Attention deficit hyperactivity disorder (ADHD), formerly known as attention deficit disorder (ADD), is a disorder in which individuals show difficulties in controlling hyperactive and impulsive behavior as well as maintaining attention. This disorder is commonly diagnosed in childhood, with symptoms present by the age of 7. A thorough evaluation of the disorder requires interviews with parents and teachers, a medical evaluation, behavior observations, and psychological tests and rating scales.
Interview with Parents and Teachers
One important component of identifying ADHD is to obtain background information from parents and teachers on the history of the child's symptoms. As described by Jerome Sattler and Robert Hodge in "Assessment of Children: Behavioral, Social, and Clinical Foundations," interviews with parents and teachers provide important information on the type of symptoms, how long they have been present, how severe and interfering they are with the child's functioning, settings where they are present, and other information about the child's needs. For parents, it is important to obtain information regarding the child's early development, home behavior, age when symptoms began, style of parenting, relationships with friends, environment at home, school behavior and performance. For teachers, it is helpful to obtain information on the child's academic performance, behavior in school, interaction with other children, and any changes over time. School records should also be reviewed. By obtaining comprehensive information about the child from both sources, a better understanding of the problems can be determined.
Medical Evaluation
Another important aspect of diagnosing ADHD is a medical evaluation by the child's pediatrician. According to the National Institute for Mental Health, pediatricians need to rule out alternative causes of the symptoms, which may include hearing problems, seizures, learning disabilities, recent stressors or changes, depression or anxiety, and other medical conditions. A thorough review of the child's medical history is important to ensure that the symptoms are not the result of other issues.
Observations of Behavior
Observing the behavior of the child in the home and school settings is an important part of an ADHD diagnosis. As indicated by the "Diagnostic and Statistical Manual of Mental Disorders," 4th edition, children must demonstrate symptoms in at least two different settings to meet criteria for the diagnosis. Sattler and Hodge discuss the importance of observing how the behaviors occur, what consequences are given, how long they last, and what precedes the behavior. The core symptoms of the disorder, inattention, hyperactivity and impulsivity, should be monitored during observations. Furthermore, the U.S. Department of Education suggests that during classroom observations, professionals should also look over the child's work to see if his symptoms are interfering with his productivity. Also, observations should be done for at least 20 minutes and preferably on more than one day to ensure a comprehensive understanding of the child's abilities.
Tests and Rating Scales
Rating scales or questionnaires are often given to parents, teachers and children to assess the symptoms of ADHD. According to Sattler and Hodge, rating scales that measure only symptoms of ADHD are used (e.g. ADHD Questionnaire, ADHD Symptom Checklist-4) as well as broader measures that look at children's behavior overall (e.g. the Conner's Rating Scales-Revised, the Child Behavior Checklist, the Behavior Assessment for Children-Second Edition). These scales help identify which symptoms or behaviors parents, teachers and the child are endorsing. To diagnose ADHD, children may also be given psychological tests that measure intelligence, school achievement, or memory. These tests can provide observations on the child's behavior as well as her abilities. Sattler and Hodge describe other computerized tests, such as the Test of Variables of Attention, which measure the child's attention and impulsivity in responding to visual stimuli on the computer. All of this information together helps to provide a comprehensive understanding of the child's symptoms and behavior as well as her abilities in order to determine whether a diagnosis of ADHD is warranted.
References
- "Assessment of Children: Behavioral, Social, and Clinical Foundations, 4th edition"; Jerome Sattler and Robert Hodge; 2006
- National Institute for Mental Health: How is ADHD diagnosed?
- "Diagnostic and Statistical Manual of Mental Disorders, 4th edition, text revision"; American Psychiatric Association; 2000
- U.S. Department of Education: Identifying and Treating Attention Deficit Hyperactivity Disorder
