Psychological Testing on Attention-Deficit Hyperactivity Disorder (ADHD)and Learning Disability (LD)
A Case Study
Submitted to Mrs. Helen C. Jagmis
In partial fulfillment of the requirements in Research II
Sarah Mae B. Sincero IV-1 Acts
February 2008
PERSONAL PROFILE
Name: Christian A. Santos Nickname: Chris Address:
San Jose, Rizal
Birthday: February 29, 1994 Age: 12 years old Father: Rafael Santos Occupation: businessman Mother: Cristy Santos Occupation: accountant Disorder: Attention- Deficit Hyperactivity Disorder (ADHD)
Description of the Chosen Respondent The
child
with
ADHD
who
is
hyperactive/impulsi lsive
is
described by the following observations. I have classified my
obse observ rvat atio ions ns
impu impuls lsiv ivit ity, y, social
and and
into into
thre three e
inat inatte tent ntio ion n
behavior,
sect sectio ions ns: : to
psychological
furt furthe her r status
hype hypera ract ctiv ivit ity, y, elab elabor orat ate e and
his his
mental
disabilities. These three are the following: I. Hyperactivity •
Runs Runs or clim climbs bs exce excess ssiv ivel ely y when when inap inappr prop opri riat ate e
•
Has
difficulty
activities quietly
playing
or
engaging
in
leisure
•
Often talks excessively
•
Fidgets with hands or feet or squirms in seat
•
Leaves seat in classroom
or in other
situations
in
which remaining seated is expected II. Impulsivity •
Interrupts or intrudes on others (for example, butts
into conversations or games). •
Blurts out answers before questions have been completed
•
Has difficulty waiting for a turn
III. Inattention •
Does not seem to listen when spoken to directly
•
Does
not
follow
directions
and
fails
to
complete
schoolwork, tests, chores, or on-the-job duties •
Is often forgetful in daily activities
•
Fails
to
pay
close
attention
to
details
or
makes
careless mistakes and is easily distracted •
Has difficulty maintaining attention in tasks or play
activities, has difficulty organizing tasks or activities
Review of Related Literature and Studies
According
Reyes
(1998),
Attention-Deficit
Hyperactivity Disorder (ADHD), or Hyperkinetic Disorder, is a neurobehavioural developmental disorder affecting about 3-5% of the world's population under the age of 19. It typically
presents
itself
during
childhood,
and
is
characterized by a persistent pattern of inattention and/or hyperactivity, control
or
currently
as
well
as
impulsivity,
considered
to
forgetfulness,
and be
poor
impulse
distractibility. a
persistent
ADHD
and
is
chronic
condition for which no medical cure is available. ADHD is most
commonly
diagnosed
in
children
and,
over
the
past
decade, has been increasingly diagnosed in adults. About 60% of children diagnosed with ADHD retain the condition as adults. It appears to be highly heritable, although 1/5 of all cases are estimated to be caused from trauma or toxic exposure.
Methods
of
treatment
usually
involve
some
combination of medications, behaviour modifications, life style changes, and counseling. Sarmiento (1996) writes that ADHD is a developmental disorder, in
that,
traits
as
such
in
the
impulse
diagnosed control
population,
significantly
certain lag
in
development when compared to the general population. Using magnetic resonance imaging, this developmental lag has been estimated
to range
between
3
years, to 5
years
in the
prefrontal cortex of those with ADHD patients in comparison to their peers; consequently these delayed attributes are considered an impairment. ADHD has also been classified as a
behavior
disorder
combinations
of
and
a
neurological
these
disorder
or
such
as
classifications
neurobehavioural or neurodevelopmental disorders. Garcia (1999) says that the most common symptoms of ADHD are distractibility, difficulty with concentration and focus,
short
problems
term
organizing
impulsivity,
and
people
ADHD
with
memory ideas
weak
slippage, and
planning
have
all
belongings, and
the
procrastination, tardiness,
execution.
symptoms.
