Diagnosis in Children
Determining if a child has ADHD is a complex process. Many biological and psychological problems can contribute to symptoms similar to those exhibited by children with ADHD. For example, anxiety, depression and certain types of learning disabilities may cause similar symptoms. In some cases, these other conditions may actually be the primary diagnosis; in others, these conditions may co-exist with ADHD. A thorough history should be taken from the parents and teachers, and when appropriate, from the child. Checklists for rating ADHD symptoms and ruling out other disabilities are often used by clinicians; these instruments factor in age-appropriate behaviors and show when symptoms are extreme for the child’s developmental level. 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 biopsychosocial 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