ADHD Diagnosis Step 1: The Consultation
Expect the ADHD diagnosis consultation to take an hour or longer. If your child is being evaluated, the doctor will talk to you and your child, and get feedback through checklists and written information from teachers and other adults who spend a lot of time with your child. Sometimes the doctor’s office will forward these forms to you before the consultation and review them with you at the initial meeting. Other doctors will meet with you first, do the interview, and give you the forms to be filled out before your next appointment.
If you are being evaluated, your doctor will interview you and someone who knows you well -- your spouse, a sibling, your parents. He may or may not use similar checklists designed for identifying symptoms of adult ADHD. The doctor will use the patient interview to determine which, if any, tests might rule out other conditions that may be causing the ADHD symptoms.
“The clinical interview is the core of any evaluation,” says Brown. “The more input from different sources, the better. Many adults come for a consultation alone, but it’s helpful to come with a spouse, sibling, or close friend.”
Many doctors ask people in the patient’s life -- a spouse, parent, or sibling for an adult, or a teacher, coach, or nanny for a child -- to write a few sentences describing the patient. Personal insight often uncovers information that can’t be culled from questionnaires.
Says Hallowell: “A teacher might write, ‘Johnny is sweet, adorable, and cute as a button, but he can’t remember to come in out of the rain. He is disorganized. He speaks out of turn. He needs more discipline.’ It’s what I call the moral diagnosis, but it often reveals a lot about a child who may have ADD. Those one-paragraph narratives give a wide range of input. Checklists don’t.”
What are doctors hoping to find by evaluating those checklists and narratives and conducting the clinical interview?
Social history. “Describe a typical day in [your life or] your child’s life” is often the first question a doctor will ask to get a sense of how [you or] your child functions -- what usually goes smoothly and what is challenging.
Medical history. Medical problems, ranging from sleep apnea and thyroid conditions to hormone fluctuations and substance abuse, can present symptoms similar to those of ADHD.
Family history. “I ask questions about the immediate family, as well as grandparents, uncles, aunts, and cousins,” says Brown. “I’ll ask things like, ‘Is there anybody who has had trouble paying attention or learning certain subjects, or who was smart but didn’t do well in school -- and did better later? The answers will give me an idea of what’s floating around in the gene pool.”
Strengths and weaknesses. “Every person I’ve seen with ADD can focus well on some activities,” says Brown. “Sometimes it’s sports. Sometimes it’s artistic or mechanical stuff. That , are telltale symptoms of ADD. In the process, I identify strengths I want to protect -- and encourage -- during treatment.”
Education. “Everybody comes in with some information about the condition. Some of it is sophisticated and accurate; the rest is just wrong,” says Brown. “I take 15 or 20 minutes to tell them what I think about ADD, how ideas about the condition have changed, and the latest thinking on managing symptoms.”
By the time the clinical interview is over, most doctors with experience treating people with ADHD will have a good idea of whether you or your child has the condition. Even so, most want to back up their opinion with objective proof from tests.
Where to Go for an ADHD Diagnosis
How Experts Make an ADHD Diagnosis
Next: ADHD Diagnosis Step 2: Testing, Testing
ADHD Diagnosis Step 3: Learning How to Manage Symptoms
Five Common Diagnosis Mistakes