All children love to be active and play with other children. In school, many of them are impatient, restless and still want to be active. A few will act out, lack focus or attentiveness, or exhibit some behavioral issues. Some of these children will be diagnosed with ADHD.
What constitutes a diagnosis of ADHD? How is it measured? And what does it mean for the future of the child diagnosed? This article addresses these questions.
What constitutes a diagnosis of ADHD?
For children 4 to 18 years old, the diagnosis of ADHD will be made by a pediatrician using the guidelines from the American Academy of Pediatrics (AAP).
Healthcare physicians also use the guidelines in the American Psychiatric Association’s Diagnostic and Statistical Manual, Fifth edition (DSM-5) to help diagnose ADHD.
The diagnosis involves several steps and includes gathering information from several sources including the child, parent and school.
The guidelines cover three areas of behavior: inattention, hyperactivity and impulsivity. If your child has been diagnosed with ADHD, then he or she would have demonstrated several of the behaviors listed in the guidelines.
Inattentive behaviors include being distracted, daydreaming, and lack of follow-through, forgetting things, and not following instructions.
Hyperactivity includes inability to stay seated, talking too much, inability to play quietly and running and jumping when not permitted.
Impulsivity includes frequently acting or speaking without thinking, having trouble taking turns or waiting for things, and interrupting others.
These are some of the 20 behaviors listed in the guidelines. A pediatrician will normally gather information from you, your child’s teacher and other people who spend time with your child, like coaches, caregivers or child care workers.
For a diagnosis of ADHD, here are some of the guidelines followed:
- For a child 4 to 17 years old, 6 or more symptoms occur
- For a child 17 or older, 5 or more symptoms occur
- There is some impairment in the child’s ability to perform homework, schoolwork, relationships, or work as part of a team
- Symptoms occur in at least two different settings (home, school, etc.)
- Symptoms have lasted at least six months
In addition to identifying these behaviors, your pediatrician probably also did a physical and neurological examination and did a work-up of your child’s medical history.
Standardized tests are used to help diagnose and measure ADHD
In addition to medical examination and history, standard tests are also used to develop a diagnosis of ADHD. For many years, ADHD rating scales have helped evaluate symptoms. These tests are actually questionnaires filled out by the child, parents, teachers, doctors and/or other caregivers.
For children 6 to 18, there are four commonly used tests:
- Child Behavior Checklist (CBCL)
- Swanson, Nolan, and Pelham-IV Questionnaire (SNAP-IV)
- Conners Comprehensive Behavior Rating Scale (CBRS)
- NICHQ Vanderbilt Assessment Scale Diagnostic Rating Scale
Questions are used to measure the extent of activities like fidgeting, excessive talking, interrupting others, or impulsive behaviors. Rating scales measure the severity of behaviors like hyperactivity, avoidance, and memory deficiency.
The CBCL screens children for emotional, behavioral and social problems. The SNAP-IV test asks about classroom performance among other things. The NCHQ scale provides separate forms for parents and teachers. Parents are asked about behavioral problems, and teachers are asked about learning disabilities.
The Conners test helps determine whether a child qualifies for inclusion or exclusion in special education. It also looks at intervention and helps outline possible treatment.
The Centers for Disease Control also has a list of symptoms similar to those of the AAP that could indicate possible ADHD.
Scores on the questionnaires indicate potential ADHD. For example, to meet the DSM-5 criteria, a child would have to score 2 or 3 (out of a possible 9) on the questions for hyperactivity or inattention.
Similarly, a child would have to score a 5 on any single behavior question or score 4 on any two questions.
Consider Gifted Testing
Gifted children often exhibit behaviors that are very similar to ADHD. Children who are gifted may appear restless, inattentive, impulsive and energetic, signs commonly confused for ADHD. It is highly important for parents to consider gifted testing when working towards a diagnosis.
Many gifted children are misdiagnosed and prevented from reaching their full academic potential. Once a student is identified as gifted, parents should consider gifted programs, or a school for gifted children. Gifted programs are designed to support and nourish gifted children’s intellectual abilities and emotional behaviors.
A diagnosis of ADHD means your child needs a plan to manage the challenges he or she will face in the coming years. While you may be somewhat saddened by the diagnosis, the disorder is very manageable.
Standard treatments for ADHD usually involve medical examinations and some kind of counseling and therapy as well as education and often, medication.
A medical consultation should involve a discussion of family history, child allergies or other health issues prior to prescribing and medication. The history analysis would look for events related to possible ADHD, like irregular sleep patterns, thyroid problems, anxiety or depression.
Hearing and vision tests should be part of the overall check-up. And you should ask for a scan known as the Neuropsychiatric ECG-Based Assessment Aid (NEBA) System. It is a non-invasive scan, FDA-approved, that evaluates certain brain waves known to be associated with ADHD.
Stimulant drugs are often recommended, like Ritalin or Adderall to balance chemicals in the brain. You as a parent should become familiar with the purpose and use of these drugs as well as side effects like altered eating patterns,
There are non-prescription treatments as well, including behavior therapy and coaching, and involves family, friends, and healthcare professionals
ADHD diagnosis needs parental planning for the future
As a parent of an ADHD child, you need to be aware of many things and have a plan that covers them. Your child needs to have had a good medical exam and have a doctor that understands ADHD and can prescribe the right treatment including any needed medications.
You need to know how the medications will affect your child. Sometimes eating schedules will be different than for other family members. Energy levels can vary with associated mood changes. Being aware of these fluctuations will allow you to be more supportive and understanding.
You should educate your child’s teachers and school officials to make sure they understand behavioral issues and treatment and can have an education plan in place that is individually designed for your child.
You should do what you can to improve your child’s self-esteem and confidence. You can try to provide a good environment for home study. And you can provide opportunities for non-threatening socializing with family and friends.
You can set realistic goals for improved behavior and performance and monitor progress toward those goals.
And another important thing to think of is safety. You want to protect your child from physical harm, and you should be mindful of dangers like traffic, firearms, swimming pools, tools, drugs and chemicals.
With a good plan in place and a team of care givers to help execute it, you will give your child the best possible outcomes in growing into the healthy adult he or she will be.