Many parents wonder if their child’s school and family struggles may be caused by ADHD. Attention Deficit Hyperactivity Disorder is a true medical condition occurring in 2-5% of the population. However, obtaining an accurate diagnosis is complicated due to its complex nature and many popular misunderstandings about it.
Even the term “ADD” is thrown around so loosely it has lost its meaning. A good evaluation should contain at least some aspect of the following 5 areas.
1. Thorough History:
This would include collecting data about the person’s past history and experiences. Minimally this should include: prenatal, developmental, early childhood and school ages. Anything significant in a person’s internal (medical, psychological) and external (family, environment) etc. should be taken into consideration.
2. Clinical Interview:
This should be completed by a qualified professional who is experienced in this area. An interview is important to get an actual feel for the person involved but, also to perform a clinical decision tree. That is, to rule out what it is not. A valid diagnosis is only possible when other causes and contributions can’t explain the current clinical picture. This means, it's not being caused by something else.
3. Subjective Ratings:
True Attention Deficit Hyperactivity Disorder is a condition that exists over time and across settings and therefore, should be observed by different people at different times. A Behavioral Rating scale is a way to ask someone what they see and think about the person in question. The more opportunity a rater has to observe and interact with someone who potentially may have Attention Deficit Hyperactivity Disorder, the more reliability they can rate them on certain measures. We are able to score these and compare them to a baseline, which gives us an idea of the probability someone has a true diagnosis.
4. Objective Testing:
Testing allows us to compare performance on measures of attention to a large base population of normal controls. Tests of attention use computers to measure many aspects of attention and see if they fit the profile of Attention Deficit Hyperactivity Disorder. These are increasingly reliable and an important part of the assessment process. The benefit, of this type of testing is it is more objective (i.e.: scientifically valid) than just the rating scales alone and allows for a precise measurement of attentional abilities.
A real time snippet of how the person is behaving in their real life situation can really be helpful. Observations can be reports (i.e.; school tallies of off task behaviors) or actual samples (i.e.: videos) of behaviors. This can really be useful to understand issues of behavior in certain environments.
In all, a good assessment is very important to really understand how to treat and improve functioning. Reliable and valid assessments minimize the risk of unnecessary treatments but, also maximize the chance that whatever interventions are selected are well informed and have the best chance of working.
- Timothy Re, Psy.D., CADC Ext. 317