How do doctors diagnose ADHD?
ADHD should only be diagnosed by a medical professional with appropriate training. Where possible this should be a child or adolescent psychiatrist, or a paediatrician familiar with ADHD.There isn't a simple test that determines whether someone has ADHD or not. A specialist can only diagnose ADHD after assessing a child thoroughly.
It's important for the specialist to do a detailed assessment of the child's behaviour. This will usually involve finding out about the child from his parent(s) and school.
What will the specialist ask parents?
You will be asked about the following things:
- your child's medical history, including any mental health problems
- any family history of ADHD and of mental health problems
- your child's development and temperament
- specific ADHD symptoms and when they started
- any other problems the child has
- your child's relationship with you (and your partner)
- any parenting problems, if present.
Sometimes parents will be asked to assess their child's behaviour using a rating scale, which is like a questionnaire to find out how severe someone's symptoms are.
What will the specialist want from your child's school?
With parental permission, the specialist will usually seek information from your child's teachers about:
- behaviour in class
- academic achievement
- relationships with other pupils
- response to discipline and authority.
The teachers will usually be asked to use rating scales to assess your child's behaviour.
What other things will the specialist look at?
The specialist will often ask about your child's history, especially older children, teenagers and adults. Sometimes your child may mention issues relevant to the assessment that you or your family don't know about.
The specialist will also want to examine your child, to find out whether there could be a physical disease causing his symptoms, or making them worse. The examination will also allow the specialist to assess the person's mental state and note down details she needs to know if prescribing medication. And it will help the specialist to decide if your child needs to be assessed in other ways, for example by a psychologist or hearing expert.
The specialist might also want to carry out 'psychometric' assessments, which are used to assess mental abilities. These tests might measure things such as your child's reading ability, IQ, or speech. There are also special tests to measure attention and impulsiveness.
If your child has another condition, such as dyspraxia (which affects co-ordination), learning disabilities, depression or autism, this can mask the symptoms of ADHD. So screening for other conditions is also part of the assessment process.
What rules does a specialist follow when diagnosing ADHD?
There are two special sets of criteria for doctors to follow when diagnosing someone with ADHD. These are called ICD-10 and DSM-IV-TR.
ICD-10
ICD-10 is a set of criteria from the World Health Organisation that is used to diagnose 'hyperkinetic disorder'. This is a narrower definition than ADHD.
DSM-IV
The DSM-IV-TR criteria is published by the American Psychiatric Association. It can be used to diagnose different types of ADHD, including hyperkinetic disorder, which is a severe type.
What are the differences?
Someone can be diagnosed with ADHD using DSM-IV when they have mainly symptoms of inattention.
But a person must show symptoms of inattention, impulsivity and hyperactivity to be diagnosed using ICD-10.
This means that a broader group of people will be diagnosed as having ADHD using DSM-IV than having hyperkinetic disorder using ICD-10.
DSM-IV is used more in the US and ICD-10 in the UK and Europe.
ICD-10 diagnoses fewer children with more severe symptoms, so using this set of criteria could mean children who would be diagnosed as having ADHD using DSM-IV don't get treatment.
On the other hand, some experts think that too many people might be diagnosed with ADHD using DSM-IV.
There isn't a straightforward way of deciding who has ADHD and who doesn't. Even though these sets of criteria are important when making a diagnosis, a specialist will still need to use her clinical judgement.
At what age is ADHD usually diagnosed?
Children are usually diagnosed with ADHD when they are at primary school (ages 5 to 11). Symptoms can be clearer when your child has started school, because the discipline and routine in the school environment makes ADHD symptoms stand out more.
It can be hard to diagnose pre-school children, because it's common for children aged between three and five to be very active, and often this behaviour isn't abnormal.
If a younger child is extremely hyperactive, this can often mean he has another condition affecting his development, such as autism.
Older children, teenagers and adults can also be diagnosed with ADHD.
What happens after diagnosis?
When someone has been diagnosed as having ADHD, the specialist will develop a treatment plan. Treatment may include medication, behavioural therapy, psychotherapy and educational approaches.
The specialist will assess your child's behaviour and work with you, your child and his teachers before treatment is started.
This may include giving a score for different aspects of the child's behaviour. The specialist can use this assessment as a starting point, or baseline, so that he can measure how much your child improves in the future.
The specialist will set targets for different aspects of your child's behaviour. This means your child can be scored after treatment has started, to measure how effective the treatment is. For example, your child's teachers may be asked to record how many times your child leaves his seat during a lesson.
The specialist will continue to monitor your child to assess:
- how effective the treatment is for your child's main symptoms
- the most suitable dose of medication and any side-effects
- how your child is getting on socially, emotionally, academically and in terms of self-esteem.
Once your child is being treated, you (and teachers) can use rating scales similar to those used during diagnosis. Rating scales can be a good way to assess how your child is responding to treatment.
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