Authors: Dr. Irma Porcic & Dr. Prisclla Butler

At Shared Vision, and at most other locations providing mental health treatment and assessment, the most frequent requests for neuropsychological testing are related to ADHD. Although there is no global consensus, the worldwide ADHD prevalence is currently estimated at between 5.3% and 7.1% in children and adolescents. (Cultural attitudes towards the interpretation of behavior may contribute to variations in prevalence.) Why do we need testing to answer parents’ questions about ADHD? And why do we find it to be so important to carefully consider the age and circumstances of each child for such a common diagnosis?

Significant emotional and interpersonal struggles can affect a child’s development and contribute to the manifestation of serious functional deficits in attention and executive skills. While in such cases attention and executive abilities are merely being hindered by emotional and developmental factors, observing these struggles in a child can lead to the appearance of ADHD symptoms, a neurodevelopmental disorder rooted in functional deficits in the brain. While observed behaviors, such as inattention and hyperactivity, can lead to the diagnosis of ADHD and referral for related treatments, we understand that sometimes such symptoms have an emotional and developmental root cause and therefore carefully consider development before making diagnostic conclusions.

The reverse is also true. Neurocognitive and neurodevelopmental concerns can impede a child’s social and emotional development and contribute to behavioral and social disorders. At any given time, each school-age child is actively navigating the developmental tasks of her age, seeking to develop her skills, succeed academically and socially, and acquire a sense of pride and competence. Her efforts may be impeded, however, by neuropsychological vulnerabilities. Neuropsychologically-based challenges not only make it difficult to excel at school and meet academic demands as expected, they can also lead to behavioral problems, emotional dysregulation, social difficulties or interpersonal conflict, decreased motivation, and mood lability.

It is especially important to understand what goes on for children with neuropsychological difficulties who also present with challenges in social settings. A child with attentional problems, for instance, is likely struggle to effectively pay attention to the many complicated aspects of social interactions, especially in a busy school setting with many surrounding distractions. When multiple peers are engaged in an interaction, it significantly increases the amount of information that she has to process, manage cognitively, and respond to. The child might become more impulsive in her interactions and, partially because she is working very hard cognitively to manage the many layers of the situation, may miss or misinterpret various aspects and struggle to effectively execute her social skills. This can result in poorer social functioning and negative feedback from peers, which in turn can affect the child’s self-esteem and sense of competence.

For younger children in particular, we often find that emotion regulation and attention skills develop in tandem. To better understand mood dysregulation in children, which can appear as hyperactivity or impulsivity, it is important to consider the process by which children learn to regulate emotions. Emotion regulation is a skill that children learn through their close relationships by seeing and feeling their caretakers manage emotions effectively and respond to the child with supportive guidance when emotions are heightened. Over time, friendships and other relationships promote practice of these skills as well. This process of co-regulation is very sensitive and can be made more difficult by familial struggles, parental stress, temperament, and the struggle for children to express cues and parents to read and respond to cues for support and regulation. Social experiences also help children strengthen their ability to regulate different types of affect; hence, insufficient or poor quality social interaction can impede this process.

Due to these complex interactions of neurological, emotional, and developmental factors, and the intricate web of visible behaviors and invisible root causes they weave, children’s psychological assessments are conducted with utmost care and provide rich insights into their well-being and functioning.