Psychiatric disorders
    • Those with LD or ADHD may be at higher risk for traumatic brain injury, alcoholism, or substance abuse because of impulsivity, risk-taking, and low self-esteem.
  • Differential diagnosis requires a careful history and review of cognitive test results, all considered in the context of the whole person.

R. L. Mapou, Ph.D., ABPP-CN

differential diagnosis1
DIFFERENTIAL DIAGNOSIS
  • Must rule these out as the primary cause
    • Neurological disorders
    • Psychiatric disorders, including alcohol/substance abuse
    • Medical disorders

R. L. Mapou, Ph.D., ABPP-CN

client feedback and documentation
CLIENT FEEDBACKANDDOCUMENTATION

R. L. Mapou, Ph.D., ABPP-CN

the interpretive conference mapou 2004 2008
THE INTERPRETIVE CONFERENCEMapou (2004, 2008)
  • Feedback is a key component of the evaluation
    • Provide test scores, interpreted within a cognitive framework
    • Explain the meaning and limitation of each
    • Discuss how weaknesses can affect everyday functioning, with examples
    • Discuss how to use strengths
    • Provide recommendations
    • Answer questions
    • Provide a brief written summary, if the report will be delayed.

R. L. Mapou, Ph.D., ABPP-CN

guidelines for documentation

GUIDELINES FOR DOCUMENTATION

Association on Higher Education and Disability (1997, July). Guidelines for documentation of a learning disability in adolescents and adults.

Educational Testing Service (2007). Policy statement for documentation of a learning disability in adolescents and adults (2nd. Edition).

Educational Testing Service (1999, June). Policy statement for documentation of attention-deficit/hyperactivity disorder in adolescents and adults (Revised; Second revision in process).

R. L. Mapou, Ph.D., ABPP-CN

guidelines for documentation1
GUIDELINES FOR DOCUMENTATION
  • These guidelines have been adapted by other organizations responsible for “high stakes” entrance examinations (e.g., GRE, GMAT, LSAT, MCAT) and professional examinations (e.g. USMLE, medical boards, bar examinations).
  • Guidelines can vary slightly among organizations, and changes occur periodically. Guidelines, along with necessary forms for the examiner to complete, can be found on the organizations’ websites.

R. L. Mapou, Ph.D., ABPP-CN

guidelines for documentation ets 1999 2007
GUIDELINES FOR DOCUMENTATIONETS (1999, 2007)
  • On letterhead, with evaluator signature and credentials
  • Be current (within 3 years for ADHD and 5 years for LD).
    • ETS has new guidelines for waiving comprehensive evaluation, if certain criteria are met.

R. L. Mapou, Ph.D., ABPP-CN

guidelines for documentation2
GUIDELINES FOR DOCUMENTATION
  • Comprehensive evaluation including
    • A complete history relevant to the disability, showing that the disability has been present since childhood, even if undiagnosed.
    • For LD, include a full assessment of cognitive and academic skills, including a list of all measures and standard scores.
      • Qualitative information can supplement, but cannot replace this.

R. L. Mapou, Ph.D., ABPP-CN

guidelines for documentation3
GUIDELINES FOR DOCUMENTATION
  • Comprehensive evaluation including
    • For ADHD, show that the diagnostic criteria have been met through diagnostic interview, history, and a review of current symptoms, beyond the test results.
    • An interpretation of the results
    • A clearly stated diagnosis
    • A description of the functional limitations
    • Recommendations, including a rationale for accommodations
  • Supplementary information can be included (IEP or 504 Plan, transcripts, letter from disability support service, etc.).

R. L. Mapou, Ph.D., ABPP-CN

interpretation of the ada
INTERPRETATION OF THE ADA
  • Many testing agencies have equated the “average” person standard with average test scores (e.g, Gordon and Keyser, 1998).
  • However, average test scores alone do not reflect the way in which a task is done or the time needed to do a task in comparison with most people (who have little or no difficulty with a task in everyday life).
  • They have also interpreted the impact of the disability with reference to the general population and not to one’s peer group.
  • This has worked against gifted and talented (high IQ) individuals with LDs, although the new ETS (2007) Guidelines now refer to gifted/LD individuals.

R. L. Mapou, Ph.D., ABPP-CN

interpretation of the ada bartlett v the new york state board of law examiners 2001
INTERPRETATION OF THE ADABARTLETT v. THE NEW YORK STATE BOARD OF LAW EXAMINERS (2001)
  • Bartlett, who had received accommodations in law school, was initially denied accommodations on the bar examination because
    • She had successfully completed a Ph.D. and law school.
    • Many of her scores on the psychoeducational evaluation were average.
  • The case reached the U.S. Supreme Court and was remanded back to the original court.

