Some parents see signs of inattention,
hyperactivity, and impulsivity in their toddler long before the child enters
school. The child may lose interest in playing a game or watching a TV show, or
may run around completely out of control. But because children mature at
different rates and are very different in personality, temperament, and energy
levels, it's useful to get an expert's opinion of whether the behavior is
appropriate for the child's age. Parents can ask their child's pediatrician, or
a child psychologist or psychiatrist, to assess whether their toddler has an
attention deficit hyperactivity disorder or is, more likely at this age, just
immature or unusually exuberant.
ADHD may be suspected by a parent or caretaker or may go unnoticed until the
child runs into problems at school. Given that ADHD tends to affect functioning
most strongly in school, sometimes the teacher is the first to recognize that a
child is hyperactive or inattentive and may point it out to the parents and/or
consult with the school psychologist. Because teachers work with many children,
they come to know how "average" children behave in learning situations that
require attention and self-control. However, teachers sometimes fail to notice
the needs of children who may be more inattentive and passive yet who are quiet
and cooperative, such as those with the predominantly inattentive form of ADHD.
Professionals Who Make the Diagnosis.
If ADHD is suspected, to whom can the family turn? What kinds of specialists do
they need?
Ideally, the diagnosis should be made by a professional in your area with
training in ADHD or in the diagnosis of mental disorders. Child psychiatrists
and psychologists, developmental/behavioral pediatricians, or behavioral
neurologists are those most often trained in differential diagnosis. Clinical
social workers may also have such training.
The family can start by talking with the child's pediatrician or their family
doctor. Some pediatricians may do the assessment themselves, but often they
refer the family to an appropriate mental health specialist they know and trust.
In addition, state and local agencies that serve families and children, as well
as some of the volunteer organizations listed at the end of this document, can
help identify appropriate specialists.
Specialty Can Diagnose ADHD Can prescribe medication, if needed Provides
counseling or training
Psychiatrists yes yes yes
Psychologists yes no yes
Pediatricians or Family Physicians yes yes no
Neurologists yes yes no
Clinical Social workers yes no yes
Knowing the differences in qualifications and services can help the family
choose someone who can best meet their needs. There are several types of
specialists qualified to diagnose and treat ADHD. Child psychiatrists are
doctors who specialize in diagnosing and treating childhood mental and
behavioral disorders. A psychiatrist can provide therapy and prescribe any
needed medications. Child psychologists are also qualified to diagnose and treat
ADHD. They can provide therapy for the child and help the family develop ways to
deal with the disorder. But psychologists are not medical doctors and must rely
on the child's physician to do medical exams and prescribe medication.
Neurologists, doctors who work with disorders of the brain and nervous system,
can also diagnose ADHD and prescribe medicines. But unlike psychiatrists and
psychologists, neurologists usually do not provide therapy for the emotional
aspects of the disorder.
Within each specialty, individual doctors and mental health professionals differ
in their experiences with ADHD. So in selecting a specialist, it's important to
find someone with specific training and experience in diagnosing and treating
the disorder.
Whatever the specialist's expertise, his or her first task is to gather
information that will rule out other possible reasons for the child's behavior.
Among possible causes of ADHD-like behavior are the following:
A sudden change in the child's life—the death of a parent or grandparent;
parents' divorce; a parent's job loss
Undetected seizures, such as in petit mal or temporal lobe seizures
A middle ear infection that causes intermittent hearing problems
Medical disorders that may affect brain functioning
Underachievement caused by learning disability
Anxiety or depression.
Ideally, in ruling out other causes, the specialist checks the child's school
and medical records. There may be a school record of hearing or vision problems,
since most schools automatically screen for these. The specialist tries to
determine whether the home and classroom environments are unusually stressful or
chaotic, and how the child's parents and teachers deal with the child.
Next the specialist gathers information on the child's ongoing behavior in order
to compare these behaviors to the symptoms and diagnostic criteria listed in the
DSM-IV-TR. This also involves talking with the child and, if possible, observing
the child in class and other settings.
The child's teachers, past and present, are asked to rate their observations of
the child's behavior on standardized evaluation forms, known as behavior rating
scales, to compare the child's behavior to that of other children the same age.
While rating scales might seem overly subjective, teachers often get to know so
many children that their judgment of how a child compares to others is usually a
reliable and valid measure.
The specialist interviews the child's teachers and parents, and may contact
other people who know the child well, such as coaches or baby-sitters. Parents
are asked to describe their child's behavior in a variety of situations. They
may also fill out a rating scale to indicate how severe and frequent the
behaviors seem to be.
In most cases, the child will be evaluated for social adjustment and mental
health. Tests of intelligence and learning achievement may be given to see if
the child has a learning disability and whether the disability is in one or more
subjects.
In looking at the results of these various sources of information, the
specialist pays special attention to the child's behavior during situations that
are the most demanding of self-control, as well as noisy or unstructured
situations such as parties, or during tasks that require sustained attention,
like reading, working math problems, or playing a board game. Behavior during
free play or while getting individual attention is given less importance in the
evaluation. In such situations, most children with ADHD are able to control
their behavior and perform better than in more restrictive situations.
The specialist then pieces together a profile of the child's behavior. Which
ADHD-like behaviors listed in the most recent DSM does the child show? How
often? In what situations? How long has the child been doing them? How old was
the child when the problem started? Are the behavior problems relatively chronic
or enduring or are they periodic in nature? Are the behaviors seriously
interfering with the child's friendships, school activities, home life, or
participation in community activities? Does the child have any other related
problems? The answers to these questions help identify whether the child's
hyperactivity, impulsivity, and inattention are significant and long-standing.
If so, the child may be diagnosed with ADHD.
A correct diagnosis often resolves confusion about the reasons for the child's
problems that lets parents and child move forward in their lives with more
accurate information on what is wrong and what can be done to help. Once the
disorder is diagnosed, the child and family can begin to receive whatever
combination of educational, medical, and emotional help they need. This may
include providing recommendations to school staff, seeking out a more
appropriate classroom setting, selecting the right medication, and helping
parents to manage their child's behavior.
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