Attention Deficit Hyperactivity Disorder - Diagnosis

Source: National Institute of Mental Health; NIH Publication No. 3572 (extract)

Some parents see signs of inattention, hyperactivity, and impulsivity in their toddler long before the child enters school.

The child may lose interest in playing a game or watching a TV show, or may run around completely out of control. But because children mature at different rates and are very different in personality, temperament, and energy levels, it's useful to get an expert's opinion of whether the behavior is appropriate for the child's age.

Parents can ask their child's pediatrician, or a child psychologist or psychiatrist, to assess whether their toddler has an attention deficit hyperactivity disorder or is, more likely at this age, just immature or unusually exuberant.

ADHD may be suspected by a parent or caretaker or may go unnoticed until the child runs into problems at school. Given that ADHD tends to affect functioning most strongly in school, sometimes the teacher is the first to recognize that a child is hyperactive or inattentive and may point it out to the parents and/or consult with the school psychologist.

Because teachers work with many children, they come to know how "average" children behave in learning situations that require attention and self-control. However, teachers sometimes fail to notice the needs of children who may be more inattentive and passive yet who are quiet and cooperative, such as those with the predominantly inattentive form of ADHD.

Professionals Who Make the Diagnosis.

If ADHD is suspected, to whom can the family turn? What kinds of specialists do they need?

Ideally, the diagnosis should be made by a professional in your area with training in ADHD or in the diagnosis of mental disorders.

Child psychiatrists and psychologists, developmental/behavioral pediatricians, or behavioral neurologists are those most often trained in differential diagnosis. Clinical social workers may also have such training.

The family can start by talking with the child's pediatrician or their family doctor. Some pediatricians may do the assessment themselves, but often they refer the family to an appropriate mental health specialist they know and trust.

In addition, state and local agencies that serve families and children, as well as some of the volunteer organizations listed at the end of this document, can help identify appropriate specialists.

Specialty	Can Diagnose ADHD	Can prescribe medication, if needed	Provides counseling or training
Psychiatrists	yes	yes	yes
Psychologists	yes	yes*	yes
Pediatricians or Family Physicians	yes	yes	no
Neurologists	yes	yes	no
Clinical Social workers	yes	no	yes

* As of October 2006, Louisiana and New Mexico laws and regulations allow psychologists who have completed specific training and meet other requirements to prescribe psychotropic medications. The other 48 states and the District of Columbia allow only physicians to prescribe medications.

Knowing the differences in qualifications and services can help the family choose someone who can best meet their needs. There are several types of specialists qualified to diagnose and treat ADHD.

Child psychiatrists are doctors who specialize in diagnosing and treating childhood mental and behavioral disorders. A psychiatrist can provide therapy and prescribe any needed medications.

Child psychologists are also qualified to diagnose and treat ADHD. They can provide therapy for the child and help the family develop ways to deal with the disorder. But psychologists are not medical doctors and must rely on the child's physician to do medical exams and prescribe medication.

Neurologists, doctors who work with disorders of the brain and nervous system, can also diagnose ADHD and prescribe medicines.

But unlike psychiatrists and psychologists, neurologists usually do not provide therapy for the emotional aspects of the disorder.

Within each specialty, individual doctors and mental health professionals differ in their experiences with ADHD. So in selecting a specialist, it's important to find someone with specific training and experience in diagnosing and treating the disorder.

Whatever the specialist's expertise, his or her first task is to gather information that will rule out other possible reasons for the child's behavior. Among possible causes of ADHD-like behavior are the following:

• A sudden change in the child's life—the death of a parent or grandparent; parents' divorce; a parent's job loss
• Undetected seizures, such as in petit mal or temporal lobe seizures
• A middle ear infection that causes intermittent hearing problems
• Medical disorders that may affect brain functioning
• Underachievement caused by learning disability
• Anxiety or depression.

