ADHD or Not? Why a Diagnosis Matters

Whether you suspect ADHD, or a teacher mentions it, an actual diagnosis is key.

From the WebMD Archives

For many children with ADHD, a call from a teacher was the first time their parents started discussing the possibility of ADHD.

"The vast majority of cases are brought to the attention of parents by educators, either at the preschool level or elementary school level," says George DuPaul, PhD, of Lehigh University. He has a background in school psychology, with a special interest in ADHD.

But even though teachers spend the entire day watching kids' behavior, "sometimes they're right and sometimes they're wrong," DuPaul says.

Getting a proper diagnosis is important for anyone who seems to have symptoms of ADHD. Many other mental and physical issues can cause similar symptoms. "Upward of 40% of elementary students are reported by their teachers to have distractibility problems or problems with their activities," DuPaul says. "That doesn't mean they have ADHD."

Finding a Diagnosis in Kids

The description of ADHD in the manual that mental health care providers use to diagnose emotional and mental concerns is fairly simple. It offers nine symptoms related to inattention and another nine symptoms of hyperactivity and impulsivity. Someone with ADHD must show at least six from each category for at least 6 months, and to a degree that is inappropriate for their age and is disruptive or impairs social, school, or work functioning.

But getting to that diagnosis isn't necessarily quick or easy, DuPaul points out. Other issues that can cause these symptoms include:

  • Short attention span. Some kids can naturally focus longer than others.
  • Emotional issues. Kids who are anxious or depressed may have trouble paying attention.
  • Problems at home. Kids' thoughts may be stuck on a family crisis when they're supposed to be focused on a test.
  • Classroom chaos. If a classroom is noisy and poorly managed, kids' attention can wander from the task at hand, DuPaul says.

There is no single test that definitively diagnoses ADHD. Instead, the diagnosis should rely on tests and different types of input from several people in the child's life.

These five steps can help you discover if ADHD is causing your child's symptoms:

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1. Go to the right professional.

"The best thing parents can do is identify, either in the school or the community, a mental health or health care professional who has expertise in ADHD," DuPaul says. Some schools have a psychologist on staff who can evaluate kids for ADHD. Other options include a child psychiatrist, a pediatrician who specializes in developmental problems, or a psychologist in your community.

Of course, most parents head to their pediatrician or family doctor. Sometimes these doctors are properly trained to make this diagnosis, he says -- but not always. If you go this route, ask the doctor about their background and comfort level in diagnosing ADHD.

2. Ask a lot of questions.

Parents should be ready to discuss with the health care provider:

  • How the child behaves and pays attention to tasks at home
  • The child's grades and behavior reports from school
  • The child's medical history
  • The family's history of medical, mood, and emotional issues
  • Steps they've taken to deal with the child's behavioral or attention problems

This may require filling out one or more rating scales that can help determine if ADHD -- or other problems such as anxiety or depression -- are causing symptoms.

3. Include the teacher.

To meet the definition of ADHD, symptoms must be causing problems in different places, such as home and school.

"They tend to come out when the person, be it a child or adult, is doing something they find difficult or uninteresting," says Lenard Adler, MD. He's an NYU professor who has studied ADHD in children, teens, and adults. "A parent might say, 'I'm not quite sure what the teacher's talking about. Daniel can play video games for several hours and has no trouble paying attention.' But life isn't a video game. It's full of things that we find difficult or challenging."

As a result, you may need to ask your child's teacher to fill out rating scales or speak with the child's doctor or mental health care provider.

4. Expect more than an ADHD drug.

"It's not automatic that just because you have ADHD you're put on medication, though it may seem that way to folks," DuPaul says. "Medication is helpful for many kids, but it's not necessary in every case, and it's not sufficient in any case."

It's important to also help kids learn tactics to change their behaviors. Your child's doctor or mental health counselor may help you make a plan for that and teach it to your child. You may need to meet with your child's teacher to put this plan into action at school.

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5. Stay on top of changing times.

It's a good idea to occasionally check on whether your child's treatment is still working as they get older, DuPaul says. Kids' medications and strategies for managing their behaviors may need to be changed as they get older.

Some kids are diagnosed with ADHD at a later-than-average age."Many kids with ADHD aren't going to be fully symptomatic until they reach the demands of middle school," Adler says. Once they have to keep track of changing classes and a locker, trouble staying focused may become more obvious.

WebMD Feature Reviewed by Brunilda Nazario, MD on April 16, 2012

Sources

SOURCES:

George DuPaul, PhD, professor of school psychology, Lehigh University, Bethlehem, Pa.

Lenard Adler, MD, professor of psychiatry and child and adolescent psychiatry, New York University.

Akinbami, L. NCHS Data Brief, August 2011.

CDC: "Attention-Deficit/Hyperactivity Disorder (ADHD) Symptoms and Diagnosis."

World Health Organization: "Adult ADHD Self-Report Scale-V1.1 (ASRS-V1.1) Screener."

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