Most
Not
all
ordinary
people exhibit some of these behaviors but not to the point where
they
seriously
interfere
with
the
person's
work,
relationships, or studies or cause anxiety or depression. Children
do
not
often
have
to
deal
with
deadlines,
organization issues, and long term planning so these types of symptoms often become evident only during adolescence or adulthood when life demands become greater. Hyperactivity is common among children with ADHD but tends to disappear during adulthood. However over half of children with ADHD continue to have symptoms of inattention throughout their lives.
According to a majority of medical research in the United States, as well as other countries, ADHD is today generally regarded as a chronic disorder for which there are some effective treatments, but no true cure. Evidence suggests
that
hyperactivity
has
a
strong
heritable
component, and in all probability ADHD is a heterogeneous disorder, meaning similar
that
symptomology.
transporter
several Candidate
(DAT), dopamine
beta-hydroxylase
causes
(DBH),
genes
receptor
monoamine
catecholamine-methyl
transferase
transporter
(SLC6A4),
promoter
could
create
include
very
dopamine
D4 (DRD4), dopamine oxidase (COMT),
A
(MAOA), serotonin
5-hydroxytryptamine
2A
receptor (5-HT2A), and 5-hydroxytryptamine 1B receptor (5HT1B). Researchers believe that a large majority of ADHD arises from a combination of various genes, many of which affect dopamine transporters. Suspect genes include the 10repeat allele of the DAT1 gene, the 7-repeat allele of the DRD4
gene,
and
the
dopamine
beta
hydroxylase
gene
(DBH
TaqI).
Genome wide surveys have shown linkage between ADHD and
loci on chromosomes
anything,
the
broad
7, 11, 12,
selection
of
15, 16,
targets
and 17.
indicates
If the
likelihood that ADHD does not follow the traditional model
of a "genetic disease" and is better viewed as a complex interaction among genetic and environmental factors. As the authors of a review of the question have noted, "Although several
genome-wide
searches
have
identified
chromosomal
regions that are predicted to contain genes that contribute to ADHD susceptibility, to date no single gene with a major contribution
to
ADHD
has
been
identified."
Chromosomes
disaffecting health or life expectancy are not expressed by everyone with the same DNA, and have only been found in combination with one or more other chromosomes. One reason for
this
may
be
that
nature
selects
against
genetic
abnormalities that do not have any advantage. Studies show that there is a familial transmission of the
disorder
which
does
not
occur
through
adoptive
relationships. Twin studies indicate that the disorder is highly heritable and that genetics contribute about three quarters of the total ADHD population. While the majority of ADHD is believed to be genetic in nature,roughly 1/5 of all ADHD cases are thought to be acquired after conception due to brain injury caused by either toxins or physical trauma prenatally or postnatally. Additionally, SPECT scans found people with ADHD to have reduced blood circulation, and a significantly higher concentration
of
dopamine
transporters
in
the
striatum
which is in charge of planning ahead.A study by the U.S. Department of
Energy’s
Brookhaven
National
Laboratory
in
collaboration with Mount Sinai School of Medicine in New York suggest that it is not the dopamine transporter levels that
indicate
ADHD,
but
the
brain's
ability
to
produce
dopamine itself. The study was done by injecting 20 ADHD subjects and 25 control subjects with a radiotracer that attaches itself to dopamine transporters. The study found that it was not the transporter levels that indicated ADHD, but the dopamine itself. ADHD subjects showed lower levels of dopamine across the board. They speculated that since ADHD subjects had lower levels of dopamine to begin with, the number of transporters in the brain was not the telling factor. acid,
In an
support index
of
of
this
notion,
dopamine
plasma
levels,
was
homovanillic found
to
be
inversely related not only to childhood ADHD symptoms in adult
psychiatric
patients,
but
to
"childhood
learning
problems" in healthy subjects as well. Although there is evidence for dopamine abnormalities in
ADHD,
it
is
not
clear
whether
abnormalities
of
the
dopamine system are the molecular abnormality of ADHD or a secondary consequence of a problem elsewhere. Researchers have described
a
form of ADHD in which
the
abnormality
appears
to
be
sensory
overstimulation
resulting
from
a
disorder of ion channels in the peripheral nervous system. An early PET glucose
scan study
metabolism
was
found that global cerebral
8.1%
lower
in
medication-naive
adults who had been diagnosed as ADHD while children. The image
on the left illustrates
glucose metabolism in the
brain of a 'normal' adult while doing an assigned auditory attention
task;
the
image
on
the
right
illustrates
the
areas of activity in the brain of an adult who had been diagnosed with ADHD as a child when given that same task; these are not pictures of individual brains, which would contain substantial overlap, these are images constructed to
illustrate
group-level
differences.
