Is Your Doctor Up to Speed on Diagnosing ADHD?
As a parent and as a physician, I’m concerned about over- and under-diagnosis of ADHD. I don’t want children to receive treatment for ADHD because their behavior at home or school doesn’t match expectations, and I don’t want children to fail to receive the care they require. I want accurate diagnosis. It’s the first step […]
As a parent and as a physician, I’m concerned about over- and under-diagnosis of ADHD. I don’t want children to receive treatment for ADHD because their behavior at home or school doesn’t match expectations, and I don’t want children to fail to receive the care they require. I want accurate diagnosis. It’s the first step toward receiving the right treatment.
So what do physicians need to do to diagnose ADHD accurately, and is there anything parents can do to help?
The American Academy of Pediatrics (AAP) published comprehensive guidelines for the assessment of children with ADHD. The guidelines, which focus on elementary school-aged children, include five recommendations that can improve ADHD diagnosis.
> The first recommendation is that general pediatricians should initiate evaluations for ADHD in children aged six to 12 years of age who present with core ADHD symptoms.
> The second is that the assessment should include evidence obtained directly from parents or caregivers and classroom teachers, to capture the aspects of the child’s life. Standardized rating scales can collect and evaluate such information, but currently more than half of initial assessments do not include parent and teacher ratings.
> The next recommendation is that before a diagnosis is made the doctor should make sure that a child meets the Diagnostic and Statistical Manual-V (DSM-V) criteria, an internationally accepted diagnostic checklist, for ADHD.
> The fourth is that the evaluation should include an assessment of psychiatric, educational, medical, and developmental disorders that might present similarly to ADHD, or that coexist with ADHD. That’s important because having some symptoms of ADHD doesn’t necessarily mean attention deficit is the correct diagnosis, and having ADHD doesn’t exclude having additional disorders.
> The final recommendation is that diagnostic tests, such as labs or scans, need not be run routinely as part of the diagnostic process. Tests may be very useful for assessing or excluding other conditions, but their routine, unreserved use for ADHD diagnosis adds cost and delay to the ADHD assessment.
Physicians could improve the accurate diagnosis of ADHD by following these guideline recommendations, and parents could select a pediatrician who does follow them, and ensure that they, and their child’s teachers, complete rating questionnaires when requested to do so.
What are the obstacles to physicians implementing these guidelines?
Despite the fact that ADHD assessment scales have been distributed to doctors, too few physicians have received training on how to score and interpret them. Mailing questionnaires to and from home and school is time consuming and poorly coordinated, and response rates are low. Physician offices often lack protocols for caring for ADHD patients efficiently, and each practice, or even each doctor, may use his or her own methods.
The good news is that help is available. A team of ADHD experts has developed software to help physicians make AAP-recommended assessments and deliver the best care to each child. The software includes online rating scales and an individualized report of the child’s symptoms that have been reported by parents and teachers. It summarizes the areas that the child is having difficulties with, including whether the patterns are consistent with an ADHD diagnosis and if the ratings suggest the possibility of a different or coexisting problem. The software then gives recommendations for further assessment and treatment.
In short, the report provides a summary of the child’s current ADHD status and a set of recommended next steps for the physician. Typically, the physician’s office uses the software to gather home and school assessments before the child’s first visit, improving efficiency and shortening the time between evaluation and possible diagnosis. The software also guides physicians to treat children according to the AAP’s five treatment recommendations.
Guideline-based assessments help physicians make an accurate diagnosis and give appropriate treatment. With more than one in 10 children having received an ADHD diagnosis, following ADHD assessment and treatment recommendations seems like a great idea to me.
Dr. Janet Munro is CEO of Optimal Medicine, a digital health company based in London and Marlborough, Massachusetts. The company launched mehealth for ADHD, software for diagnosing and treating attention deficit, in December 2013.