R. L. Mapou, Ph.D., ABPP-CN

interpretation of the ada bartlett v the new york state board of law examiners 20011
INTERPRETATION OF THE ADABARTLETT v. THE NEW YORK STATE BOARD OF LAW EXAMINERS (2001)
  • The court concluded that Bartlett had a significant functional limitation in reading and in her ability to work.
    • She did not read in the way that “most people do.”
    • Her lack of fluency and automaticity were consistent with the problems experienced by adults with reading disorders.
    • The lengths to which she went to avoid reading and writing were evidence of how limited she was.
    • Her use of compensatory strategies did not correct, mitigate, or improve her slow reading speed.
    • Her use of compensatory strategies led to fatigue, which slowed her even more.

R. L. Mapou, Ph.D., ABPP-CN

interpretation of the ada bartlett v the new york state board of law examiners 20012
INTERPRETATION OF THE ADABARTLETT v. THE NEW YORK STATE BOARD OF LAW EXAMINERS (2001)
  • The court concluded that the “average person standard” was not meant to be specific to test scores, because many tests were not designed to assess skills in adults.
  • Rather, the standard is not being able to complete tasks “in the way that most people do.”
  • An evaluation must include evidence of limitations in everyday activities; test scores alone are insufficient to do this.

R. L. Mapou, Ph.D., ABPP-CN

interpretation of the ada1
INTERPRETATION OF THE ADA
  • Nonetheless, testing agencies and educational institutions have become increasingly conservative when applying the ADA guidelines, even for individuals with documented LD/ADHD and a history of accommodations.
  • As an example, most people in medical school are above average and do not fall below the “average person” standard.
  • Consequently, obtaining accommodations for LD or ADHD on the USMLE is extremely difficult, and obtaining accommodations “lower level” entrance exams has become more difficult.

R. L. Mapou, Ph.D., ABPP-CN

key points for obtaining accommodations
KEY POINTS FOR OBTAINING ACCOMMODATIONS
  • For developmental disorders, symptoms must have been present in childhood, even if they did not become functionally limiting until later in life.
  • The client must be disabled in comparison with most people.
    • Impaired scores must be below the level of most people.
    • Gifted/LD individuals have a far harder time qualifying.
  • There must be evidence of educational impact, seen in grades and/or standardized test scores.
  • Simply having a disorder does not mean it is disabling.

R. L. Mapou, Ph.D., ABPP-CN

key points for obtaining accommodations1
KEY POINTS FOR OBTAINING ACCOMMODATIONS
  • Ask the client how s/he completes tasks affected by the LD/ADHD and document this in the report. It is especially important to document how the disability affects the client in everyday life.
  • Obtain information from instructors and professors showing how the LD/ADHD is affecting the client in class.
  • If the client has been receiving accommodations and has good grades, state that s/he has done well because of having been accommodated, extensively tutored, medicated, at great emotional cost, etc.

R. L. Mapou, Ph.D., ABPP-CN

key points for obtaining accommodations2
KEY POINTS FOR OBTAINING ACCOMMODATIONS
  • Always complete testing with the person taking any needed medication, as this is how s/he will be completing the examination.
  • Support test data with qualitative observations of how the client completes the measures. Show that the disability affects him/her in multiple settings.
  • Specify exactly how much extended time is needed (i.e., 50% or 100%) and make it reasonable, based on the degree of disability It may also be necessary to specify for which sections of the test this applies.

R. L. Mapou, Ph.D., ABPP-CN

key points for obtaining accomomdations
KEY POINTS FOR OBTAINING ACCOMOMDATIONS
  • When recommending extended time, state how the client will make use of that time (e.g., rereading material, applying compensatory metacognitive strategies, using imagery), based on the client’s report, observations, and potential compensatory strategies.

R. L. Mapou, Ph.D., ABPP-CN

final thoughts on disability determination
FINAL THOUGHTS ON DISABILITY DETERMINATION
  • Colleges and even post-graduate programs are often more open to providing accommodations than are high-stakes testing organizations.
  • Nonetheless, one must be realistic when the problems are mild or when individuals are gifted, particularly because of inconsistent interpretation of the ADA.
  • It is reasonable to consider that the requirements for entry into certain professions should be more stringent.

R. L. Mapou, Ph.D., ABPP-CN

final thoughts on disability determintion
FINAL THOUGHTS ON DISABILITY DETERMINTION
  • Uniform determination of disability will prevent individuals from being denied accommodations at a later point.
  • College (and even high school) students should be counseled realistically about the chances for accommodations, if they are considering medical school.

