Margaret V. Austin, Ph.D., edited by C. E. Zupanick, Psy.D.
The process of formal diagnosis begins with an evaluation. Professionals call this an assessment. The assessment may or may not yield a diagnosis. If it does yield a diagnosis, it may not be ADHD. The process begins with the assumption of health and well-being. The assessment process begins to identify exceptions to that assumption. The deviation from healthy averages, informs the diagnostic process. It also yields solutions to problems that may be uncovered and identified, such as ADHD.
Who can Diagnose ADHD?
Now we'll discuss how a multi-source assessment is used to make an accurate diagnosis. But first, let's talk about the team of people involved in making a diagnosis.
First, there are the parents (or other primary caregivers). The symptoms of hyperactivity and impulsivity are generally first noticed by the child's caregivers. The symptoms of inattention are more difficult to notice. Although caregivers notice their children's behavior, they often don't have a point of reference to provide comparison. Thus, while a caregiver may notice a behavior, they may not realize the magnitude of the problem.
Despite caregivers being the first to notice, the first responders, are often teachers. The symptoms of ADHD are most striking and noticeable in restrictive environments such as school. Children must be able to sit still and maintain focus for long periods of time. Unlike most caregivers, teachers do have a reference point. Teachers routinely observe lots of children, all day long. Therefore, they are quick to notice unusual behaviors.
Teachers are usually the first to identify inattentiveness. It becomes more apparent in an academic setting. School-age identification of inattention is also easier simply because it is more obvious in older children. Gauging the attention levels of very young children is more difficult since inattention is developmentally appropriate for younger children. In contrast, hyperactive and impulsive behaviors are usually hard to miss.
In addition to parents and teachers, there are various professionals that work together to determine if an ADHD diagnosis is warranted:
Clinical psychologists are the only mental health clinicians that have the specific training and expertise in all aspects of psychological testing. Therefore, it is critical to find a psychologist who has experience working with ADHD to administer the full range of tests needed. Since ADHD can have a big impact on school performance, the child's school district will often pay for testing. Typically, caregivers have the option of utilizing the school psychologist to administer educational testing (without cost). Alternatively, they can work with a privately-hired child psychologist to do the testing portion of the ADHD assessment. Bear in mind: The school psychologist works for the school. A privately-hired psychologist works for you! This nuance can become important in some cases. The particular combination of tests selected will depend upon the clinician and the needs of the child. It will likely include tests of:
personality and problem-solving styles;
current fears and concerns;
continuous, sustained performance measures; and,
Sometimes tests of learning disabilities, or other psychiatric disorders, are included as well.
Educational psychologists (school psychologists) are trained members of the school team. Their role is to strengthen student learning by supporting teachers' efforts. Also known as school psychologists, these professionals are uniquely trained with a focus on both psychology and education. They work with students academically, emotionally, and behaviorally. They use specialized knowledge and skills to promote educational success for all children. However, they are specifically trained to help students with special needs. School psychologists can administer educational testing, review test scores, and diagnose learning disabilities. Sometimes they also provide therapy to help treat emotional or behavioral problems. They usually function very well in groups and teams because that is much of their work. They are typically members of the multidisciplinary team that evaluate a student's need for specialized services. School psychologists are often the first mental health professional to see a child who was referred for an ADHD evaluation. These professionals may help to coordinate, and to involve other professionals as needed.
Psychiatrists are also a vital member of the team. Psychiatrists are medical doctors who specialize in mental and emotional problems. They usually focus on the use of medication and medication management. They are certainly qualified to diagnose ADHD, but they base findings on clinical interviews alone, rather than more objective test data. While psychiatrists can provide ongoing medication management, it's expensive. Thus, many ADHD patients see psychiatrists during the initial phase of treatment. After arriving at a helpful medication regime, it is quite common to have the family doctor take over medication management after that. This saves money and utilizes less specialist services.
Neurologists are medical doctors who specialize in the treatment of the brain and central nervous system injuries and disorders. They can be important to include in the diagnostic process since ADHD is a neurological disorder. However, their services aren't always required. One occasion when a neurologist becomes necessary is when there is concern regarding seizures. An EEG is commonly ordered. This will help identify the presence of seizures. However, EEG testing isn't typically necessary for the average ADHD diagnosis. Neurologists can order the same tests as any other doctor, and they can prescribe medication. However, they typically do not perform these tests, nor do they conduct therapy as needed for treatment.
Pediatricians are medical doctors who specialize in the treatment of children from birth to 18 years of age. They are keenly aware of the developmental milestones that indicate good health in children at different ages. They are also capable of diagnosing and prescribing medication to treat ADHD. Pediatricians can treat any childhood disorder, but they sometimes specialize in certain areas.
Pediatricians are not mental health professionals. They are physical health professionals. But, the nature of their job requires that they learn a great deal about mental health issues affecting their patients. Although ADHD is not typically a specialty area for physicians, their general knowledge enables them to evaluate, diagnose, and treat ADHD.
Pediatricians understand the science and chemistry of prescription medications. This qualifies them to prescribe medications to treat ADHD. However, since ADHD treatment is less successful with medication alone, physicians must refer for mental health treatment. A primary advantage of working with a pediatrician is the benefit that comes from working with one person over a long period of time. Families often develop trusting relationships with specific doctors. Also, it is less costly to work with a pediatrician, than a psychiatrist, for ongoing ADHD management. Pediatricians provide the highest quality care, particularly when they partner with a mental health professional.
Physicians and licensed mental-health providers can diagnose ADHD. However, obtaining an accurate diagnosis is a complex process, involving many professionals. There is no single medical, neurological, or attentional test that can reliably identify ADHD. No one person can do it alone. Not all mental health professionals use the same tools to determine if a patient has ADHD. Nonetheless, there are five basic sources of information that make a complete evaluation:
in-depth interviews with caregivers, teachers, and healthcare professionals;
information from family members and peers;
symptom checklists and behavior rating scales completed by teachers, caregivers, and children;
medical evaluation and medical history; and,
If you are looking to find professionals in your community, an ADHD support group is a good place to start (if available in your locale). People in these support groups have already worked with professionals in your community. They may be able to recommend the people they found most helpful. Your school psychologist may also be a good resource.