Identification and Diagnosis
To date, many children and adults with ADHD are diagnosed by physicians. Some are diagnosed by psychologists or counselors. Training in specific diagnostic procedures is not well controlled and practices vary considerably.
The predominant practice at this time—whether a diagnosis is prepared by a physician, psychologist, or counselor—is to conduct an interview with parents and/or the individual and collect behavior checklists from at least two sources—typically parents, caseworkers, coworkers, and/or teachers. Many clinicians assess adults based on current symptoms without investigating childhood behavior. Both of these practices are regarded as insufficient for establishing a valid diagnosis of ADHD.
Among persons who can demonstrate their expertise in this area, the following sets of criteria do represent a relative consensus:
- Complete physical examination and examination for sleep disorder.
- Detailed behavioral descriptions from early childhood to the present. These are collected in face-to-face interviews, by observation, and via standardized behavior checklists designed to measure executive functions (See Resources listed below).
- Psychological screening for co-morbid or other conditions that may mimic ADHD—including but not limited to learning disorders, depression, anxiety, and Autism Spectrum Disorders, Central Auditory Processing Disorder (CAPD). Physical screening is essential for addressing possible information processing disorders that appear behaviorally as ADHD.
- Assessment of intelligence and achievement are required to rule out learning disability, and intellectual assessment will establish whether low ability and/or certain other information processing deficits may account for behavior.
- Neuropsychological assessment is useful for identifying impairments in executive functioning and complex attention systems. However, in Minnesota there are few people fully trained in this discipline.
Behavioral Rating Scales
There are many behavioral rating scales used in diagnosing ADHD. Keep in mind that symptoms observed in adolescence and adulthood must have been obvious to others by age twelve under current diagnostic guidelines.
Conditions That May Mimic ADHD
Information Processing Disorders
These arise from impairments in the brain’s ability to interpret incoming stimuli and make efficient mental associations between sensory data and stored information. Symptoms associated with common disorders include:
Working Memory Deficit
- Difficulty following oral instructions
- Reduced carryover from one lesson to the next; needs rehearsal
- May be a slow reader
- Low reading comprehension and retention
- Learns better in smaller increments
Central Auditory Processing Disorder
- Poor “listening” skills—does not always receive information accurately
- Difficulty hearing in a noisy environment – seeks quiet place
- Difficulty following oral instructions – asks for repetition
- Difficulty acquiring a foreign language
- May have poor reading comprehension and spelling
- May lack organization and planning skills
- Frustrated in a classroom setting; restless
- Favors hands-on approach to learning
Slow Processing Speed
- Low academic fluency
- Poor reading rate and comprehension
- Needs to slow down to perform accurately
- Impulsiveness due to impatience with slow processing speed
- Dreads timed tests and deadlines; may become anxious
- Prefers to learn one step at a time
Anxiety or Depression
- Concentration difficulties
- Low frustration