There's no definitive diagnostic test for ADHD — no blood analysis, no brain scan, no genetic screen — so it's not easy to tell whether a child has the disorder. And doctors vary in their abilities to deliver an ADHD diagnosis and treat the disorder, so it's easy to go down blind alleys before getting the right ADHD information and diagnosis.
The good news is that, if you approach the ADHD diagnosis step by step, you can avoid some common pitfalls — and control your child's ADHD symptoms more smoothly than you might have imagined possible.
The "Aha" Moment
Often, the ADHD diagnosis begins with an "Aha" moment, when it dawns on you that your child's problems may be caused by ADHD or another biologically-based disorder. For some parents, this moment comes when a teacher calls to say that the child is disruptive in class or falling behind academically. For others, it comes after they read an article about ADHD or see something about it on TV — or hear that another child at school has been diagnosed with the disorder.
Whatever triggers your "Aha" moment, seek help at once. Without a prompt diagnosis, an ADHD child is apt to be branded "slow" or "lazy" (or worse). Such labels undermine self-esteem and can lead to years of underachievement and family turmoil.
Perhaps most important, don't panic. With appropriate treatment, ADHD children do well. And if your child does have the disorder, you can take comfort in the fact that it is about biology and is in no way your fault.
Consulting the Doctor
Most parents will follow an "Aha" moment with an appointment to see a pediatrician. That makes sense, but before agreeing to have your child treated, "ask how many other cases of ADHD the doctor has treated, and what the plans and outcomes were," says Russell Barkley, Ph.D., research professor of psychiatry at SUNY Upstate Medical University in Syracuse, New York. If the doctor has handled only a few cases, you might be better off going to a developmental pediatrician who has significant experience with ADHD.
"Regardless of how experienced your pediatrician is," says Barkley, "you should strongly consider a medical specialist if your child's ADHD is accompanied by another diagnosed disorder, such as oppositional behavior, depression anxiety, or if there are urgent issues involved, such as your child's hurting himself or getting kicked out of school."
Your pediatrician or health insurer can probably steer you to a qualified specialist. If not, contact your local chapter of Children and Adults with Attention-Deficit Hyperactivity Disorder (CHADD).
How is ADHD Diagnosed?
To diagnose attention deficit disorder in children, a doctor must complete several different assessments:
Behavioral history. Your initial meeting with the doctor (pediatrician or specialist) should focus on your child's behavioral symptoms. Leave your child at home, and bring along written or verbal descriptions of your child's behavior from current or former teachers, as well as copies of any psychological test results you might have.
You'll be asked where and when your child's symptoms occur and when you first noticed them. In addition, the doctor may ask you (and your child's teachers) to complete the Conners' Rating Scale, a questionnaire that helps determine the nature and severity of your child's symptoms. And don't be surprised if the doctor asks about family or marital stresses that could be making your child anxious.
Medical history and exam. If your answers convince the doctor that your child's symptoms are chronic and pervasive, he or she will probably take a detailed medical history of your child. The goal here is to rule out anxiety, depression, sleep problems, seizure disorders, vision or hearing problems, and other medical conditions that can mimic ADHD. Certain medications can also cause symptoms of hyperactivity or distractibility in some children.
Review of records. The doctor should review relevant school reports and medical records. The doctor will want to have at least one phone conversation with your child's teacher(s) or school psychologist.
Awaiting the Diagnosis
At this point, parents are dying to know: "Does my child have ADHD?" But don't expect an answer overnight. The diagnostic process typically takes a week or two.
As you await the diagnosis, inform your child's teachers and any other school officials that your child is being evaluated for ADHD. Ask for a meeting with the school psychologist or special education teacher to discuss having your child evaluated for learning disabilities (which affect 30 to 50 percent of ADHD kids).
If your school is unable or unwilling to administer the appropriate testing, you may have it done by a private educational psychologist — typically at a cost of several hundred dollars.
The Treatment Plan
A month or so into your journey, your child's diagnosis should be complete. If your child has been evaluated by a specialist, he or she will likely take the lead in formulating a treatment plan (which should be communicated to your pediatrician and other caregivers). If your child was evaluated by a psychologist, he or she will probably need to confer with your pediatrician about starting your child on one of the many ADHD medications available.
Studies show that ADHD medications are generally safe and effective for about 80 percent of the children who take them. Many experts feel that treatment with medication is essential, and may be all that your child needs to solve his problems.
Given the risk of side effects — and the persistent stigma surrounding the use of psychotropic medications — parents are often reluctant to start their children on drug therapy. In many cases, some family members oppose drug therapy, while others figure it's worth a try. In any case, using ADHD medications is a matter that warrants thorough discussion by all parties involved, including the parents, of course, the doctor who would prescribe the drugs, and, depending on his or her age, the child.
Finding the Right Drug
With most pediatric medications, the proper dosage depends upon the age and/or weight of the child. But with the stimulants used to treat ADHD, proper dosage depends upon how rapidly the child's body metabolizes the drug—body weight is seldom the deciding factor. Consequently, finding the right dosage — and the right drug — typically involves trial and error.
At first, your child may need to see the doctor every few days or so. If your child becomes unusually irritable or tearful or seems to be "in a cloud," the dosage should probably be reduced. If side effects continue, or if there's no change in your child's behavior, a different medication should be tried.
In most cases, the right drug and dosage can be discovered within a month. But there are exceptions.
As medication questions are being resolved, it's a good idea to sit down with the doctor to discuss alternative ADHD treatments, too. Your family might benefit from sessions with a family therapist — especially if there are disagreements over how the child should be treated.
In addition, your child might benefit from sessions with a child psychologist who specializes in behavioral therapy. And many parents benefit from "parent-training" classes, in which they learn new ways to set and reinforce rules governing their child's behavior. (To find parent-training classes in your area, go to taalliance.org)
If testing indicates that your child has a learning disability, your school is required to develop a treatment program to address the problem. Don't be shy about asking the school for reasonable ADHD accommodations for your child — for example, letting her sit at the front of the class to minimize distractions, permitting occasional breaks for physical activity, or allowing extra time for test-taking.
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