Demystifying the ADHD Evaluation
Anahi Ortiz, MD – Where do you go if your child’s teacher tells you your child has symptoms of attention deficit hyperactivity disorder (ADHD)? What if you see your child struggling in school?
It can be overwhelming if your child is not doing well academically, behaviorally or socially. However, there are professionals available to guide you through the process of finding a diagnosis and getting treatment.
Your pediatrician or family physician is one type of professional to approach for assistance. At the first visit, your physician most likely will get a complete academic, learning and activity history from you and your child. It would be helpful to bring information such as report cards and past evaluations.
If you have had the same physician for years, he may not take a full past medical history, while a new physician more than likely will take one. He or she will want to look for any neurological problems, hospital admissions, history of trauma, poisonings or prematurity as well as a developmental history (milestones such as walking and first word). The next step should be a complete physical exam, including a full neurological workup.
Depending on the results of the history and exam and the physician’s comfort level with ADHD, the next step usually is to have the parents and teachers fill out psychological rating scales for the child. These can give the physician specifics on whether the child has the symptoms for an ADHD diagnosis and the symptoms’ severity.
Once the scales are completed and scored, your physician will sit down with you and your child to discuss them and to discuss treatment options.
Treatment guidelines now advise that parents receive educational information on ADHD; a discussion of the various medications; information on parental support groups; and a possible referral for psychotherapy. I would also include a discussion on the importance of exercise, nutrition (increasing proteins), possibly ADHD coaching, and meditation if age-appropriate.
Many times after the physician has taken the initial history and exam, he may find atypical symptoms, significant findings on the past medical history or exam. In that case the physician may (and should) refer the child for further evaluation by a neurologist; a developmental center for evaluation of autism/Asperger’s; a psychologist for evaluation for psychological or behavioral interventions and/or psychoeducational testing; and a psychiatrist for evaluation of significant depression, bipolar, etc.
Sometimes the rating scales may demonstrate symptoms of anxiety or depression. Again, depending on the physician’s comfort level and training, he or she may address and treat this in the office or refer to a therapist or psychiatrist.
ADHD is a very complicated disorder and its diagnosis requires a lengthy evaluation. The process may take a few weeks or even more if your child requires any referrals. I hope I have been able to give an idea of what is required to evaluate ADHD and take the mystery out of the process.