Attention-Deficit/Hyperactivity Disorder: A parent’s guide to the facts, diagnosis, and treatment options for children and adolescents

As a parent, it is your innate response to keep your child safe, help them grow, and find ways to support their needs. Part of this process is knowing when you need outside support to help you find answers to better support your child or teen. You have likely typed in Attention-Deficit/Hyperactivity Disorder (ADHD) into your search engine in some form or have heard about it in your day-to-day interactions. ADHD is one of the most common Neurodevelopmental Disorders and is typically first diagnosed in school-aged children, with symptoms continuing to impact aspects of functioning into adulthood. Children with ADHD likely have trouble paying attention or regulating behaviors necessary to function effectively or consistently across school, home, and community settings. Currently, there are three subtypes of ADHD, including Predominantly Inattentive Presentation (often referred to as “ADD”), Predominantly Hyperactive-Impulsive Presentation, and Combined Presentation. Prior to learning about who diagnoses or where to find treatment, it is important to clarify a few details.

First, it is important to note that there is no single medical or psychological test for ADHD. Therefore, it is necessary to have a comprehensive evaluation conducted to diagnose ADHD, rule out other causes, and/or to determine the presence of other co-occurring conditions. As a clinical psychologist at Behind the Behavior Psychology, PLLC, Dr. Bobal specializes in diagnosis and treatment of ADHD and other Neurodevelopmental Disorders.

Next, knowing some basic information about the prevalence of ADHD is helpful and can guide your search for qualified professionals. According to the 2016 National Survey of Children’s Health (NSCH) around 9% of children ages 2-17 are diagnosed with ADHD and the numbers are rising. Another important statistic is that 2/3 of all children have at least one other co-occurring diagnosis, such as anxiety, mood disorders, behavioral concerns, or other medical needs. Why do these numbers matter? It is important to know how common ADHD is diagnosed but more importantly, how commonly it can be misdiagnosed or misunderstood. As you navigate your search for diagnostic support, intervention, or advocacy for your child, connect with professionals who specialize in diagnosing and supporting families of children with ADHD. Not sure where to start? Contact us at Behind the Behavior Psychology, PLLC and we would love to team up to help you on your journey and/or connect you with appropriate resources.

Here is what to expect when seeking qualified professionals to assess and treat suspected ADHD symptoms

1. Contact your child’s pediatrician, psychologist, or school regarding your concerns. These professionals are able to provide information as to whether symptoms are present across settings, a part of typical development, or better explained by other factors/diagnoses.

2. After you have communicated with others (who may have already provided referrals or resources) begin reaching out to qualified and trained professionals in diagnosing ADHD. Doctors, developmental pediatricians, or other mental health professionals with expertise in ADHD and differential diagnoses can help. Of note, clinical psychologists or neuropsychologists who specialize in assessing, diagnosing, and/or treating ADHD are preferred professionals with whom you can seek support. Why? Clinical psychologists and neuropsychologists not only specialize in brain development and ADHD symptomology, they also utilize a range of comprehensive evaluation tools, including cognitive or processing tests, evidence-based assessment, as well as their clinical expertise to make an accurate diagnosis. To find a specialist you can look on websites like Psychology Today or do a general search of clinical or neuropsychologists in your area. Talking with your child’s current providers for recommendations for clinical psychologists or neuropsychologists is also a great option.

3. After finding a specialist who diagnoses ADHD, your child will be scheduled for an evaluation. ADHD evaluations by a clinical psychologist typically start with an intake process that helps gather necessary background information about your child’s developmental/medical history, symptoms, and other important aspects of their environment and functioning. Next, your child will work 1:1 with the clinical psychologist to assess how their brain processes, utilizes, and learns information, as well as how these patterns relate to symptoms. Tasks can range anywhere from working on a computer, to completing puzzles, or answering questions. Many children find aspects of assessment fun. The assessment process also involves having the caregivers and child participate in a clinical interview and complete forms to assess symptoms. It is also likely that the psychologist will conduct observations or interview school professionals.

4. Next, the clinical psychologist will combine your reports, data, and their clinical expertise to determine whether symptoms and history are consistent with ADHD or indicative of another psychological, developmental, or medical diagnosis. During this time, your perspective as the parent not only matters, it is needed. Please ask questions and ask for ways to understand diagnoses or factors in more depth if needed.

