Information About Your Assessment with Accurate Assessments of San Diego

Your initial contacts will be with Dr. Jaffe, who will discuss your needs and take some preliminary information in order to determine the type of evaluation that will best suit your needs. Dr. Jaffe will help you with all administrative aspects of the assessment, including scheduling, billing, logistics, and any follow up you may need. She will most likely schedule you (or your child) with one of AASD’s highly trained and expert doctors, although she may conduct the assessment herself. You (or your child) will be matched to the staff person who is the most knowledge and experienced with the problems that will be assessed.

The entire process from the first phone call to the end of the evaluation, when the final report is completed, usually takes approximately three weeks. However, it can take up to eight weeks, as there are a number of factors that contribute to both the length of time of the assessment and the cost. These are all described, below:

What to expect from a psychological, developmental, educational, or substance abuse assessment. You and your child (if the assessment is for a child) will meet with the assigned clinician for a number of hours; an assessment can take up to seven hours, depending on what issues are being evaluated. Because no two evaluations are alike, a battery of tests will be specially tailored to address your/your child’s concerns. The tests themselves can include questionnaires, puzzles, structured interviews, timed tests, and the use of pictures and/or stories. The clinician will interview you and your child (separately and/or together) to determine the exact nature of the issues, including symptoms, history, and family history. She or he will get to know you (and your child). If your child is being assessed, the psychologist may want to talk with his/her teachers and observe his/her behavior at school.

After the tests are completed, they will be scored, the results will be analyzed, and a report or summary of the findings will be written (if you have requested one, or the person who referred you requested one). The scoring and interpretation process can take up to two weeks. Dr. Jaffe and the clinician work together as a team to understand and report the findings. The clinician will then meet with you (and your child) to discuss the results. If you have not requested a report or summary of the findings, it will be important to bring paper and pen so you can take notes. If you have requested a report or summary, it will be provided to you at the time of the meeting, if it has been completed by that time. There are some situations in which you will not receive a copy of the report; please speak with Dr. Jaffe or the psychologist you are working with about this.

Fees and insurance. The cost of the evaluation is based on the type of assessment, the hours required to complete it, the test instruments used, and whether or not a report is included. Dr. Jaffe will discuss the details of the evaluation and the fees over the phone before the assessment is scheduled. Payment is expected at the time of the first meeting with the assigned clinician. AASD accepts cash, checks, and credit/debit cards.

If you would like to use an insurance company for which AASD is a provider, Dr. Jaffe can assist you with the paperwork to submit your claim for reimbursement. If, for whatever reason your insurance company does not cover any or all of your assessment fees, you will be responsible for all uncovered fees.

Most insurance companies require pre-authorization before providing psychological testing. In some cases, the insurance company will require detailed clinical information prior to authorization. If this is the case, you (and your child) will need to meet with us for initial interviews  in order for us to obtain the clinical information that the insurance company requires before the authorization paperwork can be submitted. Depending on your insurance company, its authorization process can take up to 10 business days after they receive the paperwork from AASD.

Please note, insurance companies do not pay for written summaries or reports of findings. If a report is required, or you request a report or summary of the findings for yourself, this cost will be billed in addition to other out-of-pocket costs.

Scheduling. Every effort will be made to accommodate your calendar when scheduling appointments. However, please be aware that, along with your (and your child’s) calendar(s), the clinician’s calendar and the availability of the facility must be taken into account. We will make every effort to work with you to meet any deadlines you have. However, this may not always be possible, depending on how far in the future the deadline is, the length of time an insurance company takes to provide authorization (if insurance is being used), scheduling limitations, the type of assessment you have requested, the length of time it takes to score and interpret test measures, and the length of time it takes to write a summary or report. The lengthiest type of assessment is one in which both intellectual and psychological functioning must be evaluated.

Because most evaluations require many hours to complete, they are often scheduled on weekday mornings and last most of the day. Lengthy assessments can be scheduled on two separate days, if needed.

If you are scheduling a school-aged child for an assessment, please plan to take her or him out of school for the full day. Saturday appointments are sometimes available for children for an additional $100 fee, to be paid at the time of the initial appointment.

Staff. The clinical staff consists of licensed psychologists and registered psychological assistants who are all highly trained and experienced in the field of assessment. Each has been selected for his/her particular area of expertise. Dr. Jaffe works closely with all clinicians at every step of the process. All clinicians consult with her regarding test interpretation and writing of the final report. Feel free to obtain additional information about the clinician with whom you are working from him/her, this website, or from Dr. Jaffe.

