ADD / ADHD Test & Diagnosis

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Tests: Rating Scales and Checklists

Scales and checklists help clinicians obtain information from parents, teachers, and others about symptoms and functioning in various settings, which is necessary for an appropriate assessment for AD/HD and treatment monitoring. Symptoms must be present in more than one setting (for example, both at home and in school) to meet DSM-IV criteria for the condition. Such instruments are only one component of a comprehensive evaluation, which includes a medical examination and interviews.

According to the American Academy of Child and Adolescent Psychiatry the most commonly used scales are:

• Parent-completed Child Behavior Checklist
• Teacher Report Form (TRF) of the Child Behavior Checklist
• Conners Parent and Teacher Rating Scales (see below)
• ADD-H: Comprehensive Teacher Rating Scale (ACTeRS)
• Barkley Home Situations Questionnaire (HSQ) (see below)
• Barkley School Situations Questionnaire (SSQ) (see below)

According to the Agency for Healthcare Research and Quality (AHRQ), formerly the Agency for Health Care Policy and Research, AD/HD-specific rating scales are more accurate in distinguishing between children with and without the diagnosis of AD/HD, than global, nonspecific questionnaires and rating scales that assess a variety of behavioral conditions.

Source: www.CHADD.org

ADHD Diagnosis

We know through research that a clinically valid diagnosis of ADHD can be reached through a comprehensive and thorough evaluation done by specially trained professionals using well-tested diagnostic interview methods. The key elements include a thorough history covering the presenting symptoms, including ruling out other physical or mental conditions that may have the same symptoms, possible co morbid conditions, as well as medical, developmental, school, psychosocial and family history. The criteria for diagnosis with ADHD specify that symptoms of inattention must have persisted for at least 6 months to a degree that is maladaptive and inconsistent with the child’s developmental level.

Proper diagnosis also avoids the possibility that these symptoms are occurring exclusively during the course of a pervasive developmental disorder, schizophrenia, or other psychotic disorder and are not better accounted for by another co-morbid condition or mental disorder (e.g., mood disorder, anxiety disorder, dissociate disorder, or a personality disorder.) The problems involved with accurate diagnosis of these illnesses are particularly acute in pediatric primary care settings, where many of these children are seen, because these evaluations take time and require multiple clinical skills, for which we have few appropriately trained professionals.

Diagnosis with children: Is it really ADHD?

Not everyone who is overly hyperactive, inattentive, or impulsive has ADHD. Since most people sometimes blurt out things they didn't mean to say, or jump from one task to another, or become disorganized and forgetful, how can specialists tell if the problem is ADHD?

Because everyone shows some of these behaviors at times, the diagnosis requires that such behavior be demonstrated to a degree that is inappropriate for the person's age. The diagnostic guidelines also contain specific requirements for determining when the symptoms indicate ADHD. The behaviors must appear early in life, before age 7, and continue for at least 6 months. Above all, the behaviors must create a real handicap in at least two areas of a person's life such as in the schoolroom, on the playground, at home, in the community, or in social settings. So someone who shows some symptoms but whose schoolwork or friendships are not impaired by these behaviors would not be diagnosed with ADHD. Nor would a child who seems overly active on the playground but functions well elsewhere receive an ADHD diagnosis.

To assess whether a child has ADHD, specialists consider several critical questions: Are these behaviors excessive, long-term, and pervasive? That is, do they occur more often than in other children the same age? Are they a continuous problem, not just a response to a temporary situation? Do the behaviors occur in several settings or only in one specific place like the playground or in the schoolroom? The person's pattern of behavior is compared against a set of criteria and characteristics of the disorder as listed in the DSM-IV-TR.

Diagnosis-- Children

Some parents see signs of inattention, hyperactivity, and impulsivity in their toddler long before the child enters school. The child may lose interest in playing a game or watching a TV show, or may run around completely out of control. But because children mature at different rates and are very different in personality, temperament, and energy levels, it's useful to get an expert's opinion of whether the behavior is appropriate for the child's age. Parents can ask their child's pediatrician, or a child psychologist or psychiatrist, to assess whether their toddler has an attention deficit hyperactivity disorder or is, more likely at this age, just immature or unusually exuberant.

ADHD may be suspected by a parent or caretaker or may go unnoticed until the child runs into problems at school. Given that ADHD tends to affect functioning most strongly in school, sometimes the teacher is the first to recognize that a child is hyperactive or inattentive and may point it out to the parents and/or consult with the school psychologist. Because teachers work with many children, they come to know how "average" children behave in learning situations that require attention and self-control. However, teachers sometimes fail to notice the needs of children who may be more inattentive and passive yet who are quiet and cooperative, such as those with the predominantly inattentive form of ADHD.

