ADHD Diagnostic Evaluation

Diagnostic Evaluation

Attention Deficit Hyperactivity Disorder - ADD ADHD - is a category found in the Diagnostic and Statistical Manual, version Four (DSM-IV). The diagnostic criteria is divided into sub-groups:

• Attention Deficit Hyperactivity Disorder (ADHD), Primarily Inattentive Type;
• Attention Deficit Hyperactivity Disorder (ADHD), Primarily Impulsive-Hyperactive Type; and
• Attention Deficit Hyperactivity Disorder (ADHD), Combined Type.

We have summarized the diagnostic criteria here.

Here are the things that we recommend if you have a child that ought to be looked at for possible attention deficit 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 attentional problems caused by medications, such as allergy medications. Then, with a clean bill of health, we move on to step two. . . 

Number two, 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.

Note: Usually a psychologist or other mental health professional will do this evaluation for ADD ADHD. 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 ADHD will just waste your money and probably blame you, the parents, for the child's disorder. Find experts on Attention Deficit Disorder in your area.

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

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

Third, parent rating scales are very good. 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 Disorder children at all. It is very important for the parents to fill out these behavior rating scales. Ideally you get the teachers to fill them out too. 

Ideally you want the teacher's input because they see 30, 32, 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. 

Fourth, 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.

Next: Psychological Testing