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Diagnosing ADHD: To Test or Not to Test?

When issues of attention arise, it is often confusing for parents or individuals to determine the best course of action. Often, a thorough evaluation is helpful in clarifying what may be contributing to inattentive symptoms observed at home or at school. Consider the following scenarios:

Andrew, a 10-year-old fifth grade student, is struggling to pay attention in school. He is impulsive in class, calling out without raising his hand, chatting with other students and often getting out of his seat without asking permission. At home, he has difficulty following through with tasks, despite good intentions to do so. Both his parents and his teachers have noticed that he has difficulty sustaining attention, is easily distracted, forgetful, and disorganized. Andrew is always losing something that he needs for school or for sports. His mother has also noticed that over the years, Andrew has been slower to acquire reading skills and is a “reluctant reader.” His teacher has also noticed this, and has reported weakness in Andrew’s comprehension relative to his skills in other areas. During reading lessons, he shows an uptick in inattentive and impulsive behaviors. His parents are questioning whether there is an underlying attentional or learning disorder contributing to his academic performance and behavior and what the school can do to help him.

Jessica, a 19-year-old college sophomore, has noticed increasing difficulty in her ability to pay attention during college lectures. She noticed that she is often distracted and tends to “zone out” when her professors are talking. In talking with her parents, they reported similar difficulties through elementary school, although Jessica was always able to compensate and do well in school. Even now, Jessica is maintaining a strong GPA, her grades are good, and she is utilizing the tutoring center at her university. She has also been showing some signs of anxiety, as her workload has increased. She is considering starting therapy, and questioned whether medication would be helpful in managing her reported symptoms. Jessica is wondering whether she has ADHD or if her current difficulties are related to anxiety and adjusting to an increased workload.

In determining the best type of evaluation for each of these students, there are several factors to consider. In both cases, the families are seeking a differential diagnosis regarding the presence of Attention Deficit Hyperactivity Disorder (ADHD). In Andrew’s case, the question has also been raised as to whether there is also a learning disability, and what academic supports he may need. In Jessica’s case, she raised concerns about anxiety as a potential contributing factor, and is seeking recommendations for services to manage symptoms.

So, what type of evaluation does each student need? Because the criteria for ADHD center on behaviors (inattention, hyperactivity, impulsivity and executive functioning challenges), a diagnosis can be made with a thorough clinical interview and rating scales given to students, parents and third-party sources (such as teachers, supervisors, coaches, etc.). And for some students, this type of non-performance based ADHD evaluation is sufficient to establish a diagnosis and provide general recommendations and resources. However, for other students, a performance-based evaluation is helpful and often necessary to gain a clearer picture of a student’s functional strengths and needs, to clarify diagnoses and inform academic and therapeutic recommendations. This type of evaluation is more extensive, involving in person assessment of IQ, aspects of achievement, executive functioning, behavior and social emotional screeners. Because each type of evaluation has its benefits and limitations, it is important for families to communicate the reason for the evaluation they are seeking and to understand the pros and cons of each. In the above scenarios, Jessica may do well with a non-performance based evaluation, to distinguish between ADHD and anxiety, while Andrew’s family should consider a performance based evaluation to clarify the presence of an underlying learning disability or ADHD.

At Dragonfly Psychological Associates, we take a thoughtful, flexible and individualized approach in considering which evaluation best fits a client’s needs. Through an initial phone consultation, we gather information regarding the referral question and the specifics of each client’s situation, to inform which evaluation we recommended. Our clinicians offer both types of evaluations outlined above, as well as several others, to fit the needs of our clients.

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