R. L. Mapou, Ph.D., ABPP-CN

accommodations and interventions
ACCOMMODATIONSANDINTERVENTIONS

R. L. Mapou, Ph.D., ABPP-CN

accommodations for school
ACCOMMODATIONS FOR SCHOOL
  • Testing Accommodations
    • Extended time (50% to 100%)
    • Individual or small group testing
    • Extra breaks
    • Laptop computer for writing tests and/or note-taking
    • Calculator
    • Reader/audio format/use of technology for tests
    • Scribe (amaneuensis)
    • Alternate examination format
    • Specific written examination format

R. L. Mapou, Ph.D., ABPP-CN

accommodations for school1
ACCOMMODATIONS FOR SCHOOL
  • Class accommodations
    • Textbooks in audio form
    • Preferential seating
    • Permission to record lectures
    • Note-taker
    • Copies of overheads/PowerPoints
    • Proofreading assistance

R. L. Mapou, Ph.D., ABPP-CN

accommodations for school2
ACCOMMODATIONS FOR SCHOOL
  • Program accommodations
    • Course substitution
      • Foreign language
      • Mathematics
    • Priority registration
    • Reduced course load
    • Extended time line for graduation
    • Access to tutorial and other support services

R. L. Mapou, Ph.D., ABPP-CN

accommodations for the workplace
ACCOMMODATIONS FOR THE WORKPLACE
  • The reality of obtaining accommodations is different from being eligible for accommodations.
  • Employers may find a way to reject a client who self-discloses a learning disability or ADHD and requests accommodations during an interview.
  • It is better to obtain the job, “sweat it out,” and demonstrate one’s value to the workplace before requesting accommodations.
  • Implementation of accommodations may be facilitated by a psychologist, vocational counselor, or job coach.

R. L. Mapou, Ph.D., ABPP-CN

accommodations for the workplace1
ACCOMMODATIONS FOR THE WORKPLACE
  • Computer technology for reading, writing, and scheduling
  • Books and technical manuals in audio form
  • Dictation services
  • Written instructions
  • Note-taking services at meetings
  • Breaking assignments into smaller pieces, with deadlines for each
  • Handling only one project at a time
  • Individual office
  • Modification of job demands
  • Changing positions

R. L. Mapou, Ph.D., ABPP-CN

software and assistive technology
SOFTWARE AND ASSISTIVE TECHNOLOGY
  • Reading
    • Books in audio form
      • Recording for the Blind and Dyslexic; www.rfbd.org
      • Bookshare.org
      • Library services for the disabled
    • Kurzweil 3000
  • Writing
    • Texthelp Read and Write Gold
    • Word Q
    • Dragon Naturally Speaking or Via Voice for dictation

R. L. Mapou, Ph.D., ABPP-CN

software and assistive technology1
SOFTWARE AND ASSISTIVE TECHNOLOGY
  • Writing and organization: Inspiration
  • Universal design for instruction used by all students
    • Specific programs, such as Blackboard, that present information and permit tests to be taken on the web
    • Broader use of the Internet for posting class schedules, syllabi, PowerPoints, and handouts

R. L. Mapou, Ph.D., ABPP-CN

intervention
INTERVENTION
  • Medication
  • Evidence-based intervention for reading
    • Fluency and comprehension
    • Phonological awareness
    • Automaticity of decoding and single-word reading
    • Intensity is key, particularly if the deficit is longstanding
  • Tutoring, to remediate weaknesses, develop study skills, and work on specific subjects

R. L. Mapou, Ph.D., ABPP-CN

intervention1
INTERVENTION
  • Coaching for problems with executive functioning (ADHD), including the use of technology
  • Psychotherapy
  • Self development and growth
    • Bibliotherapy
    • Support groups

R. L. Mapou, Ph.D., ABPP-CN

other recommendations
OTHER RECOMMENDATIONS
  • Additional evaluations (medical, neurological, sleep, speech-language)
  • Vocational/career counseling
  • Legal advice or advocacy

R. L. Mapou, Ph.D., ABPP-CN

case examples
CASE EXAMPLES

R. L. Mapou, Ph.D., ABPP-CN

case ff

CASE FF

38-year-old male with veterinary degree. unable to pass licensing exam. History of problems with reading and attention.

