It takes a qualified clinician time to diagnose attention deficit. But this streamlined approach may let your doctor reach the right diagnosis faster.
by Joel Nigg, Ph.D.
The main problem with insufficient diagnostic scrutiny is false positives — labeling or identifying ADHD when the problem is something else, or, occasionally, when the behaviors are fairly normal. ADHD can also be missed because it may present as moodiness, panic, learning problems, disobedience, or other problems that co-occur with ADHD.
A four- to six-hour evaluation, which includes a history, informant interviews, and cognitive evaluation of a child’s learning style to guide educational planning, is the ideal, yet is often impractical in this era of managed care. However, a one- to two-hour evaluation with an appropriately qualified clinician can do the job.
Before the evaluation get a checkup and ask your doctor if there may be a medical explanation for you or your child’s symptoms. At the ADHD evaluation itself, be prepared for possible referral for psychological or educational testing, which is sometimes required to evaluate a potential learning disorder or a neuropsychological or information processing problem.
The basic steps for a one-to-two-hour evaluation are:
>> For adults as well as children, fill out standardized rating scales for both ADHD and for a "broadband" screen of behavior problems. Teachers and parents should fill out the forms for their children. Adult patients should fill out the forms themselves, as well as a spouse or coworker. Clinician review of the responses: 30 minutes.
>> Careful clinical interview (60-90 minutes) of either the parent of the child or of the adult patient in order to achieve the following:
1. Verify that the symptoms are pervasive, impairing, and enduring. Adults should obtain information about their childhood history by asking their parent to complete a rating scale or to do a short phone interview with the doctor.
2. For adults and children, rule out any history of trauma and mood disorder (depression versus irritability; anxiety versus inattention). For adolescents and adults, evaluate for substance abuse.
3. Consider alternative explanations for the symptoms — poor sleep or a sleep disorder, for example, or unusual environmental challenges, such as extreme family stress or an unsafe school environment.
After this short but solid evaluation process, you or your child should have a good idea of whether the symptoms are indeed ADHD.