ADHD Tests: How to Get Accurate Results
Let’s say you, or your child’s teacher, have been having problems managing your child. With the child-raising climate being what it is today, the idea may soon come up: does she have Attention Deficit Hyperactivity Disorder? Once the suggestion is made, it may not be too difficult to get a diagnosis because a lot of ADD/ADHD symptoms listed in DSM IV are just extremes of normal, and what qualifies them as a disease is their frequency and severity.
But as a parent, or a teacher, you want something accurate that will help your child. This article is about how responsible, comprehensive testing for ADD/ADHD by someone looking for an accurate diagnosis should work. It is more than the half-hour interview with a checklist and pencil in hand that sometimes (or often?) results in someone being called ADD/ADHD.
I’ve listed out the steps that every doctor or psychologist who diagnoses ADHD should follow.
Step 1: Checking that there is no physical problem
While it is true that most people diagnosed with ADD/ADHD have no physical problem, it is vitally important that everyone being screened for the disorder is checked for a range of physical problems including vision, hearing, sensory integration and thyroid issues, and epilepsy. When the attention-deficit and hyperactivity is caused by these physical problems, you can expect a dramatic improvement with the correct treatment. If absence epilepsy, characterized by periods of ‘absence’ when a person stops movement and stares into space - is left undiagnosed, it may become life-threatening if, for example, the child receives a driving license before he outgrows the disease.
For this reason, it is important that a medical doctor be involved in the process of testing for ADD/ADHD - it should not be just the psychologist working with a pencil and a checklist of problem behaviors.
Step 2: Checking the medical, social, educational and psychological history
This can throw up some important clues about the cause of the attention-deficit or hyperactivity, and again if these causes can be dealt with your child’s behavior will improve a lot without medication. A doctor would want to know about, for example, the conditions of pregnancy and birth, major illnesses or injuries, if the child reached all major developmental milestones at the correct age, and her sleep habits. Do her parents have any mental illness? Did they have learning or behavior problems? Is there any mental illness, substance abuse, or criminal behavior in the family?
He will also want to know how she is doing in school. Does she have friends? How is she temperamentally? Has she difficulty in hand-eye coordination? Has she had episodes of depression or any major traumas? All of these have a bearing on how the problem behavior is to be treated: if she is inattentive because she is depressed, conventional ADHD stimulant drugs are the wrong treatment.
Step 3: Interviewing
Children being assessed usually behave well during interviews, and the psychologist or doctor knows that if they have been sent for an evaluation this good behavior is probably not typical. He is looking for other things when he interviews the child and her parents: an assessment of self-esteem, coping strategies, and the home, social and school environment of the child.
The parents’ consistency and unity in their disciplining, their patience or lack of it, their affection or lack of it - all have an effect on how they perceive their child and how she will perceive herself. When parents are absent, or neglectful, or abusive, many children show all the classic symptoms of ADD/ADHD. Other children may feel lost in school because they cannot understand what the teacher is teaching, or they may be bored because they see no challenge. In these cases consultation with the teacher and parent-skills training will improve life at home and school.
Step 4: Doing the ADD/ADHD tests
There are a lot of ‘tests’, questionnaires and other rating scales, for ADD/ADHD. Many of them are available online, free or for a price. These tests must be always used along with the other steps outlined here if they are not to end up misleading rather than enlightening.
Questionnaires in which parents and teachers rate behavior tend to emphasize the negative, and if he or she is biased or is not in a good mood, a child is likely to end up with a diagnosis of ADD/ADHD. When adults rate themselves in tests for adult ADHD, they usually get the result they want by unconsciously checking the answers they know support their opinions.
Other tests like Connor’s continuous performance test and the Test of Variable Attention (TOVA) claim to measure a child’s performance during an actual task of concentration. But again, lack of sleep, coffee, cola and even practice in playing computer games (because these testes are often designed like computer games) can skew the results. Lack of sleep can also affect the results of brain imaging, and it is because we don’t know much about such variables that most scientists do not accept brain imaging as a definitive test for ADD/ADHD.
If after all these steps, your child does seem to have ADD/ADHD, you need to move on to think about treatment. Does she need medication, or a modified environment, or psychotherapy and social-skills training? But that is beyond the scope of this article - more on that later!