Rebecca S. Blakeman, PhD
Licensed Psychologist

There is much controversy about the diagnoses of ADHD these days.  While some skeptics argue that ADHD does not exist (or that it is a parenting problem), research actually supports the existence of a neurological condition that results in excessive impulsivity, distractibility and inattention.  That is not to say, however, that every child who exhibits the symptoms of ADHD actually has ADHD.  Before a parent makes a decision about how to treat their child’s ADHD-like behaviors, it is imperative that they understand various approaches to diagnosing ADHD, and the strengths and weaknesses of each approach.

The “minimalist” approach to diagnosing ADHD involves parents completing a thorough interview with a physician or psychologist or psychiatrist, as well as parents and teachers completing behavior questionnaires.  The purpose of the interview is to understand what problem behaviors the child exhibits, the history of those behaviors, and what things might be causing those behaviors.  The questionnaires are designed to give the provider information about the types of behaviors a child exhibits at home and at school.  Some questionnaires are focused only on ADHD symptoms, while other questionnaires also assess behaviors that might be related to depression, anxiety and other difficulties.  This is considered the bare minimum that must be done before a diagnosis of ADHD is made.  This can be a relatively quick and inexpensive process.  However, it may be an incomplete or misleading assessment in many ways.

There are many reasons why a child might exhibit ADHD-like behaviors.  For example, children who are anxious or depressed, have language disorders or learning disabilities, have an unrecognized sleep disorder, or who have ADHD all may be easily distracted, have trouble concentrating, make careless mistakes, not follow directions, and avoid mental work.  A questionnaire will not differentiate which of these problems may be causing the child’s ADHD-like behaviors.  If the actual cause of the behaviors is not known, parents and doctors may choose treatment strategies that are ineffective or inappropriate.  While a thorough interview can sometimes provide more insight into why a child is exhibiting ADHD-like behaviors, an interview cannot determine whether a child has a learning disability or some other cognitive processing problem that could explain the problematic behaviors.  Assessing for a learning disability is particularly important, as children with ADHD are more likely to have learning disabilities.

A comprehensive approach to ADHD assessment involves a thorough clinical interview, multiple questionnaires completed by parents, teachers, and the child (depending on age), as well as testing to determine if a child has cognitive processing weaknesses, learning disabilities, or impairments in neurocognitive skills that are often related to ADHD.  This type of evaluation can more thoroughly answer the question of why a child is exhibiting ADHD-like behaviors, which allows for more accurate selection of treatment strategies.  The major drawback to this type of evaluation is that it can be expensive.

Having your child assessed for ADHD and choosing the best treatment requires parents to be well educated and involved in the process.