How is ADHD Tested in Children?

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There are essentially three ways to get your child assessed for ADHD. They’ll be outline here in the order of complexity. For mild, uncomplicated cases, the first one will suffice, but for more severe or more complicated cases, the final two options will likely be more effective and more helpful for your family. First, here is some information that may help.

Identifying the symptoms of ADHD is pretty easy in some cases. For instance, it’s not hard for clinicians to identify a hyperactive child from a non-hyperactive child! What complicates the evaluation is that many other conditions mimic ADHD symptoms and can easily result in a misdiagnosis.  There are three commonly used methods to evaluate children for ADHD.

Interview with your pediatrician or family doctor: For many families, this is the starting point,and in less complex cases, it may be all that is needed. This usually consists of a simple interview of a parent, by the pediatrician or family doctor. Many physicians are now supplementing their interview with parent and teacher rating scales, which is a great practice and improves diagnostic accuracy quite a bit. The American Academy of Pediatrics considers the use of rating scales a standard of practice that all physicians should utilize when diagnosing ADHD. You should expect to spend about 15 to 30 minutes in this type of evaluation. Many physicians refer out to mental health professional for ADHD evaluations to increase accuracy of the diagnosis, depending on their familiarity and their training on mental health conditions. There two main limitations with this sort of evaluation. First, many children have a condition that mimics ADHD and are often not recognized by a physician’s interview alone, or by any individuals without extensive training in children’s mental health issues.  Conditions such as anxiety, depression, or Oppositional Defiant Disorder are often misdiagnosed as ADHD. Second, research shows that in children with ADHD, up to 80% have a co-occurring disorder, such as the ones mentioned above, namely, anxiety, depression, Oppositional Defiant Disorder.  ADHD medication will not effectively treat these conditions, and in the case of anxiety, it may exacerbate the condition.

ADHD Screener: This approach is probably suitable for most children. This is usually completed by a mental health professional, such as a Psychologist, Psychiatrist, or Licensed Psychological Examiner, who has specialized training in ADHD and related disorders. It includes a thorough developmental interview about the child. This may include parents, family members, and teachers. It also includes both “broadband” and  “narrowband” rating scales. This just means that at least two rating scales are used, one that is designed to screen for many mental health conditions that could mask as or co-occur with ADHD, and one to look specifically at ADHD symptoms. Both measures likely compare the number of symptoms exhibited with other children his or her age and gender. Rating scales of ADHD symptoms should be completed by adult reporters who observe the child in different contexts, which usually means a parent and a teacher. Due to the rate of learning disabilities in ADHD children, many psychologists and examiners will include a brief screen of learning and academic ability. In total, expect to spend about two hours in an ADHD screening.

Psychological or Psycho-educational Testing: This is the most accurate and most comprehensive method to assess for ADHD. In Arkansas, this sort of evaluation is only completed by a Psychologist or Licensed Psychological Examiner. It includes all components listed above, in addition to a thorough assessment of learning ability and/or disabilities. Specifically, it includes a thorough developmental interview, an IQ test, a test of academic ability, a broadband rating scale of mental health symptoms, and a narrowband rating scale of ADHD specific symptoms that are completed by adult raters in two locations, usually a parent and a teacher. All results are compared to same-aged peers for a developmentally accurate comparison of the child’s behavior and abilities. This type of evaluation not only looks at ADHD and other mental health symptoms, but will also demonstrate the child’s learning styles, strengths and weaknesses. It is specifically indicated when learning disabilities are expected or the child displays extreme behaviors. Expect to spend 3 to 6 hours in this sort of evaluation.

Getting your child a proper evaluation is the first step to getting help. Many children are misdiagnosed, which can lead to a delay in their getting the treatment they need. Whether you’re getting your evaluation from a psychologist, psychiatrist, pediatrician or family doctor, educate yourself about the process and the disorder. You are your child’s best advocate!

Dr. Adam H. Benton