Diagnosing ADHD in Children

When you take your child to the pediatrician for a sore throat, a quick test can tell if it’s strep throat and put your child on the way to a course of antibiotics and generally a quick recovery. But when it comes to diagnosing attention deficit hyperactivity disorder (ADHD) – a condition in which children display symptoms of hyperactivity and impulsiveness, or inattention, or a combination of these -- the diagnostic process is rarely quick or easy. In fact, in many cases, the pediatrician is not the one to make the diagnosis.

Although some pediatricians with special training in the disorder will diagnose ADHD in children, most will refer you and your child to a mental health professional such as a psychologist, psychiatrist, counselor, or social worker trained in diagnosing and treating the disorder through behavioral management. You can also find a professional who specializes in ADHD diagnosis through your health plan, your child’s teacher or school counselor, other parents of children with ADHD, or nonprofit organizations such as Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD).

Criteria for ADHD Diagnosis

The person who evaluates your child for ADHD will be looking for the presence and severity of specific behaviors. The behaviors vary, depending on which of the three types of ADHD a child appears to have: hyperactivity-impulsivity, inattention, or combination. Different types of ADHD include these different symptoms in children:

Hyperactivity

• Often fidgets with hands or feet, or squirms in seat
• Often gets up from seat
• Often has trouble enjoying quiet activities
• Often runs or climbs where not appropriate
• Often talks excessively

Impulsivity

• Often blurts out answer before questions have been finished
• Often has trouble waiting his or her turn
• Often interrupts others

Inattention

• Often makes careless mistakes in schoolwork or other activities
• Often has trouble focusing on tasks or activities
• Often does not seem to listen when spoken to directly
• Often has trouble organizing activities
• Often does not follow instructions
• Often loses things needed for tasks or activities

Although many children display some of the behaviors for ADHD, they do not necessarily have the disorder. An ADHD diagnosis requires that these behaviors have been persistent for at least six months, that some symptoms began before age seven, that symptoms are present in two or more settings (such as school and home), and that they cause significant impairment in social or school functioning.

ADHD in Children: How a Diagnosis Is Made

The first step toward diagnosing ADHD should be a full physical exam. Then the psychologist or other mental health professional who evaluates your child for ADHD will probably set up an interview with you and two or more sessions with your child before making a diagnosis.

The evaluator will rule out other causes of your child’s behavior such as:

• A sudden life change (such as divorce, a death in the family, or moving)
• Undetected seizures
• Thyroid problems
• Lead toxicity
• Sleep problems
• Hearing problems
• Learning disability
• Anxiety
• Depression

To do this, he will check your child’s medical and school records, and perhaps question both of you about what else is going on in your child's life. He may also administer tests to determine if your child has a learning disorder or some other problem that may be causing the behaviors.

If possible, the person making the diagnosis will want to observe your child’s behavior in the classroom and interview you and her teachers – and perhaps other adults who interact with your child on a regular basis – about your child's behaviors. The evaluator may also ask each of you to complete standardized forms, known as “behavior rating scales,” to rate different aspects of your child’s behavior.

Diagnosing ADHD in Adults

For an estimated 60% of children with ADHD, symptoms persist into adulthood. And, some adults with symptoms of ADHD were never diagnosed with the condition as children.

Sometimes an adult will recognize the symptoms in himself when his son or daughter is diagnosed. Other times, an adult who has sought help from a psychologist or counselor for depression, anxiety, or other problems discovers that they are related to ADHD.

Symptoms of ADHD in adults can include:

• Chronic lateness and forgetfulness
• Anxiety
• Lack of organizational skills
• Low self-esteem
• Employment problems
• Difficulty controlling anger
• Impulsiveness

Symptoms of ADHD must have been present in childhood. For adults, these behaviors can cause problems at home, work, or school if not managed appropriately. If you suspect that you may have ADHD, talk to your doctor or therapist about how to proceed with an evaluation.