What Is ADD ADHD?

The Neurology of Attention Deficit Disorder

Diagnosing ADD ADHD

Treatment Options

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Successful Treatment Planning Strategies

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Teacher Resources

Essays on the Family

Research, Research, and More Research

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Diagnosis of ADD ADHD

Everyone in a private practice setting who works with ADD ADHD children or adults is going to have their own opinion on how Attention Deficit Hyperactivity Disorder - ADD or ADHD - should be diagnosed.

Some clinics take the perspective that "more is good," and will recommend a large battery of tests, often costing many thousands of dollars.

Other clinics, typically with hurried physicians, will simply give a brief rating scales to the parents and then make a quick diagnosis and prescribe treatment.

Unfortunately neither of these extremes is in the patient's best interest. 

Over-diagnosis of Attention Deficit Hyperactivity Disorder is a big problem. There are some children who are diagnosed as having ADD ADHD that do not have it.

It is not uncommon for someone with depression, or anxiety, specific learning disabilities, early onset bi-polar disorder, or Tourette's Syndrome, to be diagnosed as Attention Deficit Hyperactivity Disorder. This is often the result of a diagnostic "work-up" which is too brief and does not take into account the many reasons why a child might be inattentive, impulsive, or over-active.

But over-diagnosis of Attention Deficit Hyperactivity Disorder is not the only problem.

Under-diagnosis of Attention Deficit Hyperactivity Disorder - ADD ADHD - is also a problem. This happens most often in the school setting where the school psychologist writes his report perfectly describing an individual with ADD ADHD, then refuses to use the label "Attention Deficit Hyperactivity Disorder" in his report anywhere.

It also often happens in therapist's offices where the therapist is not familiar with Attention Deficit Hyperactivity Disorder, and only sees the characteristic behaviors as "acting out behaviors" due to family problems, rebelliousness, and so on. Therapists operating entirely from a “Family Systems” orientation are especially at risk for making this mistake.

Some studies suggest that only one out of three people who have Attention Deficit Hyperactivity Disorder will ever get help. Two out of three people who have ADD ADHD will never receive a diagnosis of ADHD or treatment. They will never really know what it is that's bothered them through their life.

So we have two problems. One is the over-diagnosis of ADHD, and the other is the under-diagnosis of Attention Deficit Disorder – ADD ADHD.

Diagnostic Criteria for Attention Deficit Hyperactivity Disorder – ADD ADHD Made Easy

The following is a practical summary of the DSM-IV criteria for Attention Deficit Disorder. The actual criteria for "Attention Deficit Hyperactivity Disorder" is available in the DSM-IV manual.

Symptoms of INATTENTION in ADD ADHD:

• A lot of people, including his parents, complain that he just doesn't seem to listen when spoken to;
• Because of not sustaining attention, or because of acting like a "space cadet," he doesn't finish his chores or homework;
• He can't keep his mind on what he's doing for very long unless it is very exciting, or very entertaining;
• He doesn't pay close attention to what he's doing, so he makes a lot of careless mistakes. Video games are an exception because they give immediate feedback, they are exciting, and they are fun. Chores and homework are not.The inattention is seen most with homework, chores, and other boring things that you want him to do;
• He's really disorganized. Most commonly seen in spending three hours to finally finish his homework, then losing it at school (it’s in his backpack), or forgetting to turn it in;
• He really tries to avoid doing homework or chores;
• He gets distracted easily, or pays attention to the wrong thing;
• He is often forgetful and has to be reminded to do things often.

Symptoms of IMPULSIVITY in Attention Deficit Hyperactivity Disorder:

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• He often blurts out answers in class;
• He can't wait his turn when he is playing games or at school;
• He interrupts others a lot, he just doesn't wait well;
• He tends to do things without thinking about them first;
• He does not consider the consequences of his actions.

Symptoms of HYPERACTIVITY in Attention Deficit Hyperactivity Disorder:

• He has happy hands and feet which fidget and squirm a lot;
• He just can't stay in his seat for very long when he's supposed to at school or the dinner table;
• He may run around too much, or climb on things he's not supposed to;Is too loud;
• He is "On the go" as if he is "driven by a motor";
• He talks too much;
• Leaves footprints across the ceiling

Important: At least some of these symptoms must have been seen before the age of seven.

Also Important: At least some of the symptoms are seen both at home and at school.

Also Important: These behaviors are really a problem. Not just a little bit, but a lot.

For a diagnosis of Attention Deficit Hyperactivity Disorder, Inattentive Type:

• Six or more from the Inattention list.