Additionally,
the
regions with the greatest deficit of activity in the ADHD patients (relative to the controls) included the premotor cortex and the superior prefrontal cortex. A second study in
adolescents
differences patients
in
and
failed
to
global
find
glucose
controls,
but
statistically
significant
metabolism
between
did
statistically
find
ADHD
significant deficits in 6 specific regions of the brains of the ADHD patients (relative to the controls). Most notably, lower metabolic activity in one specific region of the left anterior
frontal
lobe
was
significantly
inversely
correlated with symptom severity. These findings strongly
imply
that
lowered
activity
in
specific
regions
of
the
brain, rather than a broad global deficit, is involved in ADHD doing
symptoms. an
However,
assigned
task.
these They
readings could
are
be
of
found
subjects in
ADHD
diagnosed patients because they simply were not attending to the task. Hence the parts of the brain used by others doing the task would not show equal activity in the ADHD patients. The estimated contribution of non genetic factors to the contribution of all cases of ADHD is 20 percent. The environmental factors implicated are common exposures and include alcohol, in utero tobacco smoke and lead exposure. Lead concentration below the Center for Disease Control's action level account for slightly more cases of ADHD than tobacco smoke (290 000 versus 270 000, in the USA, ages 4 to 15). Complications during pregnancy and birth—including premature observed
birth—might that
women
also who
play
smoke
a
while
role.
It
pregnant
has
been
are
more
likely to have children with ADHD. This could be related to the fact that nicotine is known to cause hypoxia (lack of oxygen) in utero, but it could also be that ADHD women have more
probabilities
to
smoke
both
in
general
and
during
pregnancy, being more likely to have children with ADHD due to genetic factors.
Head injuries can cause a person to present ADHD-like symptoms, possibly because of damage done to the patient's frontal
lobes.
Because
these
types
of
symptoms
can
be
attributable to brain damage, the earliest designation for ADHD was "Minimal Brain Damage". Michelson
(1993)
says
that
there
is
no
compelling
evidence that social factors alone can create ADHD. Many researchers believe that attachments and relationships with caregivers and other features of a child's environment have profound
effects
capacities. children
It
found
on
is
attentional
noteworthy
that
an
and
that
inordinate
a
self-regulatory study
number
of
of
foster
them
had
symptoms closely resembling ADHD. An editorial in a special edition
of Clinical Psychology in 2004 stated that "our
impression
from
spending
time
with
young
people,
their
families and indeed colleagues from other disciplines is that a medical diagnosis and medication is not enough. In our clinical experience, without exception, we are finding that the same conduct typically labeled ADHD is shown by children in the parental trauma."
context of violence and
attachments
and
Furthermore,
other
Complex
abuse, impaired
experiences Post
of
emotional
Traumatic
Stress
Disorder can result in attention problems that can look like ADHD, as can Sensory Integration Disorders.
Despite
the
lack
of
evidence
that
nutrition
causes
ADHD, studies have found that malnutrition is correlated with attention deficits. According to an advanced high-precision imaging study by researchers at the United States National Institutes of Health's delay
National
in
Institute of
physical
development
Mental in
Health,
some
brain
an
actual
structures,
with a median value of three years, was observed in the brains of 223 ADHD patients beginning in elementary school, during the period when cortical thickening during childhood begins to change to thinning following puberty. The delay was
most
prominent
in
the
frontal
cortex
and
temporal
cortex, which are believed responsible for the ability to control
and
suppress
focus
thinking,
inappropriate
attention
actions
things from moment to moment,
and and
and
thoughts,
work for
planning, remember
reward,
all
functions whose disturbance is associated with a diagnosis of ADHD; the region with the greatest average delay, the middle of the prefrontal cortex, lagged a full five years in development in the ADHD patients. In contrast, the motor cortex in the ADHD patients was seen to mature faster than normal,
suggesting
behavioral
control
that and
both
advanced
slower motor
development development
of
might
both be required for the restlessness and fidgetiness that
characterize an ADHD diagnosis. Aside from the delay, both groups showed a similar back-to-front development of brain maturation
with
different
different
times.
