Stay tuned for more in this series about ADHD and common treatments. In this post, we will explore what ADHD is, how it is diagnosed, and if it is over-diagnosed.
What is ADHD?
Attention-Deficit/Hyperactivity Disorder, also known as ADHD, is a constellation of differences in thinking and behavior that affects an individual’s ability to regulate their focus, listen or attend to directions or instructions, organize, and/or regulate their behavior in expected ways. The disorder is thought to be brain-based, meaning that certain pathways or parts of the brain are thought to play an important role in ADHD, though the way the diagnosis is typically made is based largely on behavioral observations (i.e., is the child displaying X behaviors across multiple environments?). ADHD symptoms are generally seen in childhood, though some children and adolescents find ways to compensate or hide their challenges.
Who can make a diagnosis of ADHD?
A diagnosis of ADHD can be made by medical professionals such as pediatricians, developmental pediatricians, and psychiatrists, as well as qualified mental health professionals such as psychologists and neuropsychologists.
What are the symptoms of ADHD?
Symptoms of ADHD are usually divided into 2 categories: inattentive symptoms and hyperactive-impulsive symptoms. Some kids have a mixture of both symptoms whereas some kids may exhibit symptoms primarily from one category. Moreover, ADHD is really about regulating focus. So, kids with ADHD can be strongly focused on areas of interest (e.g., they can play video games for hours at a time), whereas they can struggle to focus on tasks that are less interesting or more boring (e.g., homework, chores).
Inattention. Symptoms of inattention include difficulty with focus or concentration, attention to detail, organization, forgetfulness, getting started on tasks, and following through on instructions and directions (individuals with this profile were formally labeled as "ADD").
Hyperactivity/Impulsivity. Symptoms of hyperactivity/impulsivity include difficulty sitting still, fidgeting, interrupting, talkativeness, difficulty waiting for a turn, and constant movement or noise.
How do you test for ADHD?
There is no one test for ADHD. Often, a diagnosis of ADHD is made based on behavioral reports across multiple settings (home, school, clinical settings), which is why a pediatrician may have you and your child’s teacher fill out behavioral rating scales. The key here is that the professional is gathering data across multiple raters (e.g., parents, teachers, the student) and is using a standardized way to do this (e.g., through rating scales such as the BASC-3, Conners-4, CAARS, or Vanderbilt).
More comprehensive psychological evaluations (i.e., “testing”) can be particularly helpful in cases where there are other learning differences suspected (e.g., Dyslexia), where the case is subtle or the child is compensating well for their challenges, or where concerns regarding attention and focus may also be related to a mood disorder, such as anxiety or depression. A comprehensive evaluation can also help inform more thorough treatment recommendations, such as educational accommodations or therapeutic interventions.
Why is a diagnosis of ADHD helpful?
Symptoms of ADHD can affect a child’s learning. When children struggle to regulate or maintain their focus in the classroom, they may miss directions or educational instruction. Moreover, children with ADHD tend to struggle with organizational skills, such as keeping track of assignments, belongings, or materials needed for assignments, breaking a larger task down into smaller components, planning how a task will get done, and time management. These difficulties may cause children and adolescents to dislike school or to have a more negative view of themselves as a learner. A diagnosis of ADHD can help inform interventions that may be helpful both within and outside of the school setting, with the hope of preserving the child’s love for learning and positive identity of themselves as a student. For many students with ADHD, they are aware of their struggles, and when we can help shape the narrative within the context of a brain-based learning difference, we can hopefully reduce feelings of shame or self-doubt.
What do I do if I want to move forward with testing for ADHD?
Bring your concerns up to your pediatrician, and see if they feel comfortable administering rating scales. If more clarity is needed, or if there are other factors that may potentially be impacting your child’s attention and focus, a more comprehensive evaluation may be warranted.
Is ADHD over diagnosed?
I get this question a lot! As a whole, the answer is no, ADHD is not over diagnosed. It can be misdiagnosed (e.g., someone is incorrectly identified as having ADHD when they really do not) and missed (e.g., someone with ADHD is not identified as having ADHD), but these factors do not contribute to an over diagnosis. In general, public perception of increases in diagnosis are largely due to advances in our clinical understanding of how ADHD presents and to the need for using diagnoses to open up access to treatment services. For example, in recent years our understanding of how ADHD presents in girls and women has grown, resulting in more girls and women being diagnosed. Moreover, in the last few decades, more treatment and intervention services have become available for people with ADHD (including educational accommodations), making it important for ADHD to be accurately identified.
Understood.org gives a good overview of ADHD and has some helpful videos: https://www.understood.org/en/articles/what-is-adhd
Dr. Danielle Mohr is a licensed psychologist at Wolff Child Psychology. She specializes in comprehensive evaluations for children, teens, and young adults, and she conducts regular individual and family therapy sessions.
Wolff Child Psychology is a team of licensed psychologists and neuropsychologists, psychology trainees, and academic and behavioral coaches that provide a range of psychological, behavioral, and academic services
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