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What to Look for in Your Child’s ADHD Assessment

Original post: WVU Medicine Children’s Hope + Health Blog. 

Every October, Attention-Deficit/Hyperactivity Disorder (ADHD) Awareness Month draws attention to one of the most diagnosed neurodevelopmental conditions of childhood. Depending on the source, rates of ADHD among children range from about 7 percent to as high as 14 percent.

Given how common it is, the month is dedicated to raising awareness about ADHD and helping spread evidence-based information on how to better understand, identify, diagnose, treat, and advocate for those experiencing symptoms of the condition.

In addition to mental health-focused books and research articles, organizations, including the American Psychological Association, the American Psychiatric Association, and the American Academy of Pediatrics, have created guides and recommendations for proper ways to diagnose ADHD.

The good news is that all organizations generally recommend the same thing. The bad news is that there remains a high rate of differences between how healthcare providers diagnose in “real life.” This can make it very confusing for parents trying to understand what they should look for in an ADHD diagnosis.

In a nutshell, an ADHD assessment by any healthcare provider (e.g., psychologist, social worker, counselor, pediatrician, psychiatrist) should include clinical interviews, observations of the child in question, and rating scales.

Information should be gathered from across at least two distinct settings (e.g., home, school) to ensure that symptoms are present across places and not just at certain times of the day, specific settings, or with specific people.

Finally, the assessment should cover a range of conditions to ensure the symptoms are really from ADHD and not something else.

To assist parents in making sense out of mountains of scientific literature, the following are tips for finding the right healthcare professional to determine if your child, adolescent, or teenager has ADHD.

Tips when looking for an evaluation:

  1. Look for someone who can take the time to learn about your child to both rule-in ADHD and rule-out other psychological or medical problems. ADHD is considered a “diagnosis of exclusion.” This means you shouldn’t diagnose ADHD unless you can be reasonably sure the same symptoms of inattention, hyperactivity, and/or impulsivity aren’t caused by something else.

 

For example, a child who is fidgety, off-task, forgetful, and distracted in school may have ADHD or may have anxiety, poor sleep, or a thyroid issue or a combination. As such, it’s important your healthcare provider takes the time to learn the psychological and medical histories of your child (e.g., symptoms, birth history, family history) before diagnosing.

 

  1. Look for someone who will use validated measures that assess a range of conditions in addition to ADHD. In addition to interviews, healthcare providers should use scientifically tested questionnaires that not only clarify if specific symptoms are present, but also compare how your child is doing compared to hundreds and, in some cases, thousands of other children their age.

 

Is the child’s behavior just slightly above what is considered “typical” for their age but still in the “okay range,” or is the behavior “dialed up to 11” and needs treatment?

Typically, standards and experts suggest more than one measure be used. These can include what are referred to as broadband measures, which assess a range of behaviors (e.g., anxiety, depression, ADHD), and narrowband measures that are ADHD-specific. In this way, your provider can determine if symptoms are there and in what settings, if other symptoms are present in addition to ADHD or are causing symptoms mimicking ADHD but not really ADHD, and how severe the symptoms are in relation to other children their age.

  1. Look for someone who will take time to review the “other information.” In addition to interviews and rating scales, a “track record” can be created to showcase the symptoms and impairment across time. As such, your healthcare professional should review the “other information” available, including report cards, teacher notes, behavior charts outlining specifics of behavior issues, medical records, and past psychological or medical treatments. This can allow your provider to understand how the behaviors have stayed the same, got worse, or become better.
  2. Look for someone who will talk directly to the child. While most of the information will be gathered from the parents, documentation, and questionnaires, the healthcare provider should also take time to speak to the child and observe them. While not directly asking the child, “Do you think you have ADHD,” children are more insightful than they are often credited.

 

As such, in addition to helping the healthcare provider understand their awareness of ADHD symptoms, they can clarify details of possible anxiety, sadness, sleep issues, or other medical conditions that may be important considerations for diagnosing ADHD (or something else).

While a thorough ADHD assessment can likely take more than a 5-15-minute meeting and may even take multiple appointments, it’s suggested that it is not rushed. Allow your provider to get all the details they need, and while ADHD has become quite common, the label does remain throughout the child’s entire life. Because of this, it needs to be accurate to avoid any undue spending of time and money, as well as stress for both you and your child.

Now that I know what I need, what don’t I need?

