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ADHD

Updated 31 August 2018

Diagnosing ADHD

There is no single test to diagnose ADHD. Here's what you should know about the diagnosis of the disorder.

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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 paediatrician) 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 realise 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.

Reviewed by Prof André Venter, Head: Clinical Department of Paediatrics 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.

Read more: 
Treating ADHD

 

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ADHD Expert

Dr Renata Schoeman has been in full-time private practice as a general psychiatrist (child, adolescent and adult psychiatry) since 2008, currently based in Oude Westhof (Bellville). Renata also holds appointments as senior lecturer in Leadership (USB) and as a virtual faculty member of USB Executive Development’s Neuroleadership programme. She serves on the advisory boards of various pharmaceutical companies, as a director of the Psychiatric Management Group (PsychMG) and is the co-convenor of the South African Society of Psychiatrist (SASOP) special interest group for adult ADHD, and co-founder of the Goldilocks and The Bear Foundation (www.gb4adhd.co.za) She is passionate about corporate mental health awareness and uses her neuroscience background to assist leaders in equipping them to become balanced, healthy and dynamic leaders that take their own and their team’s emotional, intellectual, social health and physical needs into account. Renata is academically active and enjoys research and collaborative work, has published in many peer-reviewed journals, and has presented at local and international congresses. She is regularly invited to present at conferences and to engage with the media. During her post-graduate studies, she trained at Harvard, Boston in neurocognition and neuroimaging. Her awards include, amongst others, the Young Minds in Psychiatry award from the American Psychiatric Association, the Discovery Foundation Fellowship award, a Thuthuka award from the NRF, and a MRC Fellowship. She also received the Top MBA student award and the Director’s award from USB for 2015. She was a finalist for the Businesswomen’s Association of South Africa’s Businesswoman of the Year Award for 2016, and received the Excellence in Media Work award from SASOP during 2016.

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