R. L. Mapou, Ph.D., ABPP-CN

case ff1

CASE FF

BEHAVIORAL RATING SCALES

Wender Utah Rating Scale Total score: 9 (-)

Parents’ Rating Scale Total score: 7 (-)

Barkley’s Childhood ADHD Rating Scale

ScoreSelfMother

Inattentive Symptoms 2 (-) 4 (-) Hyperactive/Impulsive Sx. 9 (-) 7 (-)

Total Symptoms 11 (-) 11 (-)

R. L. Mapou, Ph.D., ABPP-CN

case ff2

CASE FF

BEHAVIORAL RATING SCALES

T-scoreT-score

CAARS ScaleSelfWife

Inattention/Memory Problems 54 56

Hyperactivity/Restlessness 61 55

Impulsivity/Emotional Lability 45 55

Problems with Self-Concept 51 58

DSM-IV Inattentive Sx 61 61

DSM-IV Hyper.-Imp. Sx 59 60

DSM-IV ADHD Sx Total 63 62

ADHD Index 54 56

R. L. Mapou, Ph.D., ABPP-CN

case ff3

CASE FF

BEHAVIORAL RATING SCALES

T-scoreT-score

BRIEF-A ScaleSelfWife

Inhibit 68* 65*

Shift 48 62

Emotional Control 43 51

Self Monitor 46 56

Behavioral Regulation Index 51 58

R. L. Mapou, Ph.D., ABPP-CN

case ff4

CASE FF

BEHAVIORAL RATING SCALES

T-scoreT-score

BRIEF-A ScaleSelfWife

Initiate 61 57

Working Memory 71* 63

Plan/Organize 64 56

Task Monitor 56 55

Organization of Materials 48 52

Metacognition Index 61 57

Global Executive Composite 57 58

R. L. Mapou, Ph.D., ABPP-CN

case ff5

CASE FF

INTELLECTUAL SKILLS

WAIS-III

Verbal IQ: 108 Verbal Comprehension Index: 96

Performance IQ: 124 Perceptual Organization Index: 130

Verbal subtest scores ranged from 7 to 17, Performance subtest scores ranged from 10 to 17.

R. L. Mapou, Ph.D., ABPP-CN

case ff6

CASE FF

LANGUAGE SKILLS

AUDITORY PHONLOGICAL AWARENESS

WJ3COG Subtest/ClusterSTD

Sound Blending 98

Incomplete Words 110

Phonemic Awareness 102

R. L. Mapou, Ph.D., ABPP-CN

case ff7

CASE FF

ACADEMIC SKILLS

WJ-III Reading Subtest/ClusterSTD

Word Attack 96 (6 errors)

Letter-Word Identification 111 (2 errors)

Basic Reading Skills 105

R. L. Mapou, Ph.D., ABPP-CN

case ff8

CASE FF

ACADEMIC SKILLS

WJ-III Writing SubtestSTD

Spelling of Sounds 109

Spelling 102

Writing Fluency 101 (1 error)

WJ-III Summary ScoreSTD

Phoneme/Grapheme Knowledge 100

R. L. Mapou, Ph.D., ABPP-CN

case ff9

CASE FF

LANGUAGE SKILLS

COMPREHENSION

WAIS-III MeasureAASS

Vocabulary 11

Gaps in his word knowledge

COMPREHENSION

WJ3ACH Subtest/ClusterSTD

Understanding Directions 107

Oral Comprehension 100

Listening Comprehension 104

R. L. Mapou, Ph.D., ABPP-CN

case ff10

CASE FF

ATTENTION

SPAN FOR VERBAL INFORMATION

MeasureRawSTD/AASS

WAIS-III Digit Span Forwards 8 digits (17)

CVLT-II, Trial 1 7 words

WJ3COG Memory for Sentences 102

WMS-III Logical Memory 1st Rec. 12

Reported that he has always been good with phone nos.

R. L. Mapou, Ph.D., ABPP-CN

case ff11

CASE FF

LANGUAGE SKILLS

PRODUCTION

MeasureRaw scoreT-score

Boston Naming Test-Total 58/60 50

Boston Naming Test-With

phonemic cuing 60/60

COWAT-Letters F,A,S 18 words 24

COWAT-Animals 21 45

WJ3COG SubtestSTD

Rapid Picture Naming 112

R. L. Mapou, Ph.D., ABPP-CN

case ff12

CASE FF

ACADEMIC SKILLS

WJ-III Reading ClusterSTD

Reading Fluency 90 (0 errors)

Nelson Denny Reading Test%ile

Reading Rate 6

Comprehension, Timed 6

Comprehension, Extended Time 78

Total Time: 32 minutes

37/38 questions correct.

R. L. Mapou, Ph.D., ABPP-CN

case ff13

CASE FF

ACADEMIC SKILLS

WJ-III Math Subtest/ClusterSTD

Math Fluency 94 (1 error)

Calculation 120

Math Calculation Skills Not reported

Missed one problem with fractions, but got algebra.