5. Lastly, feedback appointments are arguably the most valuable and important part of the ADHD evaluation process. Typically these sessions are scheduled during or after testing. Regardless of whether your child met criteria for a diagnosis of ADHD, the psychologist will help you and your child make sense of symptoms, as well as help you access necessary treatment options and resources. You will also be provided with a written report that helps explain symptoms, your child’s strengths and weaknesses, and recommendations for home, community, and school. It is important to share this information with the school and other providers. Of note, outside of a few states in the country, psychologists are not able to prescribe ADHD medication. However, they can help refer or consult with a physician, pediatrician, or psychiatrist if you have questions. 

At Behind the Behavior Psychology it is important for us to provide you with accurate information in order for you to be the best and most informed advocate for your child. Below are additional ADHD facts and information that you may find helpful! 

• School assessments and ADHD

  • School professionals, such as school psychologists, clinical social workers, or other mental health providers within the four walls of a school do not conduct assessment to provide a diagnosis for ADHD. This does not mean that they are not a valuable part of the assessment process or lack knowledge and appropriate training. Actually, the opposite is true. School psychologists, as part of a school team, conduct assessment to determine whether your child is eligible for special education services in school. This is helpful to know if your child is diagnosed with ADHD, as school psychologists will play a large role in helping you access supports. Curious about special education law or eligibility categories? Check out “What is the difference between an IEP and a 504 Plan in school?” School psychologists conduct these assessments to determine appropriate supports for your child, as well as their strengths and needs from an educational lens. Your child may have ADHD symptoms that make them eligible for special education services, however this is not the same as being diagnosed. Communicating with your child’s school is a necessary part of the diagnosis and subsequent support process, so continue to keep these professionals as an important part of your child’s support team. School professionals also provide essential perspectives and resources for qualified professionals who can diagnosis your child’s ADHD symptoms.

•  Professionals who diagnose ADHD

  • Clinical psychologists or neuropsychologists utilize comprehensive procedures to examine patterns of brain functioning, strengths and weaknesses, as well as other necessary environmental, cultural, medical, or situational factors involved for accurate diagnosis and treatment. Why is a comprehensive assessment not only recommended but necessary? Common ADHD symptoms themselves, such as hyperactivity, dysregulation, or poor concentration are often confused and misdiagnosed. While symptoms may look like ADHD, they could in fact be symptoms of traumatic stress, anxiety, mood, and/or other medical problems. When children are misdiagnosed, appropriate and necessary treatment may be overlooked or delayed. Other professionals who can aid in the diagnosis process include your child’s physician, developmental pediatrician, clinical social worker, psychiatrist, or other qualified healthcare providers.

• ADHD “Tests”

  • As noted, there is not a single medical or psychologist “test” to diagnose ADHD. Symptoms check-lists or other tools should not be used in isolation. To determine whether your child has ADHD is a comprehensive process that goes beyond symptoms lists. You can expect a qualified professional to use a number of different evidence-based tools, checklists, resources, and other tests to help answer questions about historic and current symptoms, problems, and to rule out any other diagnoses or underlying medical needs. Getting an in depth understanding of symptoms across settings is the goal.

• Diagnosis of symptoms

  • Many biological, psychological, or environmental factors can contribute to symptoms similar to those of ADHD. If you’re like the rest of us, you may have already typed “ADHD symptoms” in your search engine and gone through the list yourself. It is typically our go-to starting point for any symptom, right? Symptoms are important and they are commonly the first observable signs of concern that are brought to professionals. However, it is important to recognize that symptoms are just symptoms. What is behind the symptom is most important. Symptoms are incredibly helpful for identifying observable or reported aspects of ADHD, yet they are not and should not be the only focus for an ADHD diagnosis. When contemplating whether a child has ADHD, focusing solely on symptoms can lead to misdiagnosis and therefore, ineffective or inaccurate treatment. While symptoms are important, here are a few other questions to ask yourself…

    • How severe are the ADHD symptoms, are they impacting my child?

    • Where and when do ADHD symptoms occur? Home? School? Specific Settings?

