Why Test Your Child For ADHD?

Why Test Your Child For ADHD?

No parent wants to admit that there’s something “different” about their child.  It’s hard to get feedback from teachers that their child is not “cutting it” or even worse being disruptive in the classroom. Equally frustrating and overwhelming is not being able to manage their child’s behavior at home. Parents often take such feedback as a reflection of their own failure as parents.

The good news is that if your child has ADHD, it does not mean that you failed as a parent.  However, as a parent it is your responsibility to support, encourage and advocate for your child if you find out he or she has this disability. ADHD is a neurodevelopmental disorder that significantly impairs executive functioning. That is, its symptoms begin in childhood and impact an individual’s ability to plan, initiate and follow through while being organized on detailed tasks, sustain attention, and control their emotions and behavior. According to the Diagnostic and Statistical Manual of Mental DIsorders, Fifth Edition (DSM-5), ADHD occurs in approximately 5% of children and 2.5% of adults.

There are three presentations (types) of ADHD, according to the classification system utilized in the DSM-5: a predominantly hyperactive/impulsive presentation, a predominantly inattentive presentation and a combination of the two (combined presentation).

Typically, when people think of ADHD, they imagine the hyperactive/impulsive presentation, the type in which a child is constantly on the move. In order to meet criteria for this presentation, children under 12 must exhibit 6 or more of the following symptoms (older adolescents and adults should exhibit 5 or more):

• Often fidgets or squirms in seat
• Frequent out-of-seat behavior when remaining in one’s seat is expected or required
• Often runs or climbs about when such behavior is inappropriate
• Often unable to play or engage in leisure activities quietly
• Unable to be or is uncomfortable being still for an extended time, as in restaurants, meetings, may be experienced by others as restless or difficult to keep up with
• Often talks excessively
• Often blurts out an answer before a question has been completed
• Often has difficulty waiting his or her turn
• Often interrupts or intrudes on others

In order to meet the requirements of the predominantly inattentive presentation, which many people refer to as ADD (a term from the 1980’s), a child under 12 must exhibit 6 or more of the following symptoms (older adolescents and adults should show 5 or more):

• Fails to give close attention to details or makes careless mistakes in schoolwork, at work or during other activities
• Often has difficulty sustaining attention in tasks or play activities
• Often does not seem to listen when spoken to directly
• Often does not follow through on instructions and fails to finish schoolwork, or chores
• Often has difficulty organizing tasks or activities
• Often avoids, dislikes or is reluctant to engage in tasks that require sustained mental effort
• Often loses things necessary for tasks or activities
• Is often easily distracted by extraneous stimuli
• Is often forgetful in daily activities

When as parents, you are struggling at home with your kids, you may be less inclined to go seek professional help. Reasons may vary from feelings of embarrassment, to thinking that it may be a phase, or to feeling resolved that you will handle it on your own.  It is when your children’s behavior is brought to your attention by a teacher, a school counselor, a coach or a school administrator that you take it more seriously and recognize the need to intervene at a higher level.

Signs of ADHD can emerge anywhere from kindergarten up through graduate school and in adulthood in my experience.  No matter when you recognize that you want to intervene, the first step in getting the right treatment, which may involve therapy, medication or a combination of the two, is to seek an evaluation. Often, the individuals who bring the issue to your attention can refer you to a professional who can perform an evaluation.

What happens during ADHD testing?

These evaluations differ depending on the type of professional performing them. Also, depending on the age of the child and the severity of symptoms, these evaluations can include a clinical interview, self-, teacher- and parent-questionnaires, cognitive and achievement testing, a computerized continuous performance test, a personality assessment and classroom observation. The minimum you should consider as an appropriate evaluation for a child is a clinical interview, which focuses on developmental history and current stressors as well as parent/teacher reports of a child’s behavior. A parent’s report of a child’s symptoms alone is insufficient to warrant a diagnosis because the behaviors have to be present at home and at school.  For an older teen or adult child, whether you end up getting an evaluation from a psychologist, pediatrician or a psychiatrist, the most essential piece of evidence supporting a diagnosis of ADHD, apart from a report of current symptoms and impairment, is existence of several symptoms and impairment in childhood, or what some might refer to as a developmental history of symptoms.

What is a developmental history and what does it matter?

Developmental history, or a review of relevant background information, is so important because symptoms of ADHD also overlap with some physical problems and other mental health disorders including anxiety. That’s not to say that anxiety and ADHD cannot both be present at the same time, but it is often the case, for example, that high school comes with increased stress both socially and academically, and this in itself can cause anxiety, which manifests in distractibility and difficulty concentrating. Also, one very difficult aspect of an evaluation to consider is whether your child has experienced a recent traumatic event, such as a divorce, discrimination and/or bullying, school change, parental job loss or a move. These events put stress on a family system and can potentially cause a child to act out, which often can resemble the hyperactive/impulsive behaviors of ADHD. It is often difficult to disentangle the response to a trauma and an underlying deficit in executive functioning (ADHD). In this case, I typically recommend treatment for the anxiety and to return for a follow-up evaluation if symptoms do not subside.

What happens right after ADHD testing?

After the evaluation is complete, the psychologist will provide feedback and preferably a written report. One of the most crucial aspects of any type of evaluation is the feedback session. This is where the professional who performed the evaluation should provide you with the results and any recommendations for treatment. The more specific the recommendations to the unique needs of your child, the better. It is most helpful to use the feedback session as a place to process your reaction to the results (if you feel comfortable) as well as to ask questions that will help you prepare for the next step.

What is the next step?

If your child is provided with a diagnosis of ADHD, the choice about which treatment is right for you and your family is a personal one. Many mental health professionals will recommend a combination of stimulant medication, cognitive behavioral therapy and working with an academic specialist to develop study strategies and organizational skills. Personally, consistent with my perspective on managing the symptoms of other mental health issues, I encourage you to consider that pharmacotherapy on its own may not be the best stand-alone treatment. It is crucial that children and adults with ADHD not only learn the skills necessary to manage their symptoms, but to integrate their unique and different learning style into their identity.

 Questions to ask before seeking an ADHD evaluation

Teachers, coaches, administrators and school counselors may suspect ADHD in your child because of certain behaviors. Sometimes after a brief evaluation, results are very clear either in support or disconfirming an ADHD diagnosis. At other times, the results are inconclusive.  Therefore, if you refer to a psychologist with a specific question about ADHD, you may end up receiving a recommendation for further testing for a variety of reasons. Before seeking an evaluation, you may want to consider asking yourself the following questions:

1. What do you hope to gain from the evaluation?
2. Has your child been developing normally?
3. Has your child suffered any serious accidents, experienced significant illnesses, chronic health problems or psychological trauma that may be contributing to his or her issues
4. Does your child have other environmental difficulties (family/social/school stress) or do you have other questions, such as memory, reading or math that may need to be addressed through this evaluation?
5. Have there been any recent changes that may be stressful for your child?
6. Is your child in the appropriate learning environment for his or her needs?

As always, I hope you found this post informative and helpful.  Please feel free to contact me to ask me any questions or to schedule an evaluation for you or your child, if you are in the Nashville area.

Take good care,

Dan