Diagnosing ADHD

             

Primary care physicians, psychiatrists, and neurologists are qualified to diagnose and treat ADHD.

Psychologists and nurse practitioners can diagnose ADHD.

Neighbors, relatives, and teachers are not qualified to diagnose ADHD.

Behavioral therapy, an important component of treatment, can be provided by psychologists, social workers, counselors, and occupational and family therapists.

Correctly diagnosing ADHD requires time. The parents must be interviewed. The child must be examined and spoken with. If the child is in school, his teacher must be given a questionnaire to fill out. If the child is receiving special services in school, for instance Resource or Inclusion assistance, that teacher will also be given a questionnaire. The information from parents, child, teachers, and doctor’s observations must be analyzed, to decide the possible diagnosis, and what else might be causing the symptoms.

When children are being diagnosed by primary care physicians, many who have tight time schedules, one wonders if the right children are getting the medication. There is no one size fits all type of medication or dosage. Not every child will need medication.

Stimulant prescription rates are complicated and vary by geographic location, age, and gender. Studies have found over-prescribing in some regions of the United States and under-prescribing in others. As reported by the CDC in 2003, instances of ADHD ranged from a low of 5.0 percent in Colorado to a high of 11.1 percent in Alabama. Rates of medication treatment for ADHD ranged from 40.6 percent of patients in California to 68.5 percent in Nebraska. These data do not suggest a pattern of overprescribing of stimulants.

However, in an 11-county study of mental health status among children in western North Carolina, researchers found that 7.3 percent of children were receiving stimulants but only 3.4 percent of children met an absolute diagnosis of ADHD, which suggests that areas of over-prescribing exist (Conner, Daniel F., 2011, scribd.com).

 

Steps to making the Diagnosis

The first task is to gather information that will rule out reasons for the child’s behavior.

The specialist checks:

  • the child’s school and medical records
  • whether the home and classroom environments are stressful or chaotic
  • how the child’s parents and teachers deal with the child

 

The specialist may have a doctor:

  • look for emotional disorders, petit mal seizures, and poor vision or hearing
  • check for allergies or nutrition problems like chronic “caffeine highs” that might make the child seem hyperactive

Then the specialist gathers information on the child’s behavior to compare these behaviors to the symptoms and diagnostic criteria listed in the DSM (Diagnostic and Statistical Manual of Mental Disorders). This involves talking with the child and if possible, observing the child in school and other settings.

The child’s teachers, past and present, are asked to rate their observations of the child’s behavior on standardized evaluation forms to compare the child’s behaviors to those of other children the same age. The rating scales are subjective—they show the teacher’s personal perception of the child. However, because teachers work with many children, their judgment of how a child compares to others is usually accurate.

Parents will also fill out a standardized evaluation form describing their child’s behavior in a variety of situations, including the rating of frequency and severity of behaviors.

The specialist interviews:

  • the child’s teachers
  • parents
  • school staff
  • baby-sitters and others who frequently work with the child

Sometimes, the child may be checked for social adjustment and mental health. Learning achievement and intelligence tests may be given to see if the child has a learning disability and whether the disabilities are in all or parts of the school curriculum.

The specialist pays special attention to the child’s behavior during noisy or unstructured situations, like parties, or during tasks that require concentration, like reading, working math problems, or playing a board game.

The specialist then pieces together a profile of the child’s behavior.

  • Which ADHD-like behaviors listed in the DSM does the child show?
  • How often?
  • In what situations?
  • How long has the child been doing them?
  • How old was the child when the problem started?
  • Are the behaviors seriously interfering with the child’s friendships, school activities, or home life?
  • Does the child have any other related problems?

(pbs.org/wgbh/pages/frontline/shows/medicating/adhd/steps.html)

The answers to these questions help identify if the child’s hyperactivity, impulsivity, and inattention are significant and long-standing. If so, the child may be diagnosed with ADHD.

Alicia and Ben. Two students who might have ADHD.

The families of Alicia and Ben, third grade students at the same school, have been in contact with the children’s respective teachers. The parents and teachers believe Alicia and Ben may need to be evaluated. Both families took their children to a psychologist affiliated with their school district, concerned about the children’s impulsivity and lack of attention.

 

Ben spent time talking to the psychologist and did his best to stay engaged in the games the psychologist had him play as part of the evaluation. Both parents filled out forms, as did the classroom teachers.

After the psychologist reviewed the school records, hearing and vision information, evaluation forms, and Ben’s performance on tests given as part of the evaluation, the psychologist determined that Ben does not have ADHD.

The psychologist set up a meeting with Ben and his parents and discussed the findings. The testing results suggested a specific learning disability in the area of reading. Plans are made to develop an Individualized Education Plan (IEP) to address Ben’s difficulty with reading comprehension and fluency.

In her time with the psychologist, Alicia had difficulty paying attention to conversations and was easily distracted while playing the games which were part of the evaluation.

The psychologist gathered all the data from the school records, hearing and vision, parents, classroom teacher, and Alicia’s testing, then determined that Alicia has ADHD.

A meeting was set up with Alicia and her parents to discuss the findings from the evaluations. Alicia’s parents were in agreement with the results. As a psychologist may not prescribe, Alicia’s parents were given the names of a few pediatric neurologists for possible consultation.

During the consult, Alicia’s family learned that they would begin with six months of behavioral therapy before starting any medication as drugs are not always necessary. The therapy helped, but it was determined that a low level of stimulant medication would make a big difference in Alicia’s ability to pay attention in school and at home.

Each child is unique.

 

 

Join me for the next blog topic, Diet and ADHD/ADD. Find out what foods and supplements make a diet ADD-friendly, and what may make ADHD symptoms worse.

Resources:

http://www.pbs.org/wgbh/pages/frontline/shows/medicating/drugs/

http://www.pbs.org/wgbh/pages/frontline/shows/medicating/adhd/steps.html

http://www.pbs.org/wgbh/pages/frontline/shows/medicating/adhd/diagnostic.html

http://www.scribd.com/doc/62822748/Problems-of-Over-Diagnosis-and-Over-Prescribing-in-ADHD#scribd

http://www.cdc.gov/ncbddd/adhd/diagnosis.html

Centers for Disease Control and Prevention. Mental Health in the United States. Prevalence of diagnosis and medication treatment for attention-deficit/hyperactivity disorder. 2003. MMWR. 2005; 54:842-847.

 

Angold A, Erkanli A, Egger HL, Costello EJ. Stimulant treatment for children: a community perspective. 2000; 39:975-984.

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