Diagnostic Challenge 1: Looking into the Past
Margaret V. Austin, Ph.D., edited by C. E. Zupanick, Psy.D.The retrospective analysis of ADHD using historical data
Even though someone might not receive an ADHD diagnosis until they are an adult, it is a disorder that begins in childhood. Although it may not have been noticed or identified during childhood, historical evidence must provide confirmation that the symptoms were present prior to age 12.
The diagnostic symptoms for ADHD are the same for children and adults. However, adults do not need as many symptoms as children (five as opposed to six for the relevant subtype of ADHD). Children and adult behavioral symptoms are expressed differently across different developmental age groups. We have previously reviewed behavioral examples of these symptoms for adults. For information about other age groups, please see our companion article about ADHD in children.
The diagnosis of adult ADHD is a complex process. One reason for this complexity is the need to gather accurate historical information. This can prove to be quite tedious and challenging. The length of time between age 12 and an adult's diagnostic assessment is often 15 years or more. Most of us would have trouble accurately recalling life events that long ago. Moreover, school records are rarely stored that long. This makes the assessment process fraught with difficulty as accurate and complete information is necessary for a proper diagnosis.
A further complication is that most clinicians work with either children or adults, but typically not both. Therefore, clinicians who work primarily with adults may be less familiar with the diagnostic indicators of mental and emotional disorders in children. If adult ADHD is suspected, it is especially helpful to try to locate a mental health professional that specializes in Adult ADHD. American Psychological Association offers an excellent psychologist locator system that allows you to search for age groups served. CHADD (the National Resource on ADHD) also has a provider search system that is helpful under the Advanced Search. Please see the Reference and Resource section LINK for more information.
Like the assessment of children, adults benefit from a multi-source assessment. This means information should be gathered from as many valid sources as possible. This may include school records; employment history; and interviews with people familiar with the person being assessed. It is particularly important to be able to interview people who were familiar with the assessed person during childhood. Naturally, parents or other caregivers are a logical choice. However, such persons may be deceased, or estranged, by the time the assessment is performed. This adds another layer of complexity to the assessment process.
To diagnose adult ADHD, clinicians must first verify the presence of ADHD symptoms in childhood. This is done by interviews, questionnaires, and a review of available records. The questionnaires may be given to the adult being assessed; to the parents or other adults who knew the assessed person as a child; and, any other significant adult during that person's childhood. Whenever possible, school records are reviewed.
When reviewing these documents, the clinician is looking for diagnostic clues such as: behavioral problems, poor focus, lack of effort, or underachievement relative to ability. If possible, a clinician might also ask to obtain a developmental history by interviewing the parents or other caregivers of the assessed person. This developmental history provides valuable, detailed information about home, family life, and childhood development. A developmental history consistent with ADHD would include evidence of social, emotional, and other developmental problems. This might include problems with peers; school failures or excessive discipline; and, unusual interventions such as being made to sit in the front of the class, or needing extra time to complete tests, etc. Likewise, unusual disciplinary measures would be evaluated. In the past, shaming techniques were used to discipline underachievement, or non-conformity. These methods have proven to be harmful, not helpful. Keep in mind, these types of childhood events could point to several different childhood disorders. However, a skilled clinician is able to sort it out.
A family history of ADHD is also informative, given the strong genetic component of the disorder. Researchers believe that ADHD is caused by roughly 75% genetic influences (Sarkis, S. 2013). Once again, the clinician is looking for any clues or signs of ADHD symptoms that may be been present during childhood. Since most adults cannot accurately remember childhood details, the information from an adult who knew the assessed person as a child is invaluable.
Resources
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Articles
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Childhood ADHD Overview
- Introduction to Attention Deficit Hyperactivity Disorder (ADHD)
- Signs & Symptoms of ADHD
- ADHD Signs and Symptoms: Attention Difficulties
- ADHD Signs and Symptoms: Hyperactivity
- ADHD Signs and Symptoms: Impulsivity
- Are There Different Types of ADHD?
- The Social, Educational, Financial & Occupational Impact of ADHD
- What are the Legal Rights of Caregivers and Their Children with ADHD (USA)?
