Attention-Deficit/Hyperactivity Disorder (ADHD) is a common neurodevelopmental disorder most often first presenting in childhood. It is characterized by symptoms such as difficulty maintaining focus; struggling to complete work or follow through with instructions; wandering off task; disorganization; excessive motor activity (fidgetiness, tapping, talking); interrupting; difficulty delaying gratification; and acting in an unsafe manner.
While this is not an exhaustive list, you get the idea. Impacts can be significant, and affect family relationships, school performance, peer relationships, and sports or other activities. Diagnosis is based on criteria found in the Diagnostic and Statistical Manual, Fifth Edition, Text Revision (DSM-5-TR). ADHD has three primary types of presentation – inattentive, hyperactive/ impulsive, or combined. According to the DSM-5-TR, worldwide prevalence of the disorder is about 7.2 percent in children – though, cross-nationally, prevalence ranges from 0.1 percent to 10.2 percent.
Diagnosing ADHD
Symptoms in very young children can be difficult to distinguish relative to normal development. Symptoms need to be in evidence prior to the age of 12 years. Having said this, there can be a masking of symptoms and/or overcompensation for them, especially those less obvious ones such as the inattentive symptoms. There are a list of nine symptoms in each of the inattentive and hyperactive/impulsive categories, of which six need to be in evidence for diagnosis. The symptoms must be of sufficient severity to impact functioning across contexts before a diagnosis can be made.
Many of the symptoms that characterize ADHD are also characteristic of other disorders. With overlapping symptoms, diagnosis can be a complicated process. This is why a comprehensive and thorough course of assessment is required. While research is ongoing, there are currently no biological tests, x-rays, or brain scans to detect ADHD for diagnostic purposes. Instead, ADHD is diagnosed based on observations, clinical interviews, and ruling out other disorders and/or potential factors that may explain the behaviors being seen. Diagnosis guides treatment and intervention, so accuracy is important.
It’s important to ensure that a comprehensive course of evaluation occurs before any choices that would impact your child are made. While many people may initially reach out to their doctor, this is just one step in the exploration process. A thorough assessment takes several hours, which includes gathering and analyzing information from multiple sources. Many doctors don’t have the time or resources to do this.
Psychoeducational assessments
A psychoeducational assessment provides a thorough examination of the aspects that can help explain problems. Psychologists with expertise in school psychology and child development complete these assessments. An initial consultation to gather background and historical information begins the process. From there, standardized testing with the child to gain a sense of functioning is undertaken.
Information related to cognitive abilities, academic performance, memory and learning capacity, processing speed and motor capacity, executive functioning skill, and understanding social/emotional/behavioral functioning from multiple perspectives will be gathered. This information helps us to understand many different things. For example, if there are any underlying learning disorders interfering with ability; if there are cognitive factors that would explain the symptoms; how the individual’s memory is functioning; how the individual is presenting in different environments and with what specific symptoms; if there are historical or physiological factors that might be contributing to problems; and, if the symptoms presenting are better explained by anxiety, depression, or some other disorder.
Sometimes, a continuous performance computer task is performed to check for inattention and/or impulsivity. One way to gather information from other sources (parents, teachers, child) is to have checklists completed. At times, further information from teachers is required through an interview. At other times, observations outside of the testing environment might be informative.
Once all of the information is gathered, a report is written that provides any diagnoses, along with suggestions for ongoing support. A follow-up meeting is held to support parents in understanding their child’s functioning (strengths and weaknesses) along with next steps for support. The entire process can take between 14 to 20 hours.
Through the course of a psychoeducational assessment, additional areas for exploration may be uncovered. Some common signs seen that would require additional exploration are signs of an auditory processing problem, hearing problem, difficulties with visual perception or tracking, sensory difficulties, slower processing speed, and/or some kind of motor interference. While each of these areas could also explain some of the symptoms that led to the request for assessment of ADHD, they are distinct areas for further exploration with the appropriate professionals. As already mentioned, many symptoms overlap and ADHD can co-exist along with other disorders.
After diagnosis
Treatment for ADHD is multi-faceted. Best practice for intervention is a combination of behavioral, environmental, and medical supports. What this means is that after a comprehensive assessment has been completed, involving other professionals including the doctor, teacher, and potentially an occupational or behavioral therapist will be important to ensure your child is being supported. This may involve medications if appropriate, classroom accommodations, and being taught skills to help them navigate their world more easily.
While it may seem like a daunting process, it’s helpful to know that a comprehensive evaluation can be a significant factor in your child’s success and happiness regardless of outcomes. Knowing what your child is dealing with, and understanding symptom presentation is necessary to lead the intervention that is going to be the most meaningful and supportive over the course of your child’s schooling and life.
Nicole is a registered psychologist in the province of Alberta. She has been working with children and families for over 30 years in various capacities. Nicole holds a permanent teaching certificate and has an understanding of classroom functioning. Nicole is passionate about supporting children and families in achieving success and dignity in their lives through assessment, intervention, and collaborative approaches. Learn more at sheldonpsychology.com.
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