Differential Diagnosis of ADHD/ADD* in Children and Adults
Research Informed Assessment

by: Dr. Carrie Jaffe

ADHD is a neurobehavioral disorder that usually appears in early childhood before the age of 7. It is characterized by varying degrees of inattention, hyperactivity/impulsivity, and impairments in executive functioning, such as self-regulation, motivation, effort, processing speed, cognitive flexibility, organization, and planning. The prevalence of ADHD is estimated to be between 3-10% of school-aged children. Between 50-80% of them meet criteria for ADHD in adulthood; it is estimated that between 1.5-8% of the adult population has ADHD.

However, the symptoms of a variety of other medical, psychiatric, and developmental disorders, as well as environmental and social stressors frequently mimic the symptoms of ADHD in both children and adults. Thus, these statistics may be inaccurate. This article illustrates the importance of conducting a comprehensive, rather than focused assessment in order to rule out other frequently occurring causes of presenting symptoms.

ADHD is often diagnosed via clinical interview that consists of a thorough history of academic, development, and behavioral functioning, as well as a series of symptom-focused questions related to the DSM-IV diagnosis of ADHD. Occasionally, an astute clinician conducts a Continuous Performance Test (CPT), which is a standardized computer test of attention disorders. When the developmental history and symptoms are found to be consistent with the DSM-IV diagnostic criteria, the diagnosis is often made at that time. Although a comprehensive clinical interview is the cornerstone of diagnosing ADHD, formal psychological/ neuropsychological testing is recommended to rule out other frequently occurring causes of the symptom pattern.

In fact, the American Academy of Pediatrics (AAP) Guidelines recommend that the assessment of ADHD include a thorough evaluation of co-existing conditions, because as many as half of the children diagnosed with ADHD also have a co-existing condition. It is essential to assess the contribution of other factors as either a primary cause or secondary response to ADHD. For example, according to the AAP, research on ADHD and a thyroid disorder called Generalized Resistance to Thyroid Hormone (GRTH) indicates that a high percentage of children with GRTH are diagnosed with ADHD. Similarly, research findings indicate that cognitive response patterns similar to those of people diagnosed with ADHD have been reported in patients with other disorders that affect the frontal lobes, such as Non-Verbal Learning Disability (NVLD). Indeed, there is a high frequency of incorrect ADHD diagnoses in people found to actually have NVLD.

Conditions that mimic or co-occur with ADHD include, but are not limited to the following:

Medical conditions:

• Hearing or vision problems
• Asthma/allergies
• Syndromes such as Fetal Alcohol Syndrome (FAS), Fragile X, etc.
• Generalized Resistance to Thyroid Hormone (GRTH)
• Normal aging in adults

Psychological disorders:

• Conduct Disorder or Oppositional Defiant Disorder (Prevalent among approximately ¼- 1/3 of children diagnosed with ADHD.)
• Mood Disorders (Depression, Bipolar Mood Disorder) (Prevalent among approximately 1/5 of children diagnosed with ADHD.)
• Anxiety Disorders (Prevalent among approximately ¼ of children diagnosed with ADHD.)
• Substance-Related Disorders
• Pro Dromal Psychosis

Environmental stressors:

• Stress
• Poor self-esteem
• Family dysfunction
• Physical/psychological/sexual abuse or neglect
• Post Traumatic Stress Disorder

Developmental disorders:

• Learning Disabilities (Prevalent among 12-50% of children with ADHD)
• Language Disorder
• Mental Retardation
• Non-Verbal Learning Disability
• Pervasive Developmental Disorders (Autism, Asperger’s Disorder, Pervasive Developmental Disorder Not Otherwise Specified)

Unfortunately, these conditions are often missed or misdiagnosed when the diagnosis of ADHD is made based solely on a CPT and clinical interview, no matter how comprehensive. Thus, it is crucial to rule out co-occurring disorders and disorders that mimic ADHD by including behavior rating scales and formal psychological/neuropsychological testing in the evaluation process. According to Mapou (2009), a comprehensive assessment of ADHD should include the following:

• Comprehensive clinical interview to include complete developmental, academic, behavioral, and symptom history
• Referral to a physician for a complete physical exam
• Assessment of intelligence and academic achievement
• Assessment of attention and memory
• Assessment of learning
• Assessment of executive functioning

Accurate Assessments of San Diego specializes in Psychological, Developmental, Educational, and Substance Abuse Evaluations that target issues uniquely relevant to each individual. We are committed to a Standard of Excellence that values best- practices techniques and the use of well-validated instruments.

 * In this article, “ADHD” encompasses all types of this diagnosis, including Attention Deficit Disorder, Hyperactive Type, Attention Deficit Disorder, Inattentive Type, and Attention Deficit Disorder, Combined Type.

References:

Mapou, Robert L. (2009). Adult Learning Disabilities and ADHD: Research Informed Assessment. Oxford University Press

Leslie, Laurel K. (2008). About ADHD. Retrieved November 23, 2011, from https://research.tufts-nemc.org/help4kids