Attention Deficit Hyperactivity Disorder, or ADHD, is one of the most common mental health disorders in children. The core symptoms of ADHD are in areas of attention, impulsivity, and hyperactivity. As a physician, I often have parents coming into my office with concerns that their child may have ADHD. Sometimes a child’s teacher may bring forward these concerns to parents if symptoms are present in the classroom.
Almost all children have times when their behaviour is out of character and seems out of control. They seem like they are moving constantly and crashing about, talking non-stop, and refusing to wait their turn. Other times, they may seem like they are daydreaming. The difference between this and ADHD is that these behaviours occur often enough to interfere with daily life.
How Does A Doctor Assess for ADHD
There are two main categories of symptoms in children with ADHD:
- Difficulties with attention: easily distracted, careless, forgetful
- Difficulties with hyperactivity and impulsivity: talks too much, cannot stay seated, cannot play quietly, acts and speaks without thinking, trouble taking turns
Sometimes features of inattention, hyperactivity or impulsivity may be normal. In order for your physician to evaluate if your child does have ADHD, there are many things that must be considered. This must include a thorough medical assessment and developmental history. There must also be an evaluation of your child’s educational, psychological and social development.
Symptoms of ADHD are not always observable by your doctor when you take your child to their doctor’s appointment. Collateral information needs to be collected from people that observe your child often in their natural setting. This can include parents, grandparents, teachers, daycare workers, or nannies. This can be done with questionnaires, self-reporting symptom scales, and one-on-one tests performed by a psychologist.
Screening for ADHD
Symptoms of ADHD need to be present in two or more settings. This means that the symptoms must be present at home AND at school, or elsewhere. To screen for ADHD, doctors will give parents a questionnaire to be completed at home and other questionnaires that other family members, caregivers, or teachers can complete. It is most helpful if the second person that fills out the questionnaire is a teacher or caregiver who is often with your child when they are outside of the home.
As children get older, they may be able to convey what symptoms are causing them challenges in life. Your doctor might give them a self-rating scale to fill out to evaluate the presence of ADHD symptoms. If needed, there are also evaluations that mental health care professionals can perform to observe your child’s symptoms first-hand.
The additional input from teachers and caregivers give doctors valuable information to help them make an informed diagnosis of ADHD.
ADHD is not identified just through questionnaires. Diagnosing ADHD is not a matter of simply recognizing certain symptoms. A thorough medical evaluation is necessary to rule out other possible causes for your child’s symptoms. Proper diagnosis of ADHD takes time, and requires that the child meet specific diagnostic criteria by a health care professional.
Subcommittee on Attention-Deficit/Hyperactivity Disorder, Steering Committee on Quality Improvement and Management, Wolraich M, et al. ADHD: clinical practice guideline for the diagnosis, evaluation, and treatment of attention-deficit/hyperactivity disorder in children and adolescents. Pediatrics 2011; 128:1007.