How is my child assessed for ADHD?

I see this question get asked a lot! And I do my best to answer it as clearly as I can – whether that be to clients in our clinic, or parents on Facebook groups that I come across.

The truth is… there is no “test” for ADHD!

Some people are shocked when I say that – I mean for such a well-documented, medically accepted neurological disorder, how can we not have a test for it??

The answer to this is a little more complicated. ADHD all to do with the lack of availability of specific neurotransmitters in a particular area of the brain (namely noradrenaline and dopamine) that prevent signals or ‘messages’ from being relayed.

We simply don’t have the technology at the moment to measure this neurotransmitter availability (microscopic amounts in microscopic time!).

So instead, we look for the symptoms of ADHD – impulsivity, inattention and hyperactivity. But all children can display these symptoms you say? True. That is why the assessment for ADHD typically involves a comprehensive evaluation conduction by a qualified and experienced clinician (a paediatrician, psychiatrist or psychologist) that must suitably answer the following questions:

1. Are these ADHD symptoms excessive for the child’s age and gender?

2. Are these ADHD symptoms seen in multiple environments?

3. Could the symptoms observed be explained by anything else??

MOST importantly number three often gets overlooked. When psychologists hand you those ‘checklist forms’ asking you to rate your child’s distractibility and fidgeting, it is only looking at symptoms, not causes.

There are so many other causes that could be responsible for a child being inattentive, impulsive and hyperactive! For example, sleep disorders, learning disorders, giftedness, anxiety, parenting / family dynamics, trauma history, medical conditions and personality features just to name a few!

So where does that leave us??

Once we have established that your child is displaying features of ADHD that appear to be excessive for their age and gender, are present in multiple environments and are impacting on their functioning (for example, their school grades are slipping, or it is causing conflict in maintaining social relationships) then it is a journey of trying to RULE OUT other causes that may have not been considered.

And when other things have been looked at, accounted for and ruled out… we can say with a high certainty that your child’s difficulties are caused by the presence of ADHD!

So when you attend a medical professional for a ADHD assessment, the process can (and should!) be highly individualised and may differ from child to child.

The assessment should ALWAYS include really comprehensive clinical interview with the parents / caregivers to gather information about the child’s developmental history, symptoms and behaviours. They should also be enquiring about the child’s medical history, family history, current sleep functioning, social relationships, school performance and any other relevant factors so that they get a “whole” picture of the child.

After this, and experienced clinician MAY or MAY NOT use a variety of methods to investigate, address and rule out other causes such as:

Parent and Teacher Rating Scales: Rating scales are commonly used to assess ADHD symptoms only. Parents and teachers are asked to complete these scales to provide information on the child's behaviour in different settings.
Behaviour Observation: Direct observation of the child's behaviour in various settings, such as home and school, may be conducted to assess their attention, impulsivity, and hyperactivity levels.
Psychometric Testing: The healthcare professional may administer standardised psychological tests to assess the child's cognitive abilities, academic skills, and emotional functioning. These tests can help identify any co-existing conditions or learning difficulties that may be contributing to the symptoms. OR in fact be an alternative diagnosis to ADHD that had not been previously addressed.
Medical Evaluation: A physical examination may be conducted to rule out any underlying medical conditions that could be causing or contributing to the symptoms. The healthcare professional may also review the child's medical records and request any necessary laboratory tests.
Collaboration with School: The healthcare professional may request information from the child's school, such as academic records and teacher observations, , to gain a comprehensive understanding of the child's functioning in an educational setting.
Additional Assessments: In some cases, additional assessments may be conducted to evaluate other factors, such as executive functioning, social skills, or emotional well-being. These assessments can provide a more comprehensive picture of the child's strengths and weaknesses.

So, you see in the right experienced clinicians’ hands, the path to diagnosis could be very quick and straightforward OR could be quite comprehensive and investigative. Make sure your medical professional is individualising their approach, and assessing the whole picture – not just fishing and looking for ADHD symptoms to tick off a box!