Diagnosing ADHD

Because there is no actual single test for Attention Deficit Hyperactivity Disorder, diagnosing ADHD generally involves making sure the behaviors exhibited are not because of other reasons. In other words, in order to rule in a diagnosis of ADHD, it is very important to rule-out other conditions! ADHD-type symptoms can be seen for a variety of reasons: depression, anxiety, learning disabilities, trauma, molestation, change, abuse, psychosocial problems, stressors (e.g.–divorce, job changes, moves, births or deaths,) low IQ, medical conditions (such as thyroid problems, high lead levels, etc.,) hearing or vision problems, epilepsy, sleep disorders or poor sleep habits, oppositionality and even poor parent management and discipline.

I have seen many, many children misdiagnosed as ADHD who had hearing problems, learning problems or experienced trauma. So, it is very, very important not to simply allow your child to be diagnosed based on behavioral observations, or a simple behavior rating scale. There tends to be way too much reliance and degree of significance given to a simple behavior rating scale, such as a Conners’.

Many school systems have a teacher fill out a behavior-rating scale, find the hyperactivity and/or inattention indices to be significantly high, and tell parents that their child has ADHD, and they need to take her to a doctor and get medication. I have conducted dozens of teacher in-services on this topic. Not only does this border on practicing medicine without a license, but their interpretation is frequently inaccurate. What the rating scales can show is that there are behaviors being displayed that are of concern and outside the normal range for a child of this age (based on normative scoring.) The behavior rating scale can be a useful diagnostic tool–a tool to be used along with other measures to insure accurate diagnosis.

Diagnosing ADHD should be based on at least all of the following:

• An in-depth psycho-social history–the child doesn’t live in a vacuum

• Behavioral observations (parents, teachers and applicable others)

• Behavioral rating scales

• Developmental and medical history

• Physical exam conducted by the pediatrician–including vision and hearing screening and if indicated, certain blood tests and sleep studies; many children have sleep disorders that create symptoms looking like ADHD

When there is still a question of WHY the behaviors are being exhibited, then psychological or psycho-educational assessment is indicated. The specific test instruments are determined based on the questions raised and what may need to be ruled in or out. So assessment (I don’t used the word, ‘tests’ with kids because that implies the possibility of failure and causes many to become anxious. I usually say we have a bunch of work to do to see what they are good at and what they are not so good at, in order to help them have the best year in school possible.)

An assessment battery for diagnosing ADHD might include:

• IQ

• Academics

• Processing and perceptual measures

• Emotional (projective and subjective instruments)

• Personality

• Behavioral

It is a huge mistake to make a snap diagnosis of ADHD on the basis of behavioral observations or behavior rating scales alone. It is extremely important to fully explore the underlying causes of behavioral difficulties your child might be exhibiting! Talk to your doctor, school personnel and a child psychologist for a thorough assessment for diagnosing ADHD.