Ideally, in ruling out other causes, the specialist checks the child's school and medical records. There may be a school record of hearing or vision problems, since most schools automatically screen for these. The specialist tries to determine whether the home and classroom environments are unusually stressful or chaotic, and how the child's parents and teachers deal with the child.

Next the specialist gathers information on the child's ongoing behavior in order to compare these behaviors to the symptoms and diagnostic criteria listed in the DSM-IV-TR. This also involves talking with the child and, if possible, observing the child in class 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, known as behavior rating scales, to compare the child's behavior to that of other children the same age. While rating scales might seem overly subjective, teachers often get to know so many children that their judgment of how a child compares to others is usually a reliable and valid measure.

The specialist interviews the child's teachers and parents, and may contact other people who know the child well, such as coaches or baby-sitters. Parents are asked to describe their child's behavior in a variety of situations. They may also fill out a rating scale to indicate how severe and frequent the behaviors seem to be.

In most cases, the child will be evaluated for social adjustment and mental health. Tests of intelligence and learning achievement may be given to see if the child has a learning disability and whether the disability is in one or more subjects.

In looking at the results of these various sources of information, the specialist pays special attention to the child's behavior during situations that are the most demanding of self-control, as well as noisy or unstructured situations such as parties, or during tasks that require sustained attention, like reading, working math problems, or playing a board game. Behavior during free play or while getting individual attention is given less importance in the evaluation. In such situations, most children with ADHD are able to control their behavior and perform better than in more restrictive situations.

The specialist then pieces together a profile of the child's behavior. Which ADHD-like behaviors listed in the most recent 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 behavior problems relatively chronic or enduring or are they periodic in nature? Are the behaviors seriously interfering with the child's friendships, school activities, home life, or participation in community activities? Does the child have any other related problems?

The answers to these questions help identify whether the child's hyperactivity, impulsivity, and inattention are significant and long-standing. If so, the child may be diagnosed with ADHD.
A correct diagnosis often resolves confusion about the reasons for the child's problems that lets parents and child move forward in their lives with more accurate information on what is wrong and what can be done to help.

Once the disorder is diagnosed, the child and family can begin to receive whatever combination of educational, medical, and emotional help they need. This may include providing recommendations to school staff, seeking out a more appropriate classroom setting, selecting the right medication, and helping parents to manage their child's behavior.

Source: National Institute of Mental Health; NIH Publication No. 3572 (extract)
Added: 29th June 2007

Looking for help with a problem your child is having with ADHD?

If your child is suffering from an emotional or psychological health problem, then be assured... help is available.

Children with psychological or emotional difficulties such as Attention Deficit Hyperactivity Disorder (ADHD) often respond really well to the therapies available today that use the power of your child's imagination.

Children with Attention Deficit Hyperactivity Disorder (ADHD) often respond really well to things like hypnotherapy, where they get to enjoy using the power of their imagination. They often come away from hypnotherapy sessions feeling 'lighter'.

Avon Hypnotherapy's Paul Douglass describes the hypnotherapy sessions for children...

"They feel comfortable with a non-judgemental therapist, and can often allow themselves to express feelings of embarrasment, guilt or shame for example, that they can't 'offload' anywhere else.

The children often really enjoy the sessions, and indeed, the mums and dads that get involved often gain a lot from the session too!"

Read the full article: Hypnotherapy for Children, by Paul Douglass MIAPH Acc.

If you would like to find help for a child with ADHD, just get in touch using the contact form below, and we'll do what we can to put you in touch with a therapist in your area who is trained in treating children.

Looking for help with a problem?... Do get in touch... We're here to help...

If you're looking for help with an anxiety based problem, then we'll do what we can to help you.

There are lots of different ways we may be able to help you to feel better... we'd love to meet you for a chat at one of our practices, or, if you're not near us, there's the LifeShaping Process which is a superb, web based process that you can use at home!

If you're unsure where to start, or would just like to get in touch, just use the contact form below to tell us a bit about yourself, and we'll get back to you as soon as we can.