Diagnosing ADHD in Adults.

Many adults have been living with Adult Attention-Deficit/Hyperactivity Disorder (Adult ADHD) and don’t recognize it. Why? Because its symptoms are often mistaken for a stressful life, typically, adults with ADHD are unaware that they have this disorder—they often just feel that it's impossible to get organized, to stick to a job, to keep an appointment. The everyday tasks of getting up, getting dressed and ready for the day's work, getting to work on time, and being productive on the job can be major challenges for the ADHD adult.

Diagnosing an adult with ADHD is not easy. Many times, when a child is diagnosed with the disorder, a parent will recognize that he or she has many of the same symptoms the child has and, for the first time, will begin to understand some of the traits that have given him or her trouble for years—distractibility, impulsivity, restlessness. Other adults will seek professional help for depression or anxiety and will find out that the root cause of some of their emotional problems is ADHD. They may have a history of school failures or problems at work. Often they have been involved in frequent automobile accidents.

To be diagnosed with ADHD, an adult must have childhood-onset, persistent, and current symptoms. The accuracy of the diagnosis of adult ADHD is of utmost importance and should be made by a clinician with expertise in the area of attention dysfunction. For an accurate diagnosis, a history of the patient's childhood behavior, together with an interview with his life partner, a parent, close friend, or other close associate, will be needed. A physical examination and psychological tests should also be given. Co morbidity with other conditions may exist such as specific learning disabilities, anxiety, or affective disorders.

A correct diagnosis of ADHD can bring a sense of relief. The individual has brought into adulthood many negative perceptions of himself that may have led to low esteem. Now he can begin to understand why he has some of his problems and can begin to face them.

The following ADD / ADHD Adult Self Report Scale (ASRS) questionnaire can be used as a starting point to help you recognize the signs/symptoms of Adult ADHD but is not meant to replace consultation with a trained healthcare professional. An accurate diagnosis can only be made through a clinical evaluation. Regardless of the questionnaire results, if you have concerns about diagnosis and treatment of Adult ADHD, please discuss your concerns with your physician. (This Adult Self-Report Scale (ASRS) Screener is intended for people aged 18 years or older.) Are you living with Adult ADHD? The questions below can help you find out

ADD / ADHD Adult Self Report Scale (ASRS) Checklist
The 6-question Adult Self-Report Scale (ASRS) Screener below is a subset of the WHO's 18-question Adult ADHD Self-Report Scale (Adult ASRS) Symptom Checklist.

A score of 11 points or higher indicates that your symptoms may be consistent with Adult ADHD. It may be beneficial for you to talk with your healthcare provider about an evaluation.

PRINTED IN USA. Adult Self-Report Scale (ASRS) Screener COPYRIGHT © 2003 World Health Organization (WHO). Reprinted with permission of WHO. All rights reserved. This Adult Self-Report Scale (ASRS) Screener is intended for people aged 18 years or older.

Coaching helps clarify the challenges

Currently, there is no standardized testing that can clearly and accurately identify the diagnosis of ADHD. We do know that a clinically valid diagnosis of ADHD can be reached through a comprehensive and thorough evaluation done by specially trained professionals using well-tested diagnostic interview methods. We also know these evaluations take time and require multiple clinical skills, for which we have few appropriately trained professionals. When we do find well-trained professionals who know how to conduct a comprehensive evaluation, well-trained coaches can be instrumental in helping their clients identify patterns and situations where their impairing challenges of ADHD will tend to manifest.

Individuals seeking a proper diagnosis of ADHD who can accurately communicate how and where their challenges exist are providing a well trained diagnostician with a crucial and essential information that can dramatically improve the chances of the correct diagnosis of ADHD and the co-morbid or co-occurring conditions that are part of the diagnosis in a majority of clinical cases. conditions that shadow. The coach works with their client to insure that their description and explanation of their challenges are accurate and concise so that any clinician will understand the impairments that are holding them back.

Physicians and clinicians have reported back to us that working with clients to clearly identify their patient’s impairing has been extremely helpful in correctly identifying the ADHD and co morbid conditions Although coaches DO NOT DIAGNOSE their skills and knowledge in questioning and other coaching skills can extremely helpful in identifying the challenges and the accurately and concisely sharing that with the clinician. This can be the difference between an accurate diagnosis that leads to proper treatment and a dramatic improvement in the quality of their life.