Making the Diagnosis of ADHD

 

Mother and daughter signing consent form
Who makes the diagnosis?

Start by taking your child to see your family doctor or paediatrician. If you do not have a family doctor or paediatrician, consult with your local hospital or children's mental health agency.

In Canada and the United States, ADHD may be diagnosed by:

  • a clinical psychologist
  • a psychiatrist
  • a paediatrician
  • a neurologist
  • a family doctor

In other countries, ADHD may be diagnosed only by a paediatrician or a child psychiatrist.

What information does the doctor need to make the diagnosis?

The doctor will make a diagnosis by gathering as much information as possible.

Sources of information

The doctor will begin by taking your child's medical history and by doing a physical examination. She will ask your child some questions. She will then ask you and your child's teacher for information about:

  • your child's behaviour at home, at school, and in other situations
  • how long your child has had the symptoms
  • whether the symptoms cause problems for your child
  • your child's school work

Because it can be difficult to remember everything important when you are in the doctor’s office, it will help to write down your observations and bring them with you.

If your child spends time in other settings, such as daycare, clubs, or a religious institution, the doctor may ask for information from adults who know your child in those settings as well.

If your child has been to see another health care professional, the doctor may also ask for information from that person.

This information will help the doctor determine whether your child has ADHD or some other condition.


Symptoms of ADHD

Children with ADHD may have symptoms of inattention, hyperactivity/impulsivity, or both.

With inattention symptoms, the child may: 

  • often make careless mistakes or not pay attention to detail
  • be easily distracted
  • appear not to be listening
  • have difficulty concentrating
  • have trouble following instructions, getting organized, and starting or completing activities

With hyperactivity/impulsivity symptoms, the child may:

  • often fidget or seem constantly "on the go"
  • run around when it is not appropriate
  • become easily frustrated when asked to take turns
  • interrupt others
  • make a lot of noise

Every child may sometimes have one or two of these symptoms. For a diagnosis of ADHD, the child's symptoms need to be excessive, long-term, and pervasive:

  • Excessive: they occur more often than in other children of the same age and sex.
  • Long-term: they have continued for months and are not just a response to a temporary situation.
  • Pervasive: they occur in several different settings, not just in one specific place.

For a diagnosis of ADHD, the symptoms must also cause problems for the child at home, play, and school.


DSM-IV criteria for ADHD

The most widely used medical system for diagnosing ADHD is known as the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV). Its criteria for ADHD are:

  • evidence of at least six of nine symptoms of inattention and/or at least six of nine symptoms of hyperactivity/impulsivity 
  • symptoms are inappropriate for the child's age and stage of development
  • symptoms impair the child's functioning
  • symptoms appear in at least two areas of the child's life, such as at home, in the classroom, or in social settings
  • symptoms appear early in life, before age seven, and continue for at least six months

In Canada, the U.S.A., and many other countries, the child's pattern of behaviour is compared against these criteria to make a diagnosis of ADHD.

Will your child need to have a lot of tests?

Your child will probably not need to have a lot of tests, because there is no medical test that confirms ADHD. However, if the doctor suspects that something else is causing your child's symptoms, she may order some other tests.

What will the diagnosis include?

Elements of the diagnosis may include:

  • the subtype of ADHD, meaning whether your child has mostly inattentive symptoms, mostly hyperactive/impulsive symptoms, or both
  • whether your child has any associated conditions (comorbidities), such as a learning disability or a mood disorder

Will a diagnosis be made right away?

It will probably take two or three visits to the doctor to diagnose ADHD. The doctor will also need time to collect information from your child's teacher.

How can you make sure you understand the diagnosis?

It is important that you understand the diagnosis. If, after speaking with the doctor, you still do not understand, be sure to ask again. Do not be embarrassed. ADHD is complex and you will hear a lot of new information. It is your right to be informed, and it is essential that you are able to understand your child’s condition in order to make decisions about treatment.

Health care professionals are here to help. And if English is not your first language, the services of an interpreter can be arranged.

To make sure you understand the diagnosis fully, do not be afraid to ask questions. Some questions you could ask the doctor include:

  • What subtype of ADHD does my child have?
  • Does my child have any other conditions as well as ADHD?
  • How is ADHD affecting my child?
  • Where do we go from here?
  • What kind of treatment will my child need, and when?
  • Will you or another specialist provide the treatment?
  • Who else will be involved in my child’s care?
  • What can I do to help my child?
  • What should the school know?
  • What can teachers do to accommodate my child?
  • What problems should I watch for?
  • What does the future hold?

Each meeting with your child’s doctors and other medical professionals during diagnosis is important. You may find it overwhelming or confusing, which makes it harder to listen carefully. For these reasons, bring paper and a pen. Take notes to help you remember the new information you are learning and to write down questions as you think of them. You may also bring a relative or friend to take notes for you. Having information written down means you can reflect on it later.

You can also learn more about ADHD by doing research about it at the library, gathering brochures and books from support organizations, exploring this and other reputable web sites, and talking to other parents whose children also have ADHD.

What happens after the diagnosis of ADHD?

Once your child has been diagnosed with ADHD, treatment can begin. You, your child's doctor or psychologist, and the school will need to work together on a treatment plan. This plan may include medication, family counselling, and an education plan. For more information, please see the "Treatment" section of this site.

Peter Chaban, MA, MEd

Rosemary Tannock, PhD

3/20/2009


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