This
areas
peaking
contrasts
with
in
thickness
at
the
pattern
of
development seen in other disorders such as autism, where the peak of cortical thickening occurs much earlier than normal. The same laboratory had previously found involvement of the "7-repeat" variant of the dopamine D4 receptor gene, which accounts for about 30 percent of the genetic risk for ADHD, in unusual thinness of the cortex of the right side of the brain; however, in contrast to other variants of the gene
found
thickness
in
ADHD
during
patients,
the
the
teen
years
region in
normalized
these
in
children,
coinciding with clinical improvement. Cruz synthetic
(1994)
affirms
preservatives
that
and
many
studies
artificial
point
coloring
to
agents
aggravating ADD & ADHD symptoms in those affected. Older studies were inconclusive quite possibly due to inadequate clinical methods of measuring offending behavior. Parental reports were more accurate indicators of the presence of additives than clinical tests.
Several major studies show
academic
and
decreased
performance in
large
increased non-ADD
disciplinary
student
problems
populations
when
artificial
ingredients,
including
artificial
colors
were
eliminated from school food programs. According to Geronimo (1993), any of the symptoms of ADHD occur from time to time in everyone. In those with ADHD the frequency of these symptoms occur frequently and impair regular life functioning typically at school or at work. Not only will they perform poorly in task oriented settings but they will also have difficulty with social functioning with their peers. No objective physical test exists to diagnose ADHD in a patient. As with many other psychiatric and medical disorders, the formal diagnosis is made by a qualified professional in the field based on a set number of criteria. A review of 102 studies estimated ADHD's worldwide prevalence in people under the age of 19 to
be
5.29%.
There
was
wide
variability
in
prevalence
estimates, mostly due to the methodological characteristics of studies (for example, diagnostic criteria used) and, to a lesser extent, geographic location (North America having a significantly higher rate of ADHD than Africa and the Middle East). 10% of males, and (only) 4% of females have been diagnosed in the U.S. This apparent sex difference may reflect
either
females
with ADHD are
males.
a
difference
in
susceptibility
or
that
less likely to be diagnosed
than
Aquino written,
(2000)
visual,
defined or
Psychological
verbal
evaluations
tests
that
administered
are to
assess the cognitive and emotional functioning of children and adults. Psychological tests are formalized measures of mental functioning. Most
are objective and quantifiable;
however, certain projective tests may involve some level of subjective
interpretation.
measurements,
Also
questionnaires,
known
and
as
scales,
inventories, psychological
tests are administered in a variety of settings, including preschools,
primary
universities,
and
secondary
hospitals,
outpatient
schools,
colleges
healthcare
and
settings,
social agencies, prisons, and employment or human resource offices.
They
come
in
a
variety
of
formats,
including
written, verbal, and computer administered. According
to
Mendoza
(2002), for
children,
academic
achievement, ability, and intelligence tests may be used as a tool in school placement, in determining the presence of a
learning
identifying
disability
or
giftedness,
or
a
developmental in
tracking
delay,
in
intellectual
development. Intelligence testing may be used with adults to
determine
vocational
ability
(e.g.,
in
career
counseling) or to assess adult intellectual ability in the classroom.
Personality tests are administered for a wide variety of
reasons,
from
diagnosing
psychopathology
(e.g.,
personality disorder, depressive disorder) to screening job candidates.
They
may
be
used
in
an
educational
or
vocational setting to determine personality strengths and weaknesses, or in the legal system to evaluate parolees. Patients
who
have
experienced
a
traumatic
brain
injury, brain damage, or organic neurological problems (for example,
dementia)
are
administered
neuropsychological
tests
to assess their level
of functioning and identify
areas
of
They
evaluate
mental the
impairment.
progress
of
a
may
patient
also who
be
has
used
to
undergone
treatment or rehabilitation for a neurological injury or illness. In addition, certain neuropsychological measures may
be used to screen children for developmental delays
and/or learning disabilities. Santos neurological
(1991)
defines
disorder.
