How do I know it makes sense to seek an ADHD evaluation?
If you are unsure about whether to pursue an evaluation for ADHD we recommend that you come in for an initial session to discuss your concerns. We will give you our best judgment about whether pursuing an assessment makes sense. You can also do some research and reading on ADHD (in our resource section we offer multiple recommendations on resources [websites and books] that are reliable sources of information on ADHD). We also highly recommend a free web lecture by Russell Barkley, PhD. In addition, you can take the screener for ADHD that we have on the website (please note this is not a diagnostic tool, but a screening instrument to help people decide whether to pursue an evaluation). Finally, please keep in mind that ADHD is often not easy to diagnose. All ADHD symptoms are behaviors that people occasionally exhibit. Children may interrupt, fidget, and get distracted. Adolescents may blurt out comments inappropriately, exercise poor judgment, and be disorganized. Adults may be forgetful and procrastinate. Therefore, it is critical to not mistake typical or normal behaviors for ADHD. In addition, ADHD like symptoms can occur when other problems, not ADHD, are the primary concern. Therefore, it is critical that ADHD be assessed in a thorough and thoughtful manner (see our Blog on ADHD for more discussion of the assessment of ADHD).
How do I prepare for the ADHD assessment?
For children and teens:
For younger children, a simple explanation is best, such as: we are going to talk to a person who can help us make things better/easier at home/with school (while you can refer to any of the psychologists as a “doctor” please be sure to explain that we are doctors who just talk with people). Older children and teens can be given a more detailed explanation. Many adolescents are familiar with ADHD and may even have requested the evaluation.
No real preparation is needed.
What do I need to bring to the ADHD assessment?
Copies of previous psychological assessments, school records (including report cards, and any IEP or 504 documents, if available). If you have completed ADHD rating scales for any other professional please bring these as well. Even for adults, it is valuable to have records from childhood, if available.
Who should attend the assessment sessions?
For children and teens:
Whenever possible, both parents should attend the interview, as you each have a unique perspective on your child’s problems. If one parent is not able to attend, please be sure to discuss the problems with each other before the appointment so that both parents’ concerns can be communicated to the evaluator. It is recommended that younger children not attend the initial appointment as the primary focus will be on collecting information from parents. Middle school and high school students should attend all the assessment sessions (however, if parents prefer an initial meeting without their child or teen we can accommodate this).
For those with a spouse or significant other, it is ideal to have your partner/significant other attend at least one of the assessment sessions, and the feedback session.
Why do you involve family members (parents and significant others) in the assessment?
For children and teens:
ADHD is best assessed by obtaining as thorough as possible understanding of how a person functions in his or her daily life. The most efficient and effective way to obtain this understanding is to interview those who know your child or teen well. These clinical interviews help us get a picture of how your child or teenager behaves, manages responsibilities and copes with life’s challenges. Children and teenagers may act very differently in an interview setting with a professional than they do at home and in school. Therefore, it is essential that we interview parents (and other involved adults, such as teachers) to obtain the information we need.
Because the assessment of ADHD involves obtaining information about how you function it is optimal to have the input of those you know well (when you feel this is appropriate).
Are there any specific tests that can determine if someone has ADHD?
No. There are no tests that allow mental health professionals to determine whether someone has or does not have ADHD. While there are several tests of sustained attention, that some professionals use, the value of these tests has been questioned and debated. The leading experts (Russell Barkley, PhD and Thomas Brown, PhD) continue to recommend an interview based assessment approach (which is the approach we utilize). Both Barkley and Brown have theorized that ADHD reflects weaknesses in self-regulation/self-control as well as weaknesses in executive functioning. Both experts stress that people with ADHD are often quite variable in how they function and behave, depending on the setting they are in. Thus, snapshot type assessments, such as a psychological tests or tests of sustained attention, often fail to accurately assess whether an individual has ADHD. In addition, some of the symptoms of ADHD can overlap or be similar to symptoms associated with other disorders (e.g., anxiety or depression). Therefore, a thorough assessment is needed to insure an accurate diagnosis. Finally, ADHD is associated with a childhood onset. Thus, a detailed history is needed to help make an accurate diagnosis.
Why don’t you do neuropsychological testing?
Because such testing is not necessary for diagnosing ADHD. While some psychologists argue for comprehensive neuropsychological evaluations the leading experts in the field, e.g., Barkley and Brown, both argue that such testing is not necessary or valid in diagnosing ADHD. People with ADHD are typically variable in their behavior. Therefore, performance on specific tests (which is a one-time measurement) is not a sound way to determine if a person has or does not have ADHD. Neuropsychological testing is a useful tool for determining specific deficits or weakness in cognitive functioning (such as memory and for identifying specific learning problems), but neuropsychological testing is not a particularly effective means for assessing ADHD. In addition, neuropsychological testing is very expensive.
Could you better explain the rationale for your approach to diagnosing ADHD?
There appears to be a consensus among the major experts in the field that in-depth interviewing supplemented by rating scales is the most effective way to diagnose ADHD. Brown (2013) argues quite cogently that the nature of ADHD (a disorder characterized by variability in functioning) calls for an interview based assessment approach (to get a broad descriptive picture of how a person functions). In-depth interviewing allows the evaluator to obtain a more complete understanding of how an individual functions in their daily life. This allows the evaluator to better determine if an individual: experiences sufficient ADHD symptoms; whether these symptoms are significantly interfering with their daily; whether there is a clear and consistent history of ADHD like symptoms; and whether or not there are other problems present that might better explain current difficulties.
For more information on the Assessment of ADHD please visit our ADHD Blog.