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Diagnosing Attention-Deficit Hyperactivity Disorder (ADHD) in children and teens involves several steps. No definitive ADHD test exists, and often professionals diagnose children after just a clinical interview. When making a diagnosis, all professionals use the diagnostic guidelines from the American Academy of Pediatrics or the American Psychiatric Association’s Diagnostic and Statistical Manual (DSM-5) to determine if the child meets certain clinical criteria.
The first step in diagnosing ADHD is scheduling a consult with a medical or mental health professional. A clinical diagnosis involves the gathering of information from several sources, including teachers, parents, and caregivers. Pediatricians often diagnose a child with ADHD after caring for a child over time or through the use of behavioral rating scales.
However, pediatricians are generalists and sometimes more specific ADHD guidance is needed. Therefore, visiting a neurologist, psychiatrist or a psychologist is recommended. Psychologists can not only make an ADHD diagnosis but can also work with a child through the psychotherapy and parent coaching process.
A consult with a medical or mental health professional consists of a clinical intake. This a meeting where the medical or mental health professional gathers information to determine if your child has ADHD. They try to get a better picture of who your child is and what their strengths and needs are.
Moreover, through the interview process and observations, they will try to identify if the issues are developmental lags or clinical issues. These meetings can be lengthy and can be an hour or more.
They will collect the following information:
Whether determining ADHD in children or providing an ADHD diagnosis for adults, a physician or psychologist has to determine if certain DSM criteria are met.
ADHD symptoms must be present before age 12 and must include a persistent pattern of inattention or hyperactivity/impulsivity that interferes with functioning or development in two or more settings. Clear evidence exists that the symptoms interfere with, or reduce the quality of, social, school, or work functioning.
The DSM specifies that the symptoms can’t be explained by another mental disorder (such as a mood disorder, anxiety disorder, dissociative disorder, or a personality disorder). The symptoms do not happen only during schizophrenia or another psychotic disorder.
The following are the DSM-5 criteria for ADHD:
Inattention: Six or more symptoms of inattention for children up to age 16, or five or more for adolescents 17 and older and adults; symptoms of inattention have been present for at least 6 months, and they are inappropriate for developmental level:
Hyperactivity and Impulsivity: Six or more symptoms of Hyperactivity-impulsivity for children up to age 16, or five or more for adolescents 17 and older and adults; symptoms of hyperactivity-impulsivity have been present for at least 6 months to the extent that is disruptive and inappropriate for the person’s developmental level:
Based on the types of symptoms, which must be present before age 12 and occur for more
than six months, there are three subtypes of ADHD:
Since ADHD causes attention and executive functioning problems, part of a clinical diagnosis requires the ruling out of other conditions that present similarly. One’s impaired attention may occur for a variety of reasons with ADHD being only one. A long list of issues can impair attention in the same manner as organic-based ADHD, including but not limited to anxiety, depression, PTSD, OCD, concussion, learning disability, Dyslexia, Autism, chronic health conditions, toxic exposures, nutrient deficiencies, dietary issues, Lyme, and PANS/PANDAS.
ADHD symptoms in kids often look the same as the ones for children with anxiety, OCD, learning difficulties, depression, autism, sensory processing, birth trauma, PTSD, nutritional deficiencies, and genetic issues because they might be having a hard time focusing or controlling impulses.
A child or teen may not even have a clinical issue and instead may be reacting to developmentally inappropriate school work or the wrong classroom or peer environment. It is important that other conditions be ruled out before a diagnosis of ADHD is made to identify the right treatment.
The next step typically involves some level of testing for ADHD. Many providers use rating scales or questionnaires that tease out how specific behaviors related to attentional concerns impact the child at home or school.
The provider will consider how a child’s behavior compares with that of other children the same age. Additionally, he or she may use standardized rating scales or direct measures of attention and executive functioning to document these behaviors. While rating scales are not a perfect tool, they can provide a wealth of behavioral information that not only helps identify diagnostic criteria but guide therapy.
When one presents with attentional, executive functioning, or processing issues that interfere with academic performance, then a more comprehensive evaluation is needed. These evaluations are also referred to as psychoeducational or neuropsychological evaluations.
A comprehensive evaluation encompasses several hours of individually administered standardized tests in cognitive, behavioral, and academic areas. Not everyone with ADHD requires a comprehensive evaluation. However, for those that are struggling academically, it can be instrumental in identifying areas that need more support at school via an Individual Education Plan (IEP) or 504 Accommodation Plan.
The way a person’s central nervous system functions impacts ADHD, meaning that medical tools can help with a more definitive diagnosis. The research tells us that those with ADHD have “cortical slowing,” which is characterized by an elevation of low-frequency theta waves and a reduction of higher frequency beta waves in the prefrontal cortex. Therefore, from a medical perspective, using tools that measure brain waves can help diagnose ADHD.
In very simple terms, QEEG is a computer analysis of the EEG data, which is a measure of the surface electrical of the brain. With a QEEG, a cap is placed on one’s head, and surface electrical activity is measured. The EEG activity is recorded and statistically analyzed, and the data is compared against a database. It is a visual way to see brain functioning regarding brain waves. QEEG’s give us information about the formation of brainwaves and certain brainwaves are associated with certain conditions.
There are other more effective means of assessing if a child has ADHD than just a
clinical interview or the use of rating scales. Research demonstrates that a QEEG brain map is 89% accurate as a diagnostic test of ADHD versus behavioral rating scales which are 47 to 58% accurate. Behavioral rating scales are not only subjective; they only give us a glance as to what is impacting the Central Nervous System (CNS), especially since ADHD in adults is different than in children. Starting with a QEEG brain map is a great way to know diagnostically what the real issues are. By objectively looking at the brainwaves, we can see what is impacting the CNS and causing dysregulation and thereby get a clearer diagnostic picture. A QEEG provides a wealth of diagnostic information that is imperative in getting to the root cause.
We know through research that the brainwave activity of those with ADHD is different than those with normal attention. With a QEEG, again you can see how the brain waves form over certain
areas of the brain that coordinate with specific neuropsychological function. In other words, when we see that there is low fast activity in the frontal lobes, we can surmise that focus is a challenge for that person because there simply isn’t enough power in that part of the brain that is necessary for focus.
At our offices in Ridgefield and Newtown, CT, we use QEEG as a diagnostic tool for clients who come to us from all over North America. It has been vital in getting to the root cause of our client’s issues and guiding them to the best treatment.
To make an appointment with Dr. Roseann to get a QEEG or evaluation or how one of our clinically effective and natural therapies for ADHD, such as Neurofeedback, Biofeedback, Executive Functioning coaching, parent coaching or behavioral support can help you or your child, or to meet with one of our psychotherapists call 203.438.4848 or email us at info@drroseann.com. Live out of state? We work with children, individuals, and families through our intensive therapies program The 360° Reboot® Program.
Dr. Roseann is a Psychologist who works with children, adults, and families from all over the US, supporting them with research-based and holistic therapies that are bridged with neuroscience. She is a Dr. Roseann is a Board Certified Neurofeedback (BCN) Practitioner, a Board Member of the Northeast Region Biofeedback Society (NRBS) and Epidemic Answers, Certified Integrative Medicine Mental Health Provider (CMHIMP) and an Amen Clinic Certified Brain Health Coach. She is also a member of the American Psychological Association (APA), National Association of School Psychologists (NASP), Connecticut Counseling Association (CCA), International OCD Foundation (IOCDF) International Society for Neurofeedback and Research (ISNR) and The Association of Applied Psychophysiology and Biofeedback (AAPB).
©Roseann-Capanna-Hodge, LLC 2019