Continuing on our journey to shed some light on the challenging and important process of accurate diagnosing in mental health, we have another case we want to share with you. Hopefully this behind-the-scenes look at our process helps demystify psychological testing and diagnosing!
Here is another “Aha!” moment that we encountered:
A child client, let’s call her Jane, came to therapy to work on anxiety and symptoms that looked like Obsessive-Compulsive Disorder (OCD). She struggled with touching door handles, money, and her own face. She had anxiety about germs and had intrusive thoughts that made her uncomfortable, such as thoughts that went against her beliefs and she felt guilty for having. Typical therapy approaches for OCD (cognitive-behavioral therapy, exposure therapy, desensitization) had mild improvements at best, despite Jane being extremely motivated and engaged. She was very mature and bright beyond her years! However, things were not getting much better. Even when some obsessions and compulsions went away, they morphed into others. Treatment was suspiciously unsuccessful, so her therapist requested testing to assess for other conditions that may mimic or mix with OCD symptoms, which may require other forms of treatment.
Comprehensive testing included: intellectual assessment, academic testing, neurocognitive assessment of executive functions, attention, and impulse inhibition, mood assessments, and self-report, parent and teacher questionnaires. Results of testing showed the presence of OCD symptoms, but symptoms of Attention Deficit/ Hyperactivity Disorder (ADHD) were present as well. Jane had a hard time sustaining her attention on simple tasks, shifting attention between tasks, and feelings physically uncomfortable sitting still.
Our conclusion: OCD and ADHD co-occur about 40% of the time. This may be due to the fact that ADHD symptoms lead to the fear of making mistakes, being judged or missing things, and can cause extreme physical discomfort. The symptoms of inattention can also lead to hyper focus on thoughts that just pop up. People may fixate on small sensations, and may struggle to ditch a thought once it has come up. For this client, the ADHD came first. It was something she was likely born with, since it is a developmental condition, having to do with the way a brain forms in a baby. The OCD symptoms were acquired over time, as is the case with various anxiety-related conditions. With this in mind, the client pursued treatment for ADHD. She began a trial of stimulant medication and participated in biofeedback/neurofeedback therapy (brain training) alongside standard therapy. The whole family learned about ADHD and implemented changes in the home, as well as requested school accommodations. Very quickly (a couple of months) her OCD symptoms were a thing of the past.
Without testing, this client may have continued treatment for OCD with little or no improvement. OCD symptoms would have likely worsened, and ADHD symptoms would probably have gotten worse as well, as school and life responsibilities increased. Clarifying her diagnosis at a young age and guiding appropriate treatment lead to substantial improvement in her mental health. Years later, she is still free of OCD symptoms.
We are thrilled we were able to help guide her down a path that has changed her quality of life.
We hope you found this glimpse into what we do helpful and interesting. Keep an eye out for more, soon!