Establishing an ADHD diagnosis would seem to be a relatively straightforward matter. You simply use whatever means necessary to gather information that allows you to address the DSM-5 diagnostic criteria of ADHD (inattention, distractibility and hyperactivity), and then decide whether ADHD is present or not. Most parents and teachers would agree that these behaviors are at times so disruptive to home and school that a diagnosis of ADHD should be obvious. Unfortunately, it’s not quite that simple. Although ADHD may be present, there are many other conditions that can look like ADHD, such as anxiety, learning disorders, conduct problems, depression and even past traumatic experiences. It is important to conduct a comprehensive assessment to ensure that all possible causes are considered.
It is imperative to obtain information from individuals who observe a child across different settings. ADHD is a condition whose symptoms may or may not be present, depending on the situation (also known as situational variability). For example, situations that are unstructured or boring to the child may elicit a higher degree of symptoms. At the very least, the evaluation for ADHD should include input from parents, teachers and/or childcare providers.
Another critical factor affecting the evaluation process is the increased likelihood that children with ADHD will display co-occurring problems, such as mood and behavior disorders or learning disabilities. Secondary problems can include difficulty with anger management, lying or stealing behaviors, disobedience, peer and family relationship problems and academic challenges. Finally, a child or teen struggling with ADHD can have a significant impact on family functioning. All of these factors should be considered in the evaluation process.
Given that the problems of children with ADHD often go beyond the disorder itself, any assessment of this condition should address not only primary ADHD symptoms, but also other aspects of the child’s behavioral, emotional and social functioning. Equally important is the need for gathering information about the child’s parents and siblings, which provides a context for understanding how problem behaviors manifest. This information also often serves as a basis for determining how well parents and other caretakers will be able to implement treatment strategies.
The clinical evaluations of ADHD should be comprehensive and multidimensional and capture its impact on home, school and social functioning. The assessment may include the following:
- parent and child interviews
- a bio-psycho-social assessment interview including family history
- parent- and teacher-completed child behavior rating scales
- parent self-report measures
- direct behavioral observations of the child in natural and clinical settings
- clinic-based psychological tests
- review of prior school and medical records
- individually administered intelligence testing, educational achievement testing or screening for learning disabilities if there are academic challenges
- a standard pediatric examination or neurodevelopmental screening to rule out any unusual medical conditions that might produce ADHD-like symptoms
- additional assessment procedures, including vision and hearing screening, as well as formal speech and language assessment
There are many health care professionals who are trained in the diagnosis and treatment of ADHD in children, including child psychiatrists, pediatricians, child psychologists, clinical social workers and professional counselors. In seeking their services, it is important to be a savvy consumer and ask questions regarding their specific experience and training with persons with ADHD. Prior to making an appointment for your child, you may want to ask them about their assessment procedures to be sure that they engage in a comprehensive ADHD evaluation process.