Attention Deficit Hyperactivity Disorder: Getting an Accurate Diagnosis

Attention Deficit Hyperactivity Disorder is a topic that comes up frequently throughout my week; as a school psychologist in an elementary school, teachers often refer students for suspected problems with attention and concentration, hyperactivity, and impulse control difficulties. In my outpatient practice, I'm on the 'other side' of this equation, meeting with families often referred from school teams for suspected problems of this nature. Typically, these referrals seem appropriate and everyone is on the same page. Occasionally, the members are not. As in, 'my child's teacher told me my child has ADD and needed accommodations! Now what?!' It gave me pause and consideration for this weeks blog.  Just who can and can't diagnosis ADHD ? What might an assessment for ADHD include? Should school staff be bringing this subject up to parents to begin with? And, is it ADD or ADHD ?The term 'ADD' has been around for some time and certainly refers to attention deficit disorder. Technically, as in when a qualified professional is making a diagnosis, the term is Attention Deficit Hyperactivity Disorder, hence the ADHD. This term is from the DSM-5 (Diagnostic & Statistically Manual - 5edition) used by clinicians when diagnosing clients. Based on our understanding of the condition at this time, there are three sub-types. ADHD predominately hyperactive/impulsive; ADHD predominately inattentive; and ADHD combined. The first sub-type has characteristics related to high energy and impulsivity, specifically nine criteria of which six must be present during the past month; for example 'runs about or climbs when it is inappropriate to do so.' The second subtype, inattentive, has it's own list of nine criteria, 6 of which must be present for 6 month, for example, 'is often easily distracted by extraneous stimuli.' Combined type is when the criteria is met in both areas.ADHD is a medical diagnosis and requires a qualified professional to assess for and determine whether the diagnosis is appropriate for your child. Often it just happens that a child's pediatrician or primary care physician is the qualified professional who first recognizes the symptoms of ADHD and subsequently makes the diagnosis. However, based on training, psychiatrists, school psychologists, child clinical psychologists, neurologists, and clinical social workers may also be qualified to diagnose ADHD. In terms of what a school district may require in order to meet educational requirements for special educational services (under Other Health Impairment) or to consider accommodations under a 504 plan, there may be some variation depending on your district.  However, according to the National Association of School Psychologists, in 'ADHD: A Primer for Parents and Educators' handout, found on their website,  any of the fore-mentioned professionals are qualified to diagnose. So, while a well meaning teacher may give feedback to you as a parent, they are not qualified to diagnose! Observe behavior - yes. Bring up concerns about what they observe - yes. Diagnosis - no.After deciding on the qualified professional to assess your child, an important aspect of the assessment will be using multiple measures and gathering information from more than one source. No single test, rating scale, observation, or interview is considered sufficient for making the diagnosis, nor is gathering information from just one source.  Behavioral rating scales are typically used to provide an objective 'snapshot' of the child's social-emotional and behavioral functioning at both home and school. Interviewing parents, teachers, and the child is also helpful, along with conducting a direct observations if possible. Obtaining a developmental and medical background helps the evaluator view the child's current presentation more broadly. Best practice for assessing for ADHD specifically includes gathering information from more than one source - not just the teacher and not just the parent. At times other important adults may be included, if the parents feel their input might help the evaluator better understand their child's behavior.While the prospect of considering that your child may have ADHD can be overwhelming, the steps of having her assessed doesn't have to be, and there are very good supports available in our community.If you suspect your child may be having some difficulties with attention, hyperactivity, or impulsivity, call Amy Folger for a consultation.