For a diagnosis of Attention Deficit Hyperactivity Disorder Impulsive-Hyperactive Type:

• Six or more from the Impulsive or Hyperactive lists.

For a diagnosis of Attention Deficit Hyperactivity Disorder Combined Type:

• Both criteria are met.

Attempt at legal disclaimer. This is just for your information. Please be aware that there are several reasons why a child could have these symptoms besides Attention Deficit Hyperactivity Disorder. For example, thyroid problems, depression, anxiety disorders, hearing problems, and so on. Please do not attempt to "diagnose" your child. Follow the steps in the Diagnosis section. See your doctor. Go to a qualified mental health professional. This web site is no substitute for talking with an expert.

Here are the things that we recommend if you have a child that ought to be looked at for possible Attention Deficit Hyperactivity Disorder...

First, there should be an "adequate" physical exam by the child's pediatrician or family practice doctor. This doesn't have to be an extensive, expensive exam, but should be able to rule out possible problems like Mononucleosis, Thyroid problems, lead poisoning (if it is common in your area), and potential attention problems caused by medications, such as allergy medications. Then, with a clean bill of health, we move on to step two. . . 

Get an evaluation for attention deficit hyperactivity disorder. Usually a psychologist or other mental health professional will do this evaluation for ADD ADHD.

Note: Only get counseling or therapy from professionals who have a lot of experience treating attention deficit hyperactivity disorder. Therapists who do not have a lot of experience with ADD ADHD will just take your money and then probably blame you, the parents, for the child's disorder.

Find experts on attention deficit hyperactivity disorder in your area. Ask around at your local CHADD chapter. Call you local Psychiatric Hospital and ask for the Child or Adolescent Unit. Then ask for the "Charge Nurse." Ask the Charge Nurse who the best psychiatrists and therapists in your town are. They know.

The Evaluation

When you get an evaluation for attention deficit hyperactivity disorder, there should be a good parent interview. It's absolutely essential that somebody sits down with the parents and spends 45 minutes to an hour with them. The psychologist or therapist needs to find out what's going on now, why did the parents pick up the phone and call now instead of last week, and so on.

A good developmental history must also be taken. Important questions are:

• How did mom do during pregnancy?
• Were there any problems at all during pregnancy?
• Was there any exposure to drugs or alcohol prior to birth?
• When did he learn to walk or crawl?
• How about speech development, any problems?
• Did he have very many ear infections?
• Have there been any head injuries, high fevers, or seizures?

Head injuries and seizures can look just like attention deficit hyperactivity disorder, but aren't. They may require different treatment options. 

Then a good family history is great. The family trees of Attention Deficit Disorder kids are often very similar. Look at one and you may say, "Gee, there's no wonder this kid has it," because most of the time, about 80 percent of the time, you can trace the impact of this gene as it runs through families causing things like obsessive-compulsiveness, depression, alcoholism, attention disorders or learning disabilities throughout the family.

The clinician must also know:

• Is child depressed?
• Does he have anxiety problems?
• Is he hallucinating?
• Is he delusional?
• Is it a head injury?
• Is it a seizure disorder?

Parent rating scales are very good and should be given. The ADD ADHD scales we like are by Ned Owens out of Texas. Keith Connors has a fine tool that you have probably seen if you are involved with attention deficit hyperactivity disorder children at all. It is very important for the parents to fill out these behavior rating scales.

Ideally the teachers will fill them out also. You want the teacher's input because they see 30, 32, or 35 kids every single day, year in and year out, and they know what is normal behavior and what is not.

Note: One of the things we have noticed is that lately we are having more trouble with the teacher rating scales because the teachers ten years ago, eight years ago, five years ago used to rate the kids pretty reliably compared with the “normal” kids in the class, the non-ADD kids in the class. But what we are seeing lately is very often the teachers are comparing the child that we want rated against the “worst kid” in the class, who might be totally off the wall. And so the rating scale comes back reporting that the child we want rated isn't much of a problem at all. We have to give directions to the teachers to rate them versus "normal kids," not against the “worst kids” in the class. 

Also, an in-depth clinical interview with the child is important. This interview is needed to determine the child's reality testing, his degree of maturity, his degree of verbal skills, and so on. Ask the child if he's hallucinating. Sometimes he is, but he hasn't told anyone. Ask the child if he's anxious. Some kids have tremendous fears, but have not shared them with anyone. There is a lot going on with kids that their parents are not aware of. 

Learn about Psychological Testing and Evaluation for ADHD, or

Continue on to Lesson Four: Treatment Options for Attention Deficit Disorder