    • When did ADHD symptoms start?

    • How long have ADHD symptoms occurred?

    • Have ADHD symptoms endured over time or are they isolated?

  You may be asking yourself how to gather all this information, as managing many of the existing symptoms can be overwhelming. Try first by connecting with others in your child’s circle for help. Teachers are a great place to start. Your child spends the majority of their day inside the school walls. Talking with others does not replace your observations nor make them any less important. Think of it as information gathering. The teacher may have observations and concerns that are consistent with yours. On the contrary, it could be the case that a teacher observes different behaviors at school. It is common for children to behave differently at home and school. It says nothing about your role as the parent. This information is helpful as professionals can better understand whether symptoms are isolated, occur across settings, or if other environmental, situational, or internal factors may be at play.

• Team-based approach to ADHD diagnosis

  • Diagnosing a child with ADHD is very much a team-based approach and it can be helpful to approach the process with this mindset. ADHD symptoms in isolation may not hinder functioning as we all have moments of poor focus, hyperactivity, or inattention. However, combination or severity of symptoms can greatly impact your child’s functioning across settings, particularly in school and at home. Why is a team based approach important? As mentioned, the symptoms themselves can commonly be misdiagnosed as ADHD in children, when in fact it may be another mental health concern or diagnosis. This matters most with regards to how you treat ADHD. If your child is misdiagnosed, traditional ADHD treatment, such as parent training, self-regulation training, and/or medication may not address or may worsen underlying symptoms. A team based approach is important, as a specialist is only aware of the symptoms, severity, and onset that is communicated or observed across settings. Parents and caregivers are essential components of the diagnosis process, as well as other providers, teachers, and individuals familiar with the child. Anyone can go online and find diagnostic criteria or a symptoms check list. Specialists trained in diagnosing ADHD are able to take this information and combine it with other clinical data and observations for accuracy.

• ADHD Treatment

  • In general, a comprehensive treatment approach for children and adolescents with ADHD is most supported by research. If your child is diagnosed by a trained healthcare provider, they will inform you of the areas to focus on regarding your child’s functioning, strengths, and symptom presentation. Remember, there are three subtypes of ADHD, including inattentive, hyperactive/impulsive, and combined presentations. Treatment will vary depending on these subtypes. In general, a comprehensive treatment plan should include support to help your child develop skills and improve functioning regarding school/academic concerns, low self-esteem, sleep, and/or interpersonal relationships. Talk with your child’s current provider or the assessor for comprehensive treatment plan recommendations. Research supports that the most effective treatment for ADHD in children and adolescents includes aspects of:

    • Parent, child, and caregiver education about ADHD, including symptoms, course of treatment, and ways to advocate based on your child’s strengths

    • Positive behavioral parent training or school-based behavioral therapy to help parents and the child learn skills to manage symptoms and behavior and to acquire new skills

    • Self-regulation training or executive functioning coaching to help your child develop adaptive skills to improve functioning

    • Consulting with your child’s physician, pediatrician, or psychiatrist regarding appropriateness of medication as part of comprehensive treatment

    • Educational modifications in school, which may include a 504 plan, Individualized Education Program (IEP), tutoring, or peer support.

• Additional Resources

  • Taking Charge of ADHD, by Russell Barkley, Ph.D., published by Guilford Press

  • The ADHD Book of Lists: A Practical Guide for Helping Children and Teens with Attention Deficit Disorders, by Sandra Rief

  • 8 Keys to Parenting Children with ADHD, by Cindy Goldrich

  • Late, Lost, and Unprepared: A Parents' Guide to Helping Children with Executive Functioning (2009) by Joyce Cooper-Kahn & Laurie Dietzel

  • Executive Skills in Children and Adolescents (2004) By P. Dawson & R. Guare

  • Smart but Scattered: The Revolutionary "Executive Skills" Approach to Helping Kids Reach Their Potential (2009). P. Dawson & R. Guare

  • Children and Adults with Attention-Deficit/Hyperactivity Disorder www.chadd.org

*For more information about Attention-Deficit/Hyperactivity Disorder diagnosis and treatment or to schedule an appointment contact Behind the Behavior Psychology today!