I get many phone calls from parents who want ADHD testing for their child. Often, the child is doing poorly in school, displaying behavior problems, or is having difficulty with friendships. Sometimes, a teacher, friend, or relative has suggested the child may have ADHD. A sibling or parent might have recently been diagnosed with ADHD. So when is it a good idea to pursue an ADHD evaluation?
ADHD was the diagnosis of the day not long ago. It seemed that many children were diagnosed with ADHD and not always accurately. What is ADHD? It stands for Attention Deficit Hyperactivity Disorder. The lesser known diagnosis is ADD, which stands for Attention Deficit Disorder. The symptoms and diagnosis of ADHD/ADD are found in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5). There are several criteria that must be met for this diagnosis:
- The child must display “A persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development.”
- The child must have displayed several symptoms prior to the age of 12.
- Several of the symptoms must be displayed in 2 or more settings (home, school, daycare)
- The symptoms interfere with, or reduce the quality of, social, academic or occupational functioning.
- The symptoms are not a result of another mental disorder.
The difference between ADD and ADHD can be found in the first criteria. Children with symptoms only of inattention but without hyperactivity are those that may have ADD. When a child displays symptoms of inattention and hyperactivity, then the ADHD diagnosis is more accurate. ADD is often the disorder that is missed. These children tend to be quiet, spacy, and have difficulty paying attention to everyday tasks. If you give them a multi-step direction such as, “Go up to your room, get your shoes on, brush your teeth and come back down ready for school,” this type of child ends up in his/her room playing because s/he forgot everything past the first direction. The child with ADHD is more noticeable because the hyperactivity can get the child into troublesome situations and is often annoying and bothersome to teachers and peers.
It’s important to note the second criteria: symptoms must have occurred prior to age 12. This is not a diagnosis that rises up out of nowhere at age 15 or age 25. Often, parents and teachers have missed a child with ADD because the symptoms were mild or the child was bright enough that s/he was able to continue to get good grades in school despite the inattention. Thus, a teen or older person can receive an ADHD/ADD diagnosis but only if there was evidence that the problem started in childhood.
Criteria three is also important. A child must exhibit symptoms in more than one setting. A child who exhibits numerous behaviors at home but not at school has some other issue going on. Likewise, if your child is getting in trouble at school but you are not having issues at home, it’s time to look at what’s going on at school.
Criteria four is important in determining the severity of a child’s inattention and/or hyperactivity. ADHD/ADD is notable for its severity, even though the child may be considered mild, moderate, or severe in terms of his/her symptoms. This disorder truly hampers a child’s daily life. Parents and teachers are often frustrated with the child. The child, in turn, is really struggling with homework, organization, planning and friendships.
Finally, it’s important to note that attention issues are prevalent in many childhood mental disorders. For example, a child with an anxiety disorder can look inattentive because s/he is consumed by worry. With depression as well, a child may appear “checked out” due to the burden of depressive thoughts. These two examples are why it’s important to seek out a well-trained, experienced clinician (psychologist, psychiatrist, pediatrician) to diagnose your child.
In coming articles, I will discuss ways to treat ADHD as well as testing for other types of mental disorders and learning disabilities.
Eleanor Harrison is a psychologist at The Labyrinth Institute specializing in therapy and assessment for children and teens. You can reach her at 303-514-9780 or firstname.lastname@example.org.