In
learning simple
disability terms,
a
as
a
learning
disability results from a difference in the way a person's brain is "wired." Children with learning disabilities are as smart or smarter than their peers. But they may have difficulty reading, writing, spelling, reasoning, recalling and/or organizing information if left to figure things out by themselves or if taught in conventional ways.
A learning disability can't be cured or fixed; it is a lifelong issue. With the right support and intervention, however, children with learning disabilities can succeed in school and go on to successful, often distinguished careers later in life. Adelino (2001) advises that parents can help children with
learning
encouraging
disabilities
their
understanding professionals
strengths,
the and
achieve knowing
educational learning
such their
system,
about
success
weaknesses,
working
strategies
by
for
with
dealing
with specific difficulties. The
good
scientists
are
news
about
learning
learning
more
every
disabilities day.
Their
is
that
research
provides hope and direction. If parents, teachers, and other professionals discover a child's learning disability early and provide the right kind of help, it can give the child a chance to develop skills needed to lead a successful and productive life. A recent National Institutes of Health study showed that 67 percent
of young
students who
were at risk for
reading
difficulties became average or above average readers after receiving help in the early grades. Parents are often the first to notice that "something doesn't seem right." If you are aware of the common signs
of learning disabilities, you
will be able to recognize
potential problems early.
Statement of problem
The general problem of the research is: Does
a
child
with
Attention-
Deficit
Hyperactivity
Disorder possess learning disability?
The specific problems are the following:
a.
Is
there
a
significant
difference
between
Attention- Deficit Hyperactivity Disorder of a child and the child’s learning disability?
b. Can learning disability be assessed through the use of the psychological test made by the researcher herself?
Hypotheses No,
a
child
with
Attention-
Deficit
Hyperactivity
Disorder does not possess learning disability.
There
is
a
significant
difference
between
the
Attention- Deficit Hyperactivity Disorder of a child and the child’s learning disability ( H 0: uA = uB)
Yes, learning disability can be assessed through the use
of
the
psychological
test
made
by
the
researcher
herself.
Instrumentation Self-Made Test
Name:____________________________ Age:____ Direction: Answer each of the five questions. Base your answer in the given figures.
1.
What is the color of the rectangle?
2.
What is the shape with the blue color?
3.
What is the color of the circle?
4.
What is the shape of the triangle?
5.
What is the color of the oval?
Four Standardized Tests MEMORY TEST
Question:
1. What is the color of his pants? 2. What object is he holding? 3. What kind of slippers is he wearing? 4. What is the color of his nose? 5. What is the color of the slippers?
MATHEMATICAL ABILITY
1. What is 45+23? 2. If I have 78 eggs and my mom give me 98 how many do I have all in all? 3. What is 65-45? 4. What are 8 multiplied to 2? 5. What do you get if in a basket with 43 flowers you pick 13?
GENERAL INFORMATION
1. What is the capital of Germany?
2. How many states are there in US? 3. What is the former name of Iraq? 4. What is the capital of Japan? 5. How many stars are there in the flag of USA?
Methodology
This
chapter
presents
the
materials
used,
the
procedure to be followed in order to assess the respondent precisely and the statistical treatment of data.
A. Materials
1. sheet of paper containing the psychological test 2. timer 3. tally sheet
B. Procedure
1. Present the psychological test to the respondent. 2. Read the directions clearly before him. 3. Allow the respondent to answer the assessment for 10 minutes. 4. Collect the test sheet and tally the results.
Statistical Treatment of Data Table 1: Results of the Psychological Test Items (n)
Score (x)
1
5
2
5
3
1
4
5
5
2
N=5
Σ x = 18
Legend: 5-the child’s answer is the correct one 4-the child’s answer is closely related to the correct one 3-the child’s answer is fairly related to the correct one 2-the child’s answer is somewhat related to the correct one 1-the child’s answer is incorrect
1. H0: uA = uB There is a significant difference between AttentionDeficit Hyperactivity Disorder of a child and the child’s learning disability.
