What's the best way to diagnose AD/HD?
A proper evaluation for AD/HD should include a wide array of factors -- including a child's strengths and challenges.
By Sam Goldstein, Ph.D.
We have heard that the evaluation for AD/HD during childhood can be completed in as short a time as one hour. Yet some professionals take hours administering a variety of tests before a diagnosis is made. How can a parent be a wise consumer when seeking evaluation if they suspect their child may struggle with AD/HD? In this article, Sam Goldstein, Ph.D., answers this critical question.
First, it is important for parents to understand that when kids struggle emotionally, behaviorally, or developmentally it is likely they may experience difficulty in a number of important life activities. The process of assessment is not just to count symptoms and proclaim diagnoses but to understand a child's strengths, as well as weaknesses, in ways that assist in providing support and help.
To be wise consumers, parents must first understand the important role normally maturing self-control plays in child development. Self-control is critically important to learn, behave, manage emotions, develop friendships, and function effectively in community activities. Thus, it's not surprising that the co-occurrence of learning, behavioral, and emotional problems is the rule rather than the exception for children receiving diagnoses of AD/HD.
The diagnostic process must carefully explore many of these co-occurring problems, not only to provide appropriate diagnoses and assistance but also to identify early signs or risk factors that may speak to an emerging problem. This process allows parents, educators, and professionals to provide help and assistance before children fail.
For example, preschoolers with delayed development of self-control are often disinterested in sedentary, pre-academic activities. Their lack of practice leads to limited proficiency. This often makes them appear as if they may have a learning disability. Yet some children with AD/HD also demonstrate weaknesses in key skills necessary for early academic achievement. A thorough assessment allows a professional to not only examine the issue of AD/HD but also the possibility of weaknesses in skills necessary for early academic learning. Further, it is well recognized that among children with early language and learning problems, parent and teacher reports of hyperactive, impulsive, and inattentive behavior are often elevated, not necessarily the result of a biological risk but of the child's day in and day out frustration. Only a thorough assessment can tease out and provide an understanding of these risks and their relationships.
In the clinical diagnostic process there are eighteen symptoms of AD/HD. These symptoms can be assessed through direct observation and history taking but can also very efficiently be assessed by asking parents and teachers to complete well-researched, normative questionnaires. In fact, this quickly allows a professional to obtain parent and teacher input specifically concerning the presentation and severity of AD/HD symptoms. However, parents should be cautioned that when this type of questionnaire is the only means of assessment, the result might be an over-identification of kids with AD/HD.
Timesaving questionnaires and brief histories provide a very efficient means of identifying the 20% of children in the general population who may struggle. To truly understand the reasons for these struggles, a good evaluator must take a much more detailed and careful history, as well as explore the possibility that symptoms could be the result of other conditions. Keep in mind that inattention, off task behavior, and non-compliance are the most common complaints parents make about children. In particular, inattentiveness is a characteristic description of children with depression, anxiety, oppositional behavior and even learning disability. For many of these children, their inattentiveness is not the result of a biologically based problem with developing self-control.
At the other extreme, it is not necessary to administer a ten hour neuropsychological battery to a child referred for symptoms of AD/HD when a brief history and general questionnaires reveal no indications of delayed academic achievement, severe emotional problems, or family adversity. When parents suspect their child may experience problems as a result of AD/HD, a good place to begin is by obtaining a book or video about the subject and becoming educated about common signs, symptoms, and behaviors, as well as co-occurring problems. If parents are then concerned their child may experience symptoms of AD/HD to an impairing degree, I suggest they speak with their pediatrician or family practitioner. Most physicians working with children today also work closely with child psychologists and can refer the child for an initial consultation. I also suggest parents request a consultation with their child's school psychologist. Although school personnel usually are not in the position to make a diagnosis of AD/HD, the input they can provide to the physician and community psychologist is invaluable in the diagnostic process.
Finally, keep in mind that when children leave school they are not asked their weakest subject and most annoying behavior and then assigned that job for life. In fact, it is just the opposite. We accomplish our goals in life through our strengths and assets. For me, an evaluation considering AD/HD in a child must also place equal focus on defining and understanding that child's strengths and abilities.
AD/HD by other names and acronyms
While attention-deficit/hyperactivity disorder (AD/HD) is the official term and acronym used by today's mental health care professionals, it is sometimes referred to by other names and abbreviations. For example, it is sometimes called:
ADHD (without the slash in the middle)
Attention deficit disorder (ADD)