R. L. Mapou, Ph.D., ABPP-CN

case ff14

CASE FF

ACADEMIC SKILLS

WJ-III Summary ScoresSTD

Academic Skills 112

Academic Fluency 91

R. L. Mapou, Ph.D., ABPP-CN

case ff15

CASE FF

ATTENTION

ALERTNESS-GENERAL OBSERVATIONS

Awake and alert

FOCUSED ATTENTION/PROCESSING SPEED

WAIS-III MeasureAASS/STD

Digit Symbol-Coding 10

Symbol Search 11 (1 error)

Processing Speed Index 103

R. L. Mapou, Ph.D., ABPP-CN

case ff16

CASE FF

ATTENTION

FOCUSED ATTENTION/PROCESSING SPEED

MeasureRaw scoreT-score

Trail Making, Part A 18 seconds 56

Trail Making, Part B 45 seconds 52

Digit Vigilance-Time 441 seconds 39

Digit Vigilance-Errors 0 64

R. L. Mapou, Ph.D., ABPP-CN

case ff17

CASE FF

ATTENTION

SUSTAINED ATTENTION

IVA Continuous Performance TestSTD

Full Scale Response Control Quotient (RCQ) 67

Auditory RCQ 66

Auditory Prudence 68

Auditory Consistency 77

Auditory Stamina 86

Visual RCQ 77

Visual Prudence 69

Visual Consistency 97

Visual Stamina 94

R. L. Mapou, Ph.D., ABPP-CN

case ff18

CASE FF

ATTENTION

SUSTAINED ATTENTION

IVA Continuous Performance TestSTD

Full Scale Attention Quotient (AQ) 100

Auditory AQ 102

Auditory Speed 111 (542 ms)

Auditory Vigilance 105 (100%)

Auditory Focus 87

Visual AQ 103

Visual Speed 109 (379 ms)

Visual Vigilance 106 (100%)

Visual Focus 90

R. L. Mapou, Ph.D., ABPP-CN

case ff19

CASE FF

ATTENTION

MENTAL MANIPULATION/DIVIDED ATTENTION

WAIS-III MeasureRawSTD/AASS

Digit Span Backwards 7 digits (17)

Arithmetic 11

Letter-Number Sequencing 6-7 items 17

Working Memory Index 130

R. L. Mapou, Ph.D., ABPP-CN

case ff20

CASE FF

EXECUTIVE FUNCTIONS, PROBLEM-SOLVING SKILLS, AND REASONING ABILITIES

PLANNING AND PROBLEM SOLVING

Tower of LondonDX

Total Move Score 106

Total Correct Score 114 (7/10)

Total Rule Violation Score 82 (1 violation on #4)

Total Time Violation Score 64 (2 over 60 secs.)

Total Initiation Time 112

Total Execution Time 94

Total Problem-Solving Time 90

R. L. Mapou, Ph.D., ABPP-CN

case ff21

CASE FF

EXECUTIVE FUNCTIONS, PROBLEM-SOLVING SKILLS, AND REASONING ABILITIES

PLANNING AND PROBLEM SOLVING

D-KEFS 20 Questions TestAASS

Initial Abstraction Score 10

Total Questions Asked 11

Total Weighted Achievement Score 12

Generally systematic, but weak on the first.

R. L. Mapou, Ph.D., ABPP-CN

case ff22

CASE FF

EXECUTIVE FUNCTIONS, PROBLEM-SOLVING SKILLS, AND REASONING ABILITIES

FLEXIBILITY OF THIKING/USE OF FEEDBACK

WCST MeasureRawSTD%ile

Categories 6 >16

Total Errors 22 88

Perseverative Errors 10 86

Non-perseverative Errors 12 88

Perseverative Responses 11 86

Failure to Maintain Set 0 >16

Trouble shifting categories on F, N, then C. After that, OK.

R. L. Mapou, Ph.D., ABPP-CN

case ff23

CASE FF

EXECUTIVE FUNCTIONS, PROBLEM-SOLVING SKILLS, AND REASONING ABILITIES

ORGANIZATION

California Verbal Learning Test-II

Semantic Clustering z-score: 0.5

Serial Clustering z-score: 2

Recalled the words in order

WMS-III Logical Memory

Some details out of order. Lost context of the first story.

Rey-Osterrieth Complex Figure Test Copy

Generally organized

R. L. Mapou, Ph.D., ABPP-CN

case ff24

CASE FF

EXECUTIVE FUNCTIONS, PROBLEM-SOLVING SKILLS, AND REASONING ABILITIES

REASONING

WAIS-III MeasureAASS

Similarities 7 (Missed several easy)

Comprehension 13

Picture Completion 12

Matrix Reasoning 17

Picture Arrangement 13

R. L. Mapou, Ph.D., ABPP-CN

case ff25

CASE FF

VISUOSPATIAL SKILLS

CONSTRUCTION

MeasureRaw scoreAASS

Rey-Osterrieth-Copy 31/36 9

WAIS-III Block Design 15

Careless errors on Rey-Osterrieth.

