In recent years, there has been significant debate about whether ADHD is over- diagnosed. Studies indicate that over-diagnosis of ADHD occurs more often in children and adolescents, especially those with milder symptoms. And misdiagnosis or over-diagnosis leads to unnecessary treatments, specifically, the prescription of stimulant medication. Therefore, it is important not only to get accurate diagnoses, but it’s equally important to identify other factors that might be affecting behavioral and emotional functioning.
While there is disagreement over what a good evaluation involves, my twenty years of experience have taught me that the approach to diagnosis must be comprehensive and holistic. For me, this means that I conduct thorough clinical interviews with clients and their parents and collect a full developmental history. Only then do I administer tests that assess cognitive ability, executive functioning, and emotional and behavioral functioning.
Diagnosing ADHD is challenging because it’s not a yes or no question. It’s also a question of what other factors affect functioning, or if a patient doesn’t have ADHD, then what is the root cause of the challenges that made them seek a diagnosis.
If you or someone you know is pursuing a formal diagnosis, a good evaluation should include:
A thorough clinical interview to gather developmental history, educational background, and information regarding social history, family history, physical and mental health, and occupational history if applicable.
Performance based tests that assess cognitive functioning, attention and executive functioning, and psychological functioning. This process allows the psychologist to gather behavioral observations, as well as to assess strengths and weaknesses.
Behavioral rating scales that asses symptoms, completed by the person being diagnosed and by family members or partners. Getting a perspective beyond the person's self-report is an important aspect of the evaluation.
The results should be communicated in writing and should summarize all aspects of the evaluation. This should be accompanied or followed up by a session with the therapist where the results are presented verbally and the person has opportunities to ask questions.
Although it may be possible to diagnose ADHD using shorter methods, a more comprehensive approach provides greater confidence that the sources of challenges have been accurately identified and that interventions will be appropriate and effective. For example, if only a computerized test for attention is given, this does not provide a complete picture of the individual’s cognitive functioning. If rating scales are used, but there is no assessment of cognitive functioning, the psychologist only has the person's self-report of their symptoms without behavioral observations or collateral data.
After the evaluation is completed, the assessor should help identify next steps. One step may be a consultation regarding medication to address ADHD symptoms, but that should not be the only recommendation. The treatment plan should also include resources and strategies to improve functioning and manage emotional symptoms. Essentially, the client should be given a roadmap to understand how to navigate life with ADHD or other diagnoses.
This blog was originally posted on psychologytoday.com.
Photo by Jakub Żerdzicki on Unsplash