ADHD is the most common neurobehavioral disorder of childhood, occurring in approximately 7-8% of children and adolescents. Because of this, schools, psychologist, pediatrician, or other primary care clinician will likely want to initiate an evaluation for ADHD if a child or adolescent presents with academic or behavioral problems and inattention, hyperactivity, or impulsivity. But what’s involved in an evaluation for ADHD?
There are three key components to evaluating children and adolescents for ADHD: (1) surveys from parents or guardians and teachers about symptoms, (2) surveys from parents or guardians and teachers about symptom-related impairment, and (3) a clinical interview with parents or guardians.
Surveys from Parents or Guardians and Teachers about Symptoms
A clinician will want to obtain symptom ratings from parents or guardians and teachers because symptoms have to occur in more than one setting for a diagnosis of ADHD. Parents or guardians and teachers also both contribute unique perspectives. Parents or guardians know their child and their child’s history the best and can attest to how symptoms have developed over time. However, parents or guardians may not have as much knowledge about what levels of inattention, hyperactivity, or impulsivity is typical for a child. A lot of parents or guardians who come to me began to realize their child is struggling with attention when the child’s younger sibling has an easier time with following directions and staying on task than their older sibling. This is why symptom ratings from teachers are crucial. Teachers know a lot more about what is typical for a child at a given age because they see many more children who are the same age.
Surveys from Parents or Guardians and Teachers about Impairment
The focus of any good assessment (or treatment!) should focus on impairment—the reasons families seek out an evaluation or treatment in the first place! All mental health diagnoses and conditions are defined by symptom-related (in this case ADHD-related) impairment. Impairment among children and adolescents with ADHD often include difficulty completing tasks and schoolwork, making and keeping friends, and behaviors at home leading to parent and family stress.
Clinical Interview with Parent or Guardians
After a clinician gathers the above data, they will want to complete a clinical interview—a conversation between a clinician and parents or guardians to clarify symptoms, impairment, and the settings and situations in which the child is struggling. This is also when alternative explanations are explored. A lot of stressors or disorders can manifest as a presentation that looks very similar to ADHD (e.g., learning-specific difficulties, depression, trauma, anxiety). For example, if a child shows consistent inattention symptoms during reading, it would be important for a clinician to ask questions to determine if the cause of these difficulties are due to ADHD, reading-specific problems, or both.
Supplemental Components to an Evidence-Based ADHD Evaluation
Some clinicians will incorporate additional neuropsychological testing (e.g., cognitive/IQ, executive functioning) and academic achievement testing. These can be helpful to get a more comprehensive picture of a child or adolescent’s learning strengths and weaknesses; however, they have not been found to improve diagnostic accuracy in most cases. A child or adolescent can sometimes be asked to report on their symptoms or impairment; however, reports of their own behaviors often differ from other observers because children tend to have limited insight into their functioning and adolescents tend to minimize their own problematic behaviors.
Interested in an Evidence-Based Evaluation for ADHD?
I specialize in the treatment and assessment of ADHD and executive functioning, including planning, organization, and time management. Most of my patients also experience difficulties in school/work, depression, and anxiety. We can work together to make real, meaningful, lasting changes. It takes courage to start and I’m ready to help you make the changes you want to see in your life. I’d be happy to talk to you about my services with you in greater detail. I encourage you to contact me to schedule a free, 15-minute phone consultation appointment.
The Science
American Academy of Pediatrics (2019). Clinical Practice Guideline for the Diagnosis, Evaluation, and Treatment of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents. Pediatrics, 144(4), e20192528. https://doi.org/10.1542/peds.2019-2528
Pelham, W. E., Jr, Fabiano, G. A., & Massetti, G. M. (2005). Evidence-based assessment of attention deficit hyperactivity disorder in children and adolescents. Journal of clinical child and adolescent psychology., 34(3), 449–476. https://doi.org/10.1207/s15374424jccp3403_5
Thomas, R., Sanders, S., Doust, J., Beller, E., & Glasziou, P. (2015). Prevalence of attention-deficit/hyperactivity disorder: a systematic review and meta-analysis. Pediatrics, 135(4), e994–e1001. https://doi.org/10.1542/peds.2014-3482
*I originally wrote this post for the Issue 6 publication of Exceptional Needs Today. Click on the link to access a copy of the original publication of What’s Involved in an ADHD Evaluation. The digital, bi-monthly publication focuses on educating and energizing families, caregivers, educators, and professionals while preparing a healthy path for tomorrow. Subscribers are provided with access to the latest news/research, expert guidance, and therapies, as well as information on unique books and products. To subscribe for FREE, go to https://exceptionalneedstoday.com/