2. Ha: uA = uB There is no significant difference between AttentionDeficit Hyperactivity Disorder of a child and the child’s learning disability. 3. Compute for the Mean, Mode and Range Mean:
x= Σx
Mode: 5
n = 18 5 = 3.6 5. Graph
Range:
R= HR - LR = 5-1 =4
Figure 3. Graph of Computed mean and the Treatment Group Mean 6. Computed Value > Critical Value 3.6 > 4 Accept H 0, Reject H a 7. Conclusion There is a significant difference between AttentionDeficit Hyperactivity Disorder of a child and the child’s learning disability.
Results and Discussion
This chapter contain s the major finding of the study and
answers
chronological
all
the
questions
sequence
of
raised
problems
according presented
to in
she the
statement of the problem. It also contains a discussion on the
analysis
of
the
relationship
between
the
variables
included in the study.
The result of the computation for mean, which is 3.6, is close to the accepted value 4.0. This indicates that the answers of the child all in all are closely related to the correct ones, and therefore the special child has a good test result. This signifies that the respondent, the child with the ADHD, has no learning disability, rather he has a good capability of thinking. Based on his answers to the queries given, he has no deficits in cognitive functioning.
A child with Attention- Deficit Hyperactivity Disorder does not necessarily possess learning disability. Not all children affected by ADHD have learning disabilities. Some may even excel among those children who have no disorder at all. There
is
a
significant
difference
between
the
Attention- Deficit Hyperactivity Disorder of a child and the child’s learning disability. Although ADHD may cause
learning disabilities due to the behavior of the child, it does not necessarily mean that a child with ADHD is born having learning disabilities.
Learning disability can be assessed through the use of the psychological test made by the researcher herself. The psychological testing is said to be successful based on its results. Therefore, the psychological test made by the researcher herself can be effective in assessing a child with ADHD.
Summary, Conclusion, Recommendation This
chapter
presents
the
overview
of
the
study,
summary of the significant findings, the conclusions drawn, and the recommendations made.
A child with Attention- Deficit Hyperactivity Disorder does not necessarily possess learning disability. Moreover, it is proved by this research that ADHD is not the same as learning
disability.
The
researcher
therefore
concludes
that the psychological testing done using the assessment she made can be utilized the same way as the standardized psychological tests are used.
The take
researcher
advantage
of
then all
recommends
the
support
that and
parents
should
education
that's
available, and a parent should be able to help her child with ADHD navigate his or her way to success.
She
recommends
parent education and support groups to help family members accept the diagnosis and to teach them how to help their child
organize
his
or
her
environment,
develop
problem-
solving skills, and cope with frustrations. Parent training can also teach parents to respond appropriately to their child's most trying behaviors and to use calm disciplining techniques.
Individual
or
family
counseling
may
also
be
helpful.
A parent is a stronger advocate for his child when she fosters child's
good
partnerships
treatment
-
that
with
everyone
includes
involved
teachers,
in
her
doctors,
therapists, and even other family members.
Bibliography Adelino, Harold P. 2001. ADHD Defined. New York: American dfdfBook Company. Aquino, Anne. 2000. Psychological Testing. 4th ed. New dfdfYork: Macmillan Publishing Co., Inc.
Cruz, William H.1994. ADHD and Children with it. New York: dfdfD. Appleton Company, Inc. Garcia, John Mark.1999. What is ADHD? New York: Macmillan dfdfPublishing Co., Inc. Geronimo, Christian.1993. Parents and ADHD. New York: D. sdsdAppleton Company, Inc. Mendoza, Carlo, T.2002. ADHD: Its Symptoms and Causes. New sdffYork: American Book Company. Michelson, Anderson, Q.1993. Psychological Assessment. New dfdfYork: Macmillan Publishing Co., Inc. Reyes, Tristan R.1998. What is Learning Disability? New asasYork: D. Appleton Company, Inc. Santos, Derrick, L.1991. Coping with Learning Disability. asasNew York: American Book Company. Sarmiento, Katherina, M.1996. All about Psychological asasDisorders. New York: Macmillan Publishing Co., Inc.