- A Positive Spin: Is There Anything Good about ADHD?
- Signs of ADHD in Children at Home
- Signs of ADHD in Children at School
- Signs of ADHD in Children in Peer Relationships
- How Do I know if My Child Needs an ADHD Evaluation?
- What Should I Do If I Think My Child Might Have ADHD?
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ADHD Discoveries and Controversies
- ADHD: New and Exciting Brain Research
- ADHD: New and Exciting Brain Research - Part II
- Neurotransmitter Changes with ADHD
- Executive Functions
- Neurodiversity: Is ADHD a True Mental Disorder?
- ADHD Statistics
- Cultural and Gender Differences in Prevalence Rates
- Should Children with ADHD Be Medicated?
- New and Promising Areas of Research
- Causes of ADHD in Children
- ADHD or Another Condition?
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Diagnosis of ADHD in Children
- Who Can Diagnose ADHD?
- How Does ADHD Multi-Source Assessment Work?
- Assessment Instruments: Behavioral Checklists
- Assessment Instruments: Intelligence Tests
- Assessment Instruments: Achievement Tests (or Academic Tests)
- Assessment Instruments: Tests of Attention
- Assessment Instruments: Memory and Other Common Tests
- Step 2: Clinical Interviews
- Step 3: Physical Exam and Medical History
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ADHD Treatment in Children
- Multimodal ADHD Treatment Approach
- ADHD Medications
- Treating ADHD with Stimulant Drugs
- Commonly Prescribed ADHD Stimulant Medications
- Treating ADHD with Non-Stimulant Drugs
- Risks of ADHD Medication
- Risks of ADHD Medications - Part II
- Benefits of ADHD Medication
- Side Effects of ADHD Medications
- Medication Decisions and Medication Management
- How Long Should ADHD Medication Treatment Last
- Psycho-Education about ADHD and Its Management
- Family Therapy
- Individual and Cognitive Behavioral Psychotherapy for the Child with ADHD
- Skills Training
- Social Skills Training and Coaching
- Supports
- Alternative ADHD treatment: What Does NOT Work?
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Family and Personal Supports
- Effective Disciplinary Techniques
- Learn about Resources and Be Proactive
- Manage Stress, Self-Regulation & Provide Order
- Develop Routines, Organization and Expectations
- Communicate and Collaborate with Schools
- Express Confidence in Your Child's Abilities
- Help Children Improve Social Skills and Peer Relationships
- Avoid Homework Battles and Monitor Medication
- I Think I have ADHD. What should I do?
- I Think I Have ADHD - Part II
- Famous People with ADHD
- Adult ADHD Overview
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Diagnosis of Adult ADHD
- How is Adult ADHD Diagnosed?
- Diagnostic Challenge 1: Looking into the Past
- Diagnostic Challenge 2: ADHD versus Similar Disorders
- Diagnostic Challenge 2 - Part II
- Diagnostic Challenge 3: ADHD Symptoms
- Diagnostic Challenge 3 - Part II
- Diagnostic Challenge 4: A Concealed Disorder
- Specialized Tests and Tools
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Adult ADHD Treatment
- ADHD Medication Treatment
- Stimulant and Non-Stimulant Drugs for Adult ADHD
- Medication Timing, Dosage, Monitoring, and Duration of Treatment
- Weighing the Risks and Benefits of Adult ADHD Medications
- Psychotherapy for ADHD
- Coaching/Supported Employment for Adult ADHD
- Social Skills Training for Adult ADHD
- Psycho-Education and Cognitive Behavioral Therapy (CBT)
- ADHD Resources and References
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Childhood ADHD Overview
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Questions and Answers
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- Does Your Child Have ADHD?
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- Ask the Expert: Mindfulness, Stress, & Emotion
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- Helping Parents & Kids Understand the Social & Emotional Aspects of ADHD
- Social and Emotional Concerns of Children with ADHD: Strategies to Help
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- Out-of-School: Parenting During the Summer
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- The Role of Medication in Managing Children's ADHD Symptoms
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