Evaluating for Childhood ADHD
Children who have ADHD often show symptoms while they are very young. Parents may notice their child is more active, talkative, impulsive, or has more trouble listening or following directions than siblings or playmates.
When should I seek help, and where do I start?
A child can be evaluated for ADHD beginning at age four. Some children will have an evaluation in kindergarten or first grade. Many parents wait until symptoms are causing difficulties at home and in school before seeking an evaluation.
Parents should talk with their child’s healthcare provider if they have concerns. The healthcare provider can do an evaluation or send the parents to a specialist in childhood ADHD. If the child has difficulty in school, the school can also conduct an educational assessment in order to provide academic accommodations. Children who attend schools that receive federal funding have educational rights that include evaluation.
There are many specialists who can evaluate a child for ADHD. When making an appointment, it is important to be a savvy consumer. Ask the professional about specific experience with and training on children who have ADHD. You may want to ask how the specialist evaluates a child for ADHD so you can be sure that a complete evaluation will be done.
What is involved in a complete evaluation?
An ADHD evaluation has several purposes:
- To find out whether a child has the kinds of symptoms that indicate ADHD
- To understand whether they are severe enough and cause enough problems to require a diagnosis
- To make sure there are no different conditions that explain the symptoms better
- To understand if the child has more than one condition at the same
To understand whether the child has ADHD symptoms, the healthcare provider or ADHD specialist will ask about symptoms of:
- inattention
- impulsivity
- hyperactivity
Evaluating ADHD symptoms can be enough to get an ADHD diagnosis, but it is often not enough to help a child get the right treatment. A complete evaluation will consider all possible causes for problem behaviors.
The complete evaluation will ask about the child’s behavior at home, at school, and in activities like sports or scouting. It will include information from parents or guardians, childcare providers, teachers, other school personnel, or other mental health clinicians who are involved in the child’s care. Sometimes a child will have ADHD symptoms in one place but not another.
Information from these other adults can show where and why the child has some of the behaviors. The information can help rule in or rule out some additional reasons for the behaviors that might need different treatment.
A complete evaluation may include:
- Interviewing the parent and child
- Reviewing family medical history, especially if other family members have ADHD
- Parent- and teacher-completed child behavior rating scales
- Parent self-reports of parenting style
- Spending time with the child to observe behavior either at home, school, or in the medical office
- Clinic-based psychological tests
- Review of earlier school and medical records
- Intelligence testing, educational achievement testing, or screening for learning disabilities if the child has poor grades or struggles with learning
- A medical, physical, or neurodevelopmental screening to rule out any other medical conditions that might produce ADHD-like symptoms
- Additional vision and hearing screening, as well as formal speech and language assessment
Not every child receives the same evaluation; their assessment will depend upon their specific symptoms and problems. For example, children who have difficulties with learning may need a different evaluation than those who struggle with managing emotions.
Health insurance often covers some of the assessments; however, testing for learning disability may not be included in insurance coverage and may need to be done by the local public school.
The results from the complete evaluation can be used to develop a treatment plan that is right for the specific child, including therapy and support at home, at school, and in other activities.
References:
- American Academy of Pediatrics. Clinical Practice Guideline for the Diagnosis, Evaluation, and Treatment of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents, Pediatrics, October 2019.
Further Reading: