ADHD Assessment and Diagnosis
Everyone has moments where they do something impulsive, such as blurt out something they didn't mean to say, or lose interest in one task and switch to another before the first is complete. Sometimes, people get forgetful and disorganized, especially if they have a lot on their minds or are under a great deal of stress. Knowing when to have a child evaluated can be confusing. Some questions that can be considered when deciding whether or not to seek an evaluation include:
- Do these behaviors occur more often than in other children of the same age?
- Are these behaviors a continuous problem, rather than a response to a temporary situation?
- Do the behaviors occur in several settings or only in one specific place, like the playground or in the schoolroom?
If a parent, educator, caregiver, or other adult thinks that a child may have ADHD, the first step is to make an appointment with a professional (e.g., a child psychiatrist, psychologist, developmental/behavioral pediatrician, behavioral neurologist, or clinical social worker) who is trained to recognize the symptoms and pattern of onset. Although a pediatrician or general medical practitioner is often consulted first when families or individuals are seeking help, it is critical to remember that these individuals are trained in medicine and do not typically have expertise in psychological disorders or their diagnosis and treatment. Nevertheless, a medical evaluation to rule out other possible medical causes for the symptoms can be an important first step in the diagnostic process.
According to The American Academy of Pediatrics Clinical Practice Guideline, there are three criteria that must be fulfilled in order to make a diagnosis of ADHD in children:
- DSM-IV-TR diagnostic criteria (described previously) must be met
- Information about the child's condition in more than one setting must be obtained
- Other coexisting conditions that may make the diagnosis more difficult or complicate treatment planning must be considered
Understanding a person's general health status is an important component of the diagnosis, especially if symptoms have a recent onset (which may indicate a cause other than ADHD). A psychiatric and/or medical exam is necessary to assess for the presence of other conditions that can impact attention and impulsivity, such as learning disabilities, hyperthyroidism (too much thyroid hormone), fetal alcohol syndrome (high levels of exposure to alcohol while in the womb), depression, anxiety, and vision or hearing problems. By having your child examined by a professional, you can make certain that these other conditions (rather than ADHD) are not the correct diagnosis.
As part of the exam, the doctor will ask about the child's medical history (e.g., history of allergies, asthma, tics, epilepsy or other medical conditions) and the family history of psychiatric illness, depression, or alcoholism. The doctor will also be interested in the child's developmental history including age of major developmental milestones (e.g., crawling, walking, speaking, etc.), as well as school history (e.g., grades, friends and need for special classes).
The next step in the diagnostic process is to interview the parents. Although teachers are often the first to suggest that a child has ADHD, parents are usually the first people to suspect that a child has a problem. It is important for caregivers to find a psychologist or other ADHD specialist with whom they feel comfortable because the process will be a long one. Parents are most likely feeling greatly stressed and concerned at this stage of the process and the development of a solid relationship with the evaluating clinician can help make the entire process more agreeable.
Living with a child with ADHD places extreme pressure on everyone. Many parents get through the day (at least partly) by avoiding a direct examination of the true impact of the child's behavior, which may be affecting individual coping styles, and the parent-child relationship. Discussing these issues may be painful and quite difficult. However, many people find the act of discussing their child and any concerns about him or her a stress-reducing process. These conversations also provide the clinician with valuable information regarding your child (e.g., the extent of the symptoms and subsequent distress), his or her behaviors, family history and current family functioning. All of this information will be helpful in determining a correct diagnosis and subsequent treatment plan.
After interviewing the parents, the clinician will interview the child. Children likely have a number of concerns regarding their behavior, the consequences of their behavior, and seeing a mental health professional. It may be more difficult to get children talking about their problems than to coax parents to discuss their concerns, but the child's perspective can be very valuable.
The child interview is designed to elicit information about his or her understanding of the problematic behavior and what causes it, current emotions related to the problems and concerns regarding parents or other family members. In addition, the clinician will assess the child's general developmental functioning level, strengths, and weaknesses. As mentioned above, it is critical that the child feels comfortable with the clinician in order to maximize the likelihood of an accurate diagnosis and a successful therapeutic outcome. All information gleaned from this discussion will be helpful in the treatment planning stage.
The final diagnostic interview should be conducted with the teacher. Although many professionals rely solely on a written report or an ADHD checklist (see the list of assessment tools below) for information, there is much to be gained from a direct conversation with the teacher. A teacher interview is not always practical in today's demanding fast-paced world, but it should always be attempted once the ADHD checklist is completed and reviewed by the clinician. If the clinician cannot meet directly with the teacher, a phone or email conversation can provide the information necessary to complete the diagnostic process. Parents can sometimes be quite helpful in facilitating a meeting or a successful information exchange with the child's teacher.