Completed all Block Designs correctly and quickly.

R. L. Mapou, Ph.D., ABPP-CN

case ff26

CASE FF

LEARNING AND MEMORY-VERBAL

California Verbal LT-IITotalz-score

Trials 1-5 62 62 (T)

Trial 1 7 0

Trial 5 15 1

List B 5 -0.5

Short Delay-Free 14 1

Short Delay-Cued 14 0.5

Long Delay-Free 15 1

Long Delay-Cued 14 0.5

R. L. Mapou, Ph.D., ABPP-CN

case ff27

CASE FF

LEARNING AND MEMORY-VERBAL

California Verbal LT-IITotalz-score

Total Repetitions 3 0

Total Intrusions 0 1

Recognition-Total Hits 16 0.5

Total False Positives 0 1

R. L. Mapou, Ph.D., ABPP-CN

case ff28

CASE FF

LEARNING AND MEMORY-VERBAL

WMS-III MeasureAASS

Logical Memory I Recall Total 13

Logical Memory I Learning Slope 13

Logical Memory II Recall Total 14

Logical Memory Retention: 95% 14

Logical Memory I Thematic Total 11

Logical Memory II Thematic Total 14

Logical Memory II Recognition–A: 14/15 B: 15/15

R. L. Mapou, Ph.D., ABPP-CN

case ff29

CASE FF

LEARNING AND MEMORY-VISUAL

WMS-III MeasureAASS

Family Pictures I Recall Total 15

Family Pictures II Recall Total 15

Family Pictures Retention: 100% 12

R. L. Mapou, Ph.D., ABPP-CN

case ff30

CASE FF

LEARNING AND MEMORY-VISUAL

Rey-Osterrieth RecallTotalAASS

Immediate 27.5/36 13

20 Minute Delay 27.5/36 13

WAIS-III Dig. Sym. Inc. LearningTotal%ile

Paired Recall 7/9 >50

Free Recall 8/9 >50

R. L. Mapou, Ph.D., ABPP-CN

case ff31

CASE FF

DIAGNOSES

784.61 Reading disorder

314.9 ADHD, Not otherwise specified

854.0 S/P traumatic brain injury, severity unknown

R. L. Mapou, Ph.D., ABPP-CN

case ff32

CASE FF

RECOMMENDATIONS

50% additional time on the licensing examination

Specialized training to improve reading fluency and comprehension

Medical H.E.L.P. program at Marshall University

Tutoring, to improve study skills

Get sufficient sleep

Books on improving study skills and cognitive skills

Books on ADHD in adults

Compensatory strategies for attentional problems

R. L. Mapou, Ph.D., ABPP-CN

case ff33

CASE FF

OUTCOME

Granted double time on the licensing exam, based on an initial summary letter.

Do not know if he passed.

R. L. Mapou, Ph.D., ABPP-CN

case cc

CASE CC

43-year-old male shop teacher. History of problems with attention, organization, work production, and dysthymia. At risk of losing his teaching job.

BEHAVIORAL RATING SCALES

Wender Utah Rating Scale Total score: 51 (+)

Parents’ Rating Scale Total score: 12 (+)

Barkley’s Childhood ADHD Rating Scale

ScoreSelfMother

Hyperactive/Impulsive Sx. 20 (+) 9 (-)

Inattentive Symptoms 15 (+) 10 (-)

Total Symptoms 35 (+) 19 (-)

R. L. Mapou, Ph.D., ABPP-CN

case cc1

CASE CC

BEHAVIORAL RATING SCALES

T-scoreT-score

CAARS ScaleSelfWife

Inattention/Memory Problems 77 74

Hyperactivity/Restlessness 51 50

Impulsivity/Emotional Lability 58 65

Problems with Self-Concept 62 68

DSM-IV Inattentive Sx 85 71

DSM-IV Hyper.-Imp. Sx 52 64

DSM-IV ADHD Sx Total 69 70

ADHD Index 59 65

R. L. Mapou, Ph.D., ABPP-CN

case cc2

CASE CC

BEHAVIORAL RATING SCALES

T-scoreT-score

BRIEF-A ScaleSelfWife

Inhibit 62 72

Shift 66 66

Emotional Control 61 57

Self Monitor 64 75

Behavioral Regulation Index 66 68

R. L. Mapou, Ph.D., ABPP-CN

case cc3

CASE CC

BEHAVIORAL RATING SCALES

T-scoreT-score

BRIEF-A ScaleSelfWife

Initiate 66 73

Working Memory 76 73

Plan/Organize 82 83

Task Monitor 71 73

Organization of Materials 74 76

Metacognition Index 78 80

Global Executive Composite 75 76

R. L. Mapou, Ph.D., ABPP-CN

case cc4

CASE CC

UTAH CRITERIA FROM INTERVIEW

Persistent motor hyperactivity Yes

Attentional difficulties Yes

Affective lability No

Disorganization, inability to complete tasks Yes

Hot temper, explosive short-lived outbursts Yes

Impulsivity Yes

Emotional overreactivity Yes

PROPOSED ADULT ADHD CRITERIA FROM INTERVIEW (Barkley et al (2008)

Six out of nine symptoms endorsed as problems

Impairment reported at work and, to a lesser extent, at home and during past schooling.

