Many parents wonder if they should test their child for ADHD. After all, somewhere between 3 percent and 7 percent of children preschool age or older, mostly boys, meet the diagnostic criteria for Attention Deficit Hyperactivity Disorder (ADHD). And the testing process can be confusing.
What is Attention Deficit/Hyperactivity disorder?: Children with Attention Deficit Disorder have difficulty maintaining age-appropriate levels of attention and concentration. They may also have tendencies to be excessively active and impulsive. Although this is a bit of a simplification, children will be diagnosed with Attention Deficit/Hyperactivity Disorder if their inattention, overactivity and impulsivity are greater than an established cut-off level, and also if no other psychiatric condition is present that can account for these symptoms. If the symptoms are restricted to problems paying attention or concentrating, the diagnosis is Attention Deficit Disorder; if the symptoms include excessive overactivity and impulsivity, the diagnosis is Attention Deficit/Hyperactivity Disorder.
One point deserves emphasis: The diagnosis of ADHD, like many psychiatric diagnoses, is based primarily upon the presence or absence of certain symptoms and behaviors. The psychiatric diagnostic system is generally not intended to explain why a group of symptoms are present. The diagnosis of ADHD is known as a "symptom diagnosis." A diagnosis of fever is another example of a symptom diagnosis. Just as a physician would generally not begin a treatment until knowing the cause of the fever, mental-health professionals optimally base their treatment plan upon their knowledge of the various reasons for an individual child's ADHD symptoms. With this perspective in mind, Lucy Daniels Center clinicians recommend that the assessment determines (1) whether a child has AD/HD and (2) why the child has the symptoms.
What's involved in the testing?: We prefer to describe the testing process as "assessment" or "evaluation" rather than testing, because the term "testing" can be misleading. It's much better if the professional(s) making the determination gather many kinds of information so the evaluator can properly diagnose the condition and understand the basis of the symptoms. The diagnosis should be made only after considering multiple sources and kinds of information. Based upon our experience and the guidelines of professional mental-health organizations, we recommend that evaluations for ADHD contain at least the following components:
· The parents should provide a detailed history of the child's development, beginning with the prenatal period and including a thorough description of his physical and emotional development. The evaluator should learn about the child's family, school history, and other aspects of his life, because development is profoundly influenced by relationships and important experiences. The evaluator should also determine if there are any signs of learning disorders or social disorders that are sometimes associated with ADHD symptoms.
· The child should be properly prepared for the evaluation visit(s). Preparation makes the visit understandable for the child, enhancing the child's positive feeling about the visit and increasing the amount of information the evaluator will likely obtain. Although professionals vary in their approaches, we recommend a play-based assessment that allows the child to feel a comfortable level of involvement, pleasure and control. Parents should join the session if their child needs them there in order to feel comfortable. Because children, particularly when young, vary in their capacities and behaviors from one hour of the day to another, we recommend multiple meetings to guarantee an accurate picture of a child's strengths and challenges. It is also especially important to identify a child's strengths, because treatment plans often build upon what a child does well.
· The evaluator should also learn about the child's ability to successfully function in settings outside the home, particularly in school. Insights from an experienced observer can be particularly helpful in developing a well-rounded profile of preschool and kindergarten children. Telephone discussions with the teacher of a grade-school child are often useful, as well.
· Medical records should be reviewed when appropriate.
· Parents often understand ADHD testing to be equivalent to the use of specialized scales. These scales are only one source of data for the kind of sophisticated evaluation that we recommend. There are various versions of these scales on which parents or teachers rate the presence or absence of typical AD/HD behaviors. A child might meet the cut-off for ADHD according to one scale but not another because professionals disagree about how extensive the behaviors must be in order to be an actual disorder.
· More extensive and refined psychological tests, administered by a qualified psychologist, provide helpful information in many situations. For example, children with ADHD tend to have problems in certain subtests of the standard IQ measures. Additionally, some children with ADHD also have learning disabilities, which are important to identify as early as possible.
One size does not fit all: A comprehensive assessment like the one we've described above enables an experienced mental-health professional to answer the question of whether a child's symptoms and behaviors fall into the category of Attention Deficit Hyperactivity Disorder, and, more importantly, to develop treatment approaches that are tailored to the individual child's specific needs and strengths. Many children whose symptoms do not quite meet the criteria for the ADHD or ADD diagnoses still may need professional help.
Parents should keep in mind that the children, not the diagnosis, need attention. Only an approach that seeks to understand the particulars and specifics of each child's development, life and personal way of experiencing the world can be of the fullest assistance.
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