05 February 2013

How is ADHD diagnosed?

There is no single test to diagnose ADHD. Instead, a comprehensive evaluation is required.

 There is no single test to diagnose ADHD. Instead, a comprehensive evaluation is necessary to:

•    reach a diagnosis rule out other causes for the symptoms
•    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 a paediatrician, should be involved in the assessment process.

Before reaching a diagnosis, it is important to rule out the following conditions, which usually manifest 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-co-ordination difficulties – if present this often leads to problems with task completion and the quality of work presented. It often coexists in patients with ADHD.
•    Sensory Modulation Disorders – These children have problems being tactile or 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 - often presents between ages six - 10 years.
It is important to realise that some of the above can also be present in patients with a classical picture of ADHD. Other problems may present with symptoms suggestive of ADHD but often leads to a later diagnosis because the interaction with concentration problems is not 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 seven.
•    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.

 (Reviewed by Dr A van der Walt, MMed (Paed) BSc Hon (Human Genetics),
May 2007 and July 2010)




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