R. L. Mapou, Ph.D., ABPP-CN

case cc5

CASE CC

INTELLECTUAL SKILLS

WAIS-III

Full Scale IQ: 143

Verbal IQ: 137 Verbal Comprehension Index: 142

Performance IQ: 142 Perceptual Organization Index: 145

All but Digit Symbol were above average.

R. L. Mapou, Ph.D., ABPP-CN

case cc6

CASE CC

ACADEMIC SKILLS

WJ-III Reading SubtestSTD

Letter-Word Identification 115

Reading Fluency 119

WJ-III Writing SubtestsSTD

Spelling 128

Writing Fluency 131

R. L. Mapou, Ph.D., ABPP-CN

case cc7

CASE CC

ACADEMIC SKILLS

WJ-III Math Subtest/ClusterSTD

Math Fluency 112

Calculation 120

Math Calculation Skills 121

WJ-III Summary ScoresSTD

Academic Skills 128

Academic Fluency 125

R. L. Mapou, Ph.D., ABPP-CN

case cc8

CASE CC

ACADEMIC SKILLS

Nelson Denny Reading Test%ile

Reading Rate 94

Comprehension, Timed 99

Total Time: 18 minutes

R. L. Mapou, Ph.D., ABPP-CN

case cc9

CASE CC

ATTENTION

FOCUSED ATTENTION/PROCESSING SPEED

WAIS-III MeasureAASS/STD

Digit Symbol-Coding 10

Symbol Search 18

Processing Speed Index Not reported

R. L. Mapou, Ph.D., ABPP-CN

case cc10

CASE CC

ATTENTION

FOCUSED ATTENTION/PROCESSING SPEED

MeasureRaw scoreT-score

Trail Making, Part A 20 seconds 53

Trail Making, Part B 30 seconds 67

Digit Vigilance-Time 290 seconds 48

Digit Vigilance-Errors 1 58

R. L. Mapou, Ph.D., ABPP-CN

case cc11

CASE CC

ATTENTION

SUSTAINED ATTENTION

Test of Variables of AttentionScoreSTD

Reaction Time 365 ms 84

Variability 74 ms 89

Percent Omission Errors 0 101

Percent Commission Errors 2.16 114

ADHD Score -1.46

R. L. Mapou, Ph.D., ABPP-CN

case cc12

CASE CC

ATTENTION

SPAN FOR VERBAL INFORMATION

MeasureRawSTD/AASS

WAIS-III Digit Span Forwards 8-9 digits (14)

CVLT-II, Trial 1 11 words

WJRCOG Memory for Sentences 118

WMS-III Logical Memory 1st Rec. 10

R. L. Mapou, Ph.D., ABPP-CN

case cc13

CASE CC

ATTENTION

RESISTANCE TO INTERFERENCE

Consonant TrigramsRawz-score

Total Correct 33/42 -0.9

R. L. Mapou, Ph.D., ABPP-CN

case cc14

CASE CC

ATTENTION

MENTAL MANIPULATION/DIVIDED ATTENTION

WAIS-III MeasureRawSTD/AASS

Digit Span Backwards 4-7 digits (14)

Arithmetic 13

Letter-Number Sequencing 7 items 19

Working Memory Index 128

Consonant TrigramsRawz-score

Total Counted 21.7 1.9

R. L. Mapou, Ph.D., ABPP-CN

case cc15

CASE CC

EXECUTIVE FUNCTIONS, PROBLEM-SOLVING SKILLS, AND REASONING ABILITIES

PLANNING AND PROBLEM SOLVING

Tower of LondonDX

Total Move Score 120

Total Correct Score 118 (7/10)

Total Initiation Time 148

Total Execution Tim 104

Total Problem-Solving Time 88

Total Time Violation Score 78 (2/10 exceeded 1 min.)

R. L. Mapou, Ph.D., ABPP-CN

case cc16

CASE CC

EXECUTIVE FUNCTIONS, PROBLEM-SOLVING SKILLS, AND REASONING ABILITIES

PLANNING AND PROBLEM SOLVING

D-KEFS 20 Questions TestAASS

Initial Abstraction Score 14

Total Questions Asked 13

Total Weighted Achievement Score 14

Sometimes made questions more complicated. Lost track of what he had asked once.

