How Is ADHD Identified and Diagnosed?
Many parents see signs of an attention deficit in toddlers long before
the child enters school. For example, as a 3-year-old, Henry's
son already displayed some signs of hyperactivity. He seemed to
lose interest and dart off even during his favorite TV shows or
while playing games. Once, during a game of "catch," he left the
game before the ball even reached him!
Like Henry's son, a child may be unable to focus long enough
to play a simple game. Or, like Mark, the child may be tearing
around out of control. But because children mature at different
rates, and are very different in personality, temperament, and
energy level, it's useful to get an expert's opinion of whether
the behaviors are appropriate for the child's age. Parents can
ask their pediatrician, or a child psychologist or psychiatrist
to assess whether their toddler has an attention disorder or is
just immature, has hyperactivity or is just exuberant.
Seeing a child as "a chip off the old block" or "just like his
dad" can blind parents to the need for help. Parents may find
it hard to see their child's behavior as a problem when it so
closely resembles their own. In fact, like Henry, many parents
first recognize their own disorder only when their children are
In many cases, the teacher is the first to recognize that a
child is hyperactive or inattentive and may consult with the school
psychologist. Because teachers work with many children, they come
to know how "average" children behave in learning situations that
require attention and self control. However, teachers sometimes
fail to notice the needs of children like Lisa who are quiet and
Types of Professionals Who Make the Diagnosis
School-age and preschool children are often evaluated by a school
psychologist or a team made up of the school psychologist and
other specialists. But if the school doesn't believe the student
has a problem, or if the family wants another opinion, a family
may need to see a specialist in private practice. In such cases,
who can the family turn to? What kinds of specialists do they
||Can diagnose ADHD
|| Can prescribe medications, if needed
|| Provides counseling or training
|Pediatricians or family physicians
The family can start by talking with the child's pediatrician
or their family doctor. Some pediatricians may do the assessment
themselves, but more often they refer the family to an appropriate
specialist they know and trust. In addition, state and local agencies
that serve families and children, as well as some of the volunteer
organizations listed in the back of this booklet, can help identify
an appropriate specialist.
Knowing the differences in qualifications and services can help
the family choose someone who can best meet their needs. Besides
school psychologists, there are several types of specialists qualified
to diagnose and treat ADHD. Child psychiatrists are doctors who
specialize in diagnosing and treating childhood mental and behavioral
disorders. A psychiatrist can provide therapy and prescribe any
needed medications. Child psychologists are also qualified to
diagnose and treat ADHD. They can provide therapy for the child
and help the family develop ways to deal with the disorder. But
psychologists are not medical doctors and must rely on the child's
physician to do medical exams and prescribe medication. Neurologists,
doctors who work with disorders of the brain and nervous system,
can also diagnose ADHD and prescribe medicines. But unlike psychiatrists
and psychologists, neurologists usually do not provide therapy
for the emotional aspects of the disorder. Adults who think they
may have ADHD can also seek a psychologist, psychiatrist, or neurologist.
But at present, not all specialists are skilled in identifying
or treating ADHD in adults.
Within each specialty, individual doctors and mental health
professionals differ in their experience with ADHD. So in selecting
a specialist, it's important to find someone with specific training
and experience in diagnosing and treating the disorder.
Steps In Making a Diagnosis
Whatever the specialist's expertise, his or her first task is
to gather information that will rule out other possible reasons
for the child's behavior. In ruling out other causes, the specialist
checks the child's school and medical records. The specialist
tries to sense whether the home and classroom environments are
stressful or chaotic, and how the child's parents and teachers
deal with the child. They may have a doctor look for such problems
as emotional disorders, undetectable (petit mal) seizures, and
poor vision or hearing. Most schools automatically screen for
vision and hearing, so this information is often already on record.
A doctor may also look for allergies or nutrition problems like
chronic "caffeine highs" that might make the child seem overly
Next the specialist gathers information on the child's ongoing
behavior in order to compare these behaviors to the symptoms and
diagnostic criteria listed in the DSM (Diagnostic and Statistical
Manual of Mental Disorders). This involves talking with the child
and if possible, observing the child in class and in other settings.
The child's teachers, past and present, are asked to rate their
observations of the child's behavior on standardized evaluation
forms to compare the childžs behaviors to those of other children
the same age. Of course, rating scales are subjective--tthey only
capture the teacher's personal perception of the child. Even so,
because teachers get to know so many children, their judgment
of how a child compares to others is usually accurate.
The specialist interviews the child's teachers, parents, and
other people who know the child well, such as school staff and
baby-sitters. Parents are asked to describe their child's behavior
in a variety of situations. They may also fill out a rating scale
to indicate how severe and frequent the behaviors seem to be.
In some cases, the child may be checked for social adjustment
and mental health. Tests of intelligence and learning achievement
may be given to see if the child has a learning disability and
whether the disabilities are in all or only certain parts of the
In looking at the data, the specialist pays special attention
to the child's behavior during noisy or unstructured situations,
like parties, or during tasks that require sustained attention,
like reading, working math problems, or playing a board game.
Behavior during free play or while getting individual attention
is given less importance in the evaluation. In such situations,
most children with ADHD are able to control their behavior and
The specialist then pieces together a profile of the child's
behavior. Which ADHD-like behaviors listed in the DSM does the
child show? How often? In what situations? How long has the child
been doing them? How old was the child when the problem started?
Are the behaviors seriously interfering with the child's friendships,
school activities, or home life? Does the child have any other
related problems? The answers to these questions help identify
whether the child's hyperactivity, impulsivity, and inattention
are significant and long-standing. If so, the child may be diagnosed
Adults are diagnosed for ADHD based on their performance at
home and at work. When possible, their parents are asked to rate
the person's behavior as a child. A spouse or roommate can help
rate and evaluate current behaviors. But for the most part, adults
are asked to describe their own experiences. One symptom is a
sense of frustration. Since people with ADHD are often bright
and creative, they often report feeling frustrated that they're
not living up to their potential. Many also feel restless and
are easily bored. Some say they need to seek novelty and excitement
to help channel the whirlwind in their minds. Although it may
be impossible to document when these behaviors first started,
most adults with ADHD can give examples of being inattentive,
impulsive, overly active, impatient, and disorganized most of
Until recent years, adults were not thought to have ADHD, so
many adults with ongoing symptoms have never been diagnosed. People
like Henry go for decades knowing that something is wrong, but
not knowing what it is. Psychotherapy and medication for anxiety,
depression, or manic-depression fail to help much, simply because
the ADHD itself is not being addressed. Yet half the children
with ADHD continue to have symptoms through adulthood. The recent
awareness of adult ADHD means that many people can finally be
correctly diagnosed and treated.
A correct diagnosis lets people move forward in their lives.
Once the disorder is known, they can begin to receive whatever
combination of educational, medical, and emotional help they need.
An effective treatment plan helps people with ADHD and their
families at many levels. For adults with ADHD, the treatment plan
may include medication, along with practical and emotional support.
For children and adolescents, it may include providing an appropriate
classroom setting, the right medication, and helping parents to
manage their child's behavior.
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