Here is the process that we believe makes for a good diagnostic evaluation to see if someone has ADHD or not:
When you get an evaluation for attention deficit hyperactivity disorder, there should be a good parent interview. It's absolutely essential that somebody sits down with the parents and spends 45 minutes to an hour with them.
In this interview the psychologist or therapist needs to find out what's going on now, why did the parents pick up the phone and call now instead of last week, and so on. Was there a recent trigger event? A recent trauma? A recent loss? Or is there a problem at school, or a threat from the teacher? What is happening that you had to call for help?
A good developmental history must also be taken. Important questions are:
Head injuries and seizures can look just like attention deficit hyperactivity disorder, but aren't. They may require different treatment options.
The family trees of Attention Deficit Disorder kids are often very similar. It seems that about 80 percent of the time one can trace the impact of this gene, either the "ADHD" gene or the "Tourettes" gene, as it runs through families causing things like obsessive-compulsiveness, depression, alcoholism, attention disorders or learning disabilities throughout the family.
The clinician must take the time to rule out a long list of other possibilities:
Parent rating scales are very good and should be given. The ADD ADHD scales we like best are by Ned Owens out of Texas. Keith Connors has a fine tool that you have probably seen if you are involved with ADHD children at all. It is very important for the parents to fill out these behavior rating scales.
Ideally the teachers will fill out rating scales also. You want the teacher's input because they see 30, 32, or 35 kids every single class, year in and year out, and they know what is normal behavior and what is not.
Note: One of the things we have noticed is that lately we are having more trouble with the teacher rating scales because the teachers ten years ago, eight years ago, five years ago used to rate the kids pretty reliably compared with the “normal” kids in the class (the non-ADD kids in the class).
But what we are seeing lately is very often the teachers are comparing the child that we want rated against the “worst kid” in the class, who might be totally off the wall. When this happens the rating scale often comes back reporting that the child rated isn't much of a problem at all. We have to give specific directions to the teachers to rate them compared to "normal kids," not against the “worst kids” in the class.
Also, an in-depth clinical interview with the child is essential. This should last 45 minutes to 60 minutes, and should touch on about a dozen different areas with about 100 questions.
This interview is needed to determine the child's reality testing, his degree of maturity, his degree of verbal skills, and so on.
As part of this interview the child should be asked about his world, his relationship with peers, with parents, with school.
Is there some reason that the child can think of that can explain why he cannot focus, concentrate, get his work done, or pay attention?
The child should be asked if he's anxious. Some kids have tremendous fears, but have not shared them with anyone.
The child should be asked questions that would reveal if the child is depressed.
The child should be asked if he's hallucinating. Sometimes he is, but he hasn't told anyone. A small percentage of children and teens can hear or see things that no one else does for a variety of reasons, some are very serious and some are less so, but the question should be asked.
There is a lot going on with kids that their parents are not aware of, so the kids should be asked.