Diagnosing ADHD

There is no single test to diagnose ADHD - a comprehensive evaluation of the symptoms and the patient's medical history is required to make an accurate diagnosis.

There is no single test to diagnose attention-deficit hyperactivity disorder (ADHD). Instead, a comprehensive evaluation is necessary to:

• Reach a diagnosis and rule out other causes for the symptoms of ADHD 
• Establish whether coexisting conditions are present

Such an evaluation requires time and effort and should include a clinical assessment of the individual’s academic, social and emotional functioning. In children, a careful history should be taken from parents and teachers. Often both a psychologist and a medical practitioner (usually a psychiatrist or pediatrician) should be involved in the assessment process. Before reaching a diagnosis, it’s important to rule out the following conditions, which usually manifest with similar symptoms to those of ADHD:

• Emotional difficulties / social and environmental problems. 
• Low muscle tone. Some children have to focus so hard on sitting up straight that they fidget more. 
• Motor-coordination difficulties. If present, this often leads to problems with task completion and the quality of work presented. It often coexists in children with ADHD. 
• Sensory modulation disorders. These children have problems being tactile or are light defensive. The noise-defensive child has difficulty blocking out background noise when having to pay attention.
• Global development delay. Concentration and functioning should be evaluated according to functional, not chronological age. 
• Absence epilepsy, which often presents between the ages of 6 and 10 years. These small seizures cause lapses in awareness, sometimes with staring.
• Sleep disorders such as sleep apnoea cause tiredness and may present as attention disorders.

It’s important to realize that some of the above problems can also be present in children with a classical picture of ADHD. Other problems may present with symptoms suggestive of ADHD, and this often leads to a later diagnosis because the interaction with concentration problems isn’t explored. They often coexist.

In order for a diagnosis of ADHD to be made, the following conditions should be met:

• Some symptoms must have appeared by the age of 12. 
• At least six symptoms must be present and must have persisted for at least six months. 
• Symptoms must occur in at least two different settings (for example, at school and at home). 
• The symptoms must cause significant impairment of social and academic functioning.

Many restless children are misdiagnosed with attention-deficit hyperactivity disorder (ADHD). A proper diagnosis of ADHD requires a comprehensive and multidisciplinary evaluation.

If you suspect that a child may have ADHD, it will be important to consult with teachers, a doctor, a psychologist and other health professionals.

The role of the doctor

The doctor has to take a thorough medical and family history and should do a physical and neurological examination. It may be necessary to do tests to exclude medical illnesses that could masquerade as ADHD.

If the child needs medication, the doctor will have to supervise and monitor this.

The teacher

The child’s teacher should evaluate and monitor the child's behavior, work completion, achievement and social interaction.

The psychologist and other associated professionals

A psychologist should facilitate the information-gathering process by liaising with parents, teachers and the doctor. This healthcare professional should also use a variety of psychological tests to measure IQ, social and emotional adjustment, and specific learning disabilities.

Intervention

Holistic intervention is the best approach to the treatment and management of ADHD, and should include:

• Parent training with regards to management
• Parent/child problem solving and communication training
• Medication (if indicated)
• Teacher counselling about ADHD and training in classroom management
• Social-skills training in the classroom and at home
• Individual therapy when justified
• Parent/family interventions
• Parent support groups

Adult ADHD

Adult attention deficit hyperactivity disorder (ADHD) can have serious implications for an individual’s career, social life and mental health. Yet most people with this condition remain untreated because it’s one of the most misdiagnosed disorders.

Take a look at the list of symptoms below. Remember that most adults exhibit these symptoms from time to time. To be diagnosed with adult ADHD, you have to show symptoms over a long period of time and it must disrupt your day-to-day life.

Do you easily feel emotionally overwhelmed?

People with ADHD are like tortoises born without a shell. The tiniest thing can provoke an excessive emotional reaction. It’s as if the emotion takes over your entire being and you can’t see it in perspective.

People with ADHD also have little emotional and social intelligence, and struggle to read the emotional messages of others.

Do you struggle with relationships?

Because people with ADHD are so impulsive, they quickly lose their temper, don’t listen to others, blurt out responses, and don’t communicate well. This is bad news for personal relationships.

People who are diagnosed with ADHD when they’re older often have a divorce or two behind them. They often end relationships impulsively or start affairs.

Do you suffer from depression or anxiety?

Most adults with ADHD suffer from one or more additional conditions too, particularly anxiety and depression. Other conditions often associated with ADHD include bipolar disorder, sleeping disorders, obsessive-compulsive disorder (OCD), and drug abuse. It’s no wonder then that doctors so easily misdiagnose adult ADHD.

If you complain about depression, your doctor is going to treat you for that and probably miss the underlying ADHD.

Is your working life a mess?

If you have adult ADHD, you’re probably late for work most of the time and terrible with time management. You procrastinate and get tangled up in unimportant details. As a result, your performance is dramatically impaired and your productivity is often very low because you work so slowly and may try to compensate by being a perfectionist.

Do you abuse alcohol and drugs?

Many people with ADHD abuse drugs, prescription medication or alcohol. It’s often a form of self-medication because substance abuse provides the stimulation people with ADHD desperately seek, or help them cope with depression and anxiety.

Among the criticisms levelled at Ritalin is the theory that it can turn one into a drug addict. But research shows that the opposite is true: the risk of becoming an addict is far greater if ADHD goes untreated than if you’re treated with medication at an early stage.

Do you get bored quickly?

Most people don’t enjoy mundane chores, but people with ADHD have an active aversion to such tasks. That’s why the home of someone with ADHD is often messy and untidy. But give them a task that stimulates them and they’ll focus on it with no effort at all.

Boredom and ADHD don’t go together well. Sufferers are starters, not finishers. They often begin a new project or even career, but don’t see it through.

Do you get a lot of speeding tickets or cause car accidents?

Hyperactive people love speed and often drive too fast. People with attention deficit struggle to concentrate on driving.

Do you become stressed out when multifunctioning is required?

People with ADHD often function very well at work – until they’re promoted. Then they fall apart because they can’t keep all the balls in the air. The same can happen with parents. A mother with ADHD can possibly handle her first child well but when the second arrives, a breakdown threatens.

Does someone in your family have ADHD?

ADHD runs in families. If you have it, chances are high that one or more of your siblings also suffer from it. Many adults realize they have ADHD only when their kids are diagnosed.

Sources:
Reviewed by Prof André Venter, Head: Clinical Department of Pediatrics and Child Health, Faculty of Health Sciences at the University of the Free State. MB ChB, MMed, PhD (Canada), DCH, FCP (Paed) SA. July 2018.