Dan DaSilva, Ph.D. Morris Psychological Group Rutgers University, Graduate School of Education Atlantic Neuroscience Insitute

Transcription

1 Assessment of the ADHD (not) Pilot Dan DaSilva, Ph.D. Morris Psychological Group Rutgers University, Graduate School of Education Atlantic Neuroscience Insitute Demographics 15 year, 10 month-old male left handed Presenting history of Attention Deficit Hyperactivity Disorder (ADHD) Focalin XR d/c 10 months prior to evaluation Diagnosed in 2009 at around age 7 1

2 Demographics Classified eligible to receive special services under the Other Health Impaired Category (OHI) Provided with services from 4 th -8 th grade. Small group testing Extended time No special instruction Attends competitive high school for international studies 3.44 GPA with no accommodations Demographics Interested in career in commercial aviation Wants to join USAF Active in Civil Air Patrol 30 hrs total flight time 2

3 FAA s Specifications for Neuropsychological Evaluations for ADHD FAA s Specifications for Neuropsychological Evaluations for ADHD (Continued) 3

4 Age of the Pilot was Factor Age appropriate measures for specific domains were used At the same time, traditional NP measures for which there are aviation norms were used as was the CogScreen-AE CogScreen-AE Regional Carrier Norms LRPV:

5 CogScreen-AE CogScreen-AE Taylor Aviation Factors 5

6 Speed Math: Previous Number Alone: Pathfinder Number: Accuracy Manikin: Process Discovery Persev. Errors: CogScreen-AE 5 th percentile 12.5 th percentile 15 th percentile 5 th percentile 5 th percentile Wechsler Intelligence Scale for Children 5 th Ed. Verbal Comprehension Index: 103 (58 th percentile) Visual Spatial Index: Fluid Reasoning Index: Working Memory Index: Processing Speed Index: Full Scale IQ: Average, overall 102 (55 th percentile) 121 (92 nd percentile) 107 (68 th percentile) 108 (70 th percentile) 109 (73 rd percentile) 6

7 Wechsler Intelligence Scale for Children 5 th Ed. SUBTESTS SCALED SCORE PERCENTILE RANK Verbal Comprehension Similarities Vocabulary Visual Spatial Block Design Visual Puzzles Wechsler Intelligence Scale for Children 5 th Ed. SUBTESTS SCALED SCORE PERCENTILE RANK Fluid Reasoning Matrix Reasoning Figure Weights 9 37 Working Memory Digit Span Picture Span Processing Speed Coding Symbol Search

8 Attention/Executive Matrix WISC-V Working Memory: SS= 107, 68 th percentile Digit Span Picture Span Connors CPT-II: Confidence Index = 50% (No Decision) Hit RT T = Variability T = # Commissions T = # Omissions T = Attention/Executive Matrix NEPSY-II Auditory Attention: Total Correct: Total Omission Errors: Total Inhibitory Errors: Total Commission: 75 th percentile 51 st -75 th percentile 51 st -75 th percentile 26 th -50 th percentile 26 th -50 th percentile Response Set Combined: 50 th percentile Total Correct: 51 st -75 th percentile Total Omission Errors: 51 st -75 th percentile Total Commission Errors: 51 st -75 th percentile Total Inhibitory Errors: 51 st -75 th percentile 8

9 Attention/Executive Matrix NEPSY Inhibition-Naming: Combined Score 75 th percentile Completion Time 91 st percentile Total Errors 51 st -75 th percentile Inhibition-Inhibition: Combined Score: 63 rd percentile Completion Time: 63 rd percentile Total Errors: 51 st -75 th percentile Inhibition-Switching: Combined Scaled Score: 75 th percentile Completion Time: 84 th percentile Total Errors: 51 st -75 th percentile Attention/Executive Matrix Trail Making Test (Kay, 2002): TMT Part A = 21 secs T = 51 TMT Part B = 54 secs T = 45 WISC-V Processing Speed: SS = 108, 70 th percentile Paced Auditory Serial Addition Test (Kay, 2002): PASAT 1 = 47 T = 52 PASAT 2 = 44 T = 53 9

10 Wisconsin Card Sorting Test Attention/Executive Matrix Categories Completed = 6 >16 th percentile Trials to Complete 1 st Cat. = 11 >16 th percentile % Perseverative Errors 86 th percentile Total Errors 63 rd percentile Failure to Maintain Set = 1 >16 th percentile Language NEPSY-II Comprehension of Instructions: 91 st percentile NEPSY-II Speeded Naming: Total Correct Completion Time 75 th percentile 6 th -10 th percentile 91 st percentile NEPSY-II Word Generation Semantic Initial Letter 98 th percentile 75 th percentile 10

11 NEPSY-IIArrows: NEPSY-II Geometric Puzzles: NEPSY-II Design Copying: Visuospatial 75 th percentile 84 th percentile >75 th percentile Rey Complex Figure: Copy = 35/36 >16 th percentile (Manual) 16 th percentile (Kay 2002) Verbal Memory California Verbal Learning Test Child Version Total Learning T = 53 Trial 1 z = 0.5 Trial 5 z = -0.5 Total Learning Slope z = -1 Semantic Clustering z = 1 List B Recall z = 1 List B vs Trial 1 z = 0.5 Short Delay Free Recall z = 0 Short Delay Cued Recall z = 0.5 Delayed Free Recall z = 0 Delayed Cued Recall z = 0Total Discriminability d z = 0.5) 11

12 Visual Memory Rey Complex Figure: CF Immediate Recall = 33 T = 68 (Meyers and Meyers) CF Delayed Recall = 32 T = 67 CF Recognition T = 51 CF Immediate Recall T = 66 (Kay) CF Delayed Recall T = 63 MMPI-A T VR TR F1 F2 F L K Hs D Hy Pd Mf Pa Pt Sc Ma Si Raw Score: T Score:

13 Additional Clinical Information Review of previous child study team evaluations revealed no evidence of learning disability. School records cite mostly behavioral disturbances without teacher reports of inattention or hyperactivity According to mother: Elementary school described him more as a bully and trouble maker. At home, mother did not see inattention but he was argumentative and saw himself as her equal. Behaviors were at their worst mid-elementary school as father when to prison for the first of several incarcerations. Essentially single parent household marked by financial stress and frequent moves. Conclusions Behavioral observations and current as well as past school history not consistent with clinical criteria for ADHD. Neurocognitive testing essentially intact for age and, when available, relative to pilot norms. No evidence of neurocognitive-based disorder of attention No evidence of executive dysfunction No evidence of disturbance of other functional domains Behavioral/Psychological: Essentially normal MMPI-A profile. History much consistent with past history of adjustment disorder with disturbance of mood and conduct. 13

14 Conclusions No evidence of disqualifying conditions as per FAR s Recommend consideration for first class medical when eligible. 14