What to expect from an ADHD diagnosis

In our survey a majority of parents (69 percent) said their child's primary-care physician or pediatrician was involved in making an ADHD diagnosis. The second most frequently visited professional was a child psychiatrist (34 percent). Clinical psychologists (30 percent) and school psychologists (27 percent) were the next most likely professionals to be involved in the diagnostic process.

It was not uncommon for parents to consult more than one practitioner before their child was given an ADHD diagnosis. Many parents in our survey took their child to one provider (34 percent), but many saw two (32 percent), three (20 percent), or four or more (15 percent).

Unlike many disorders, there is no simple imaging or blood test that can diagnose ADHD. An ADHD diagnosis is based on such factors as interviews with parents, teachers, and others who can provide information, a physical examination, and observing the child in various settings, including the classroom. Medical conditions, such as hearing loss, and other behavioral and psychological conditions should also be considered. How the ADHD diagnosis is done may vary depending on the professional involved, the child's symptoms, and parent preferences.

There are several ratings scales commonly used. The Conners' Rating Scale, for example, evaluates a variety of behavioral difficulties, including sleeping, eating, and problems with peers. It's available in several versions, including those for parents, teachers, and children.

In our survey, we asked parents to tell us what each provider did during the diagnostic process. Because a majority of children saw more than one professional, the survey results presented below show whether or not a particular procedure was conducted at all during the process.

Overall, interviews with the children (93 percent) and parents (92 percent) were the most frequently used techniques. Teachers were not included in the diagnostic process as often as they should have been; only in 73 percent of the cases did they complete questionnaires, and in only 52 percent of the cases were they interviewed. (Twenty-seven percent of the parents had teachers do both.)

Professional guidelines emphasize the importance of obtaining information about the child's symptoms in more than one setting, especially in schools, but almost one-third of the parents (27 percent) indicated that teachers did not complete questionnaires. Professionals did not interview teachers in 48 percent of the cases and did not observe the child in a classroom setting in 59 percent of the cases. These omissions undermine the goal that most parents have in seeking help in the first place: acquiring knowledge about how to improve their child's behavior and/or academic performance.

When it came to ruling out other medical explanations for attention problems, 70 percent of the children had a physical exam, but only 48 percent were given a hearing test.

The diagnostic process should give parents a better understanding of their children and how to help them achieve their goals. Our survey found that many parents (46 percent) felt more confident about their child's chances for improvement after the ADHD diagnosis. But a substantial number of parents (19 percent) were disheartened and more worried about their children after the ADHD was diagnosed.

That may be the result of health professionals not following recommendations for ADHD diagnoses. Most parents (69 percent) were left without a plan for managing their child's problem. More than half of them said they lacked a clearer understanding of their child's strengths and weaknesses. And less than half (45 percent) felt they had a professional whom they could contact with future concerns.

Guidelines for diagnosing ADHD from the American Academy of Pediatrics and the American Academy of Child and Adolescent Psychiatry recommend that parents receive a clear assessment of their child's strengths and weaknesses, and an action plan, and have a professional contact for follow-up consultations. A lack of dialogue with health professionals may also explain why 14 percent of the parents were not convinced that their children really had ADHD.

More than half of the children (59 percent) were prescribed medication immediately after an ADHD diagnosis was made. (See Consumer Reports Best Buy Drugs report on ADHD for information on those medications.) Parents who got a prescription felt more confident about their child's chances of improvement and thought they had a professional they could reach with any concerns, though many said they lacked a clear plan for the future.

Because ADHD is often associated with other problems, you can expect your doctor to ask you a variety of questions about your child's development, mood, and behavior.

Many of the individual symptoms of ADHD occur with other conditions, and children with ADHD often have additional disorders that can make a diagnosis even more challenging. According to an investigation sponsored by the National Institute of Mental Health, only 32 percent of the study population had ADHD alone: 29 percent had ADHD plus oppositional defiant disorder (ODD) and/or conduct disorder, 14 percent had ADHD plus anxiety or depression, and 25 percent had all three disorders.

While those disorders are among the most common associated conditions, ADHD is also associated with learning disabilities, substance abuse, autism, Asperger's syndrome, tic disorders such as Tourette's syndrome, epilepsy, and sleep disorders. Those conditions can often complicate the treatment of ADHD, so it's important for parents to have their child evaluated for other conditions, especially if he or she does not respond well to treatment.

ADHD and mood disorders have been reported to occur together in 15 percent to 75 percent of cases. It's not surprising that early ADHD symptoms have been found to lead to poor school performance, poor social relationships, and poor interactions with parents, all of which can contribute to bouts of depression. The two conditions, if undiagnosed, can lead to high disability and a poor prognosis.

Children diagnosed with ADHD have higher rates of a number of anxiety disorders, including agoraphobia, obsessive-compulsive disorder, overanxious disorder, separation anxiety disorder, and social phobia. In fact, anxiety disorders have been found to occur in about 25 percent of the children with ADHD, but they are often missed in overactive children, much like ADHD may be overlooked in children who are quieter. When present together, both conditions play a role in academic, behavioral, and social problems.

Oppositional defiant disorder (ODD) is a disruptive pattern of behavior in children and adolescents characterized by defiant, disobedient, and hostile behaviors directed toward adults in positions of authority. Studies have shown that 54 percent to 84 percent of the children and adolescents with ADHD may meet the criteria for ODD, and a significant number of them will develop conduct disorder, a personality disorder involving persistent antisocial behavior. Additionally, 15 percent to 19 percent of children with ADHD will start to smoke cigarettes or develop other substance-abuse disorders.

If you suspect that your child has ADHD, you should consult a qualified professional. There are a variety of clinicians who see children with ADHD:

• Pediatrician or child's primary health-care provider
• Psychiatrist (M.D.)
• Child psychiatrist (M.D.)
• Clinical psychologist (Ph.D., Psy.D., Ed.D.)
• School psychologist
• Neuropsychologist (Ph.D., Psy.D.)
• Learning disability specialist (master's degree)
• Pediatric neurologist
• Neurologist
• Social worker

An evaluation should include

• An examination by a doctor or other health-care professional, including:

1. A basic medical exam
2. A hearing test
3. A vision test

• A questionnaire for parents about their child's behavior
• An interview with the parents and observation and/or testing of the child by a professional
• An assessment of the child's behavior in school by one or more of the following:

1. An interview with the teacher
2. A questionnaire completed by teacher
3. Professional observation of the child in the classroom

Diagnosis and follow-up should include

• Diagnosis of the particular type of ADHD or alternate explanations for your child's problems that may need further exploration (e.g., a learning disability or other medical or psychological problem)
• Specific recommendations for how to help your child at home and in school, and what type of improvements to expect
• Information on how to monitor improvements
• Places to go for more information about ADHD
• A schedule for follow-up care

If medication is prescribed, you should

• Make an appointment for a medical exam for your child before starting the medication
• Get suggestions about how to explain the medication to your child
• Get information on dosages and side effects to watch for
• Get information on how to monitor improvements
• Schedule follow-up care