With everything written above, the question becomes whether you need “fancy testing,” such as a brain scan, blood test, psychoeducational assessment (i.e., learning and intelligence), or neuropsychological evaluation (i.e., looking at brain functioning, including cognition and executive functioning). Put simply by experts, no, you don’t (in most cases).

First, there are no singular brain scans or blood tests to assess for ADHD. While science may get there in the future, we’re not there yet.

What about the psychoeducational assessments? These are often completed by many healthcare providers as part of an ADHD assessment; however, they are often not needed unless there are secondary concerns of learning (e.g., math, reading, writing), or a general developmental delay. If the child is doing well enough in school and being behind is more due to being off-task (i.e., they can do the work one-on-one without major issue), a psychoeducational assessment is probably not needed.

Similarly, if there aren’t concerns of brain functioning, cognition, or executive functioning (e.g., your child’s ability plan or organize thoughts), a neuropsychological evaluation is likely not needed.

Ultimately, brain scans, blood tests, psychoeducational assessments, and neuropsychological evaluations are not required to diagnose ADHD.

Mental Health Questions or Referrals?

Think your child needs an ADHD assessment? Please review our specialty clinic flyer to see if it’s the right fit for you: https://rni.wvumedicine.org/wp-content/uploads/2022/04/ADHD-RNI.pdf.

For additional questions or concerns regarding a child, adolescent, or teenager with signs of ADHD or another mental health condition, please reach out to the WVU Medicine Behavioral Medicine and Psychiatry Department at 304-598-4214, or find us at https://rni.wvumedicine.org/bmed/.

Resources

References

  • American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders, Fifth edition, Text Revision (DSM-5-TR). American Psychiatric Association.
  • Davidovitch, M., Koren, G., Fund, N., Shrem, M., & Porath, A. (2017). Challenges in defining the rates of ADHD diagnosis and treatment: Trends over the last decade. BMCPediatrics,17(1), Article218. https://doi.org/10 .1186/s12887-017-0971-0
  • Visser, S. N., Bitsko, R. H., Danielson, M. L., Perou, R., & Blumberg, S. J. (2010). Increasing prevalence of parent-reported Attention-Deficit/Hyperactivity Disorder among children—United States, 2003 and 2007. Morbidity and mortality weekly report, 59(44), 1439–1443.
  • Visser, S. N., Danielson, M. L., Bitsko, R. H., Holbrook, J. R., Kogan, M.D., Ghandour, R. M., Perou, R., & Blumberg, S. J. (2014). Trends in the parent-report of health care provider-diagnosed and medicated Attention Deficit/Hyperactivity Disorder: United States, 2003–2011. Journal of the American Academy of Child & Adolescent Psychiatry, 53(1), 34–46. https://doi.org/10.1016/j.jaac.2013.09.001

About the Author

Jonathan Perle, PhD, ABPP, is a board-certified clinical child and adolescent psychologist, associate professor, director of telepsychology, director of the ADHD Assessment Clinic, and director of the Parent Management Training Clinic within the Department of Behavioral Medicine and Psychiatry at the WVU School of Medicine. He has significant experience providing youth-focused clinical assessment and intervention within diverse clinical settings (e.g., medical centers, primary care, schools, university clinics) and roles (e.g., interdisciplinary, multidisciplinary, outpatient, inpatient). In addition to his current responsibilities that include teaching, supervising, and conducting research, Dr. Perle provides both face-to-face and virtual psychological care.

General disclaimer:
This content is not intended to address all possible diagnosis methods, treatments, follow up, drugs or their related contraindications or side effects. Standards of practice change as new data becomes available. Therefore, it is strongly recommended that practitioners independently assess and verify diagnosis, treatments and drugs for each individual patient. The authors of the WV ACC guidelines assume no liability for any aspect of treatment administered by a practitioner with the aid of this publication.

Drug disclaimer:
The authors do not endorse or recommend the use of any particular drug mentioned in this publication. Before prescribing a new drug to a patient, practitioners are advised to check the product information accompanying each drug to ensure it is appropriate for a specific patient and to identify appropriate dosage, contraindications, side effects and drug-to-drug interactions.

Standard of care disclaimer:
This publication is not intended to establish a standard of care applicable to practitioners who treated patients diagnosed with ADHD. “Standard of care” is a legal term, not a medical term, which refers to the degree of care a reasonable practitioner would exercise under the same or similar circumstances. The standard of care is a continuum and does not imply optimal care. Practitioner discretion and clinical judgment are paramount and this publication is only intended to aid practitioners’ judgment, not to serve as a substitute for said judgment.