R. L. Mapou, Ph.D., ABPP-CN

case cc17

CASE CC

EXECUTIVE FUNCTIONS, PROBLEM-SOLVING SKILLS, AND REASONING ABILITIES

ORGANIZATION

California Verbal Learning Test-II

Semantic Clustering z-score: 3

Serial Clustering z-score: -2

Rey-Osterrieth Complex Figure Test Copy

Made good use of the organization to guide his copy.

R. L. Mapou, Ph.D., ABPP-CN

case cc18

CASE CC

EXECUTIVE FUNCTIONS, PROBLEM-SOLVING SKILLS, AND REASONING ABILITIES

REASONING

WAIS-III MeasureAASS

Similarities 16

Comprehension 14

Picture Completion 14

Picture Arrangement 16

Matrix Reasoning 18

R. L. Mapou, Ph.D., ABPP-CN

case cc19

CASE CC

LANGUAGE SKILLS

COMPREHENSION

WAIS-III MeasureAASS

Vocabulary 17

WJ3ACH Subtest/ClusterSTD

Understanding Directions 121

Oral Comprehension 117

Listening Comprehension 121

R. L. Mapou, Ph.D., ABPP-CN

case cc20

CASE CC

LANGUAGE SKILLS

PRODUCTION

MeasureRaw scoreT-score

Boston Naming Test-Total 60/60 61

COWAT-Letters F,A,S 69 words 68

COWAT-Animals 47 79

Could go on at length and in great detail when recounting his history.

R. L. Mapou, Ph.D., ABPP-CN

case cc21

CASE CC

VISUOSPATIAL SKILLS

CONSTRUCTION

MeasureRaw scoreAASS

Rey-Osterrieth-Copy 35/36 13

WAIS-III Block Design 19

R. L. Mapou, Ph.D., ABPP-CN

case cc22

CASE CC

LEARNING AND MEMORY-VERBAL

California Verbal LT-IITotalz-score

Trials 1-5 74 74 (T)

Trial 1 11 1.5

Trial 5 16 1.5

List B 11 2

Short Delay-Free 16 1.5

Short Delay-Cued 16 1.5

Long Delay-Free 16 1.5

Long Delay-Cued 16 1

R. L. Mapou, Ph.D., ABPP-CN

case cc23

CASE CC

LEARNING AND MEMORY-VERBAL

California Verbal LT-IITotalz-score

Total Repetitions 3 0

Total Intrusions 1 0.5

Recognition-Total Hits 16 0.5

Total False Positives 0 1

R. L. Mapou, Ph.D., ABPP-CN

case cc24

CASE CC

LEARNING AND MEMORY-VERBAL

WMS-III MeasureAASS

Logical Memory I Recall Total 11

Logical Memory I Learning Slope 17

Logical Memory II Recall Total 13

Logical Memory Retention: 94% 13

Logical Memory I Thematic Total 10

Logical Memory II Thematic Total 12

Logical Memory II Recognition–A: 14/15 B: 15/15

R. L. Mapou, Ph.D., ABPP-CN

case cc25

CASE CC

LEARNING AND MEMORY-VISUAL

WMS-III MeasureAASS

Family Pictures I Recall Total 12

Family Pictures II Recall Total 12

Family Pictures Retention: 98% 8

R. L. Mapou, Ph.D., ABPP-CN

case cc26

CASE CC

LEARNING AND MEMORY-VISUAL

Rey-Osterrieth RecallTotalAASS

Immediate 18/36 10

20 Minute Delay 17.5/36 10

WAIS-III Dig. Sym. Inc. LearningTotal%ile

Paired Recall 5/9 25

Free Recall 8/9 >50

R. L. Mapou, Ph.D., ABPP-CN

case cc27

CASE CC

DIAGNOSES

314.00 ADHD, predominantly inattentive type

300.4 Dysthymia, based on prior diagnosis

300.02 Rule out generalized anxiety disorder

R. L. Mapou, Ph.D., ABPP-CN

case cc28

CASE CC

RECOMMENDATIONS

Treatment with psychostimulant medication

Coaching

An assistant to help with materials logistics for class

Cognitive-behavioral therapy for ADHD and anxiety

Books on ADHD

R. L. Mapou, Ph.D., ABPP-CN

case cc29

CASE CC

OUTCOME

Started on Adderall with good results, but would forget to take it. Switched to Adderall XR, with better results, but still seeing the need for a short-acting dose later in the day.

Started working with a coach. Included wife to address marital issues.

Began to look for a cognitive-behavioral therapist.

Improvement seen in classroom performance

Given another year to show continued improvement.

R. L. Mapou, Ph.D., ABPP-CN

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