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There is no single test to diagnose ADHD. Instead, a comprehensive evaluation is necessary to:
• Reach a diagnosis to 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 medical practitioner, usually a psychiatrist or 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-coordination 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 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 – often presents between ages 6 - 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, and this 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).
