Children mature at different rates and have different personalities, temperaments, and energy levels. Most children get distracted, act impulsively, and struggle to concentrate at one time or another. Sometimes, these normal factors may be mistaken for ADHD. ADHD symptoms usually appear early in life, often between the ages of 3 and 6, and because symptoms vary from person to person, the disorder can be hard to diagnose. Parents may first notice that their child loses interest in things sooner than other children, or seems constantly "out of control." Often, teachers notice the symptoms first, when a child has trouble following rules, or frequently "spaces out" in the classroom or on the playground.
ADHD is difficult to assess and formally diagnose. A Family Physician or other licensed behavioral health professional may use a multi-disorder assessment tool called the Mind Screen to gather information about the child. Once assessed they will spend time speaking with the parents and learning about his or her behavior and environment. A Family Physician may diagnose the child themselves or they may refer the child to a behavioral health specialist with experience in childhood mental disorders such as ADHD.
The Family Physician or behavioral health specialist will first try to rule out other possibilities for the symptoms. For example, certain situations, events, or health conditions may cause temporary behaviors in a child that seem like ADHD. Between them the referring Family Physician and specialist will determine if a child:
• Is experiencing undetected seizures that could be associated with other medical conditions
• Has a middle ear infection that is causing hearing problems
• Has any undetected hearing or vision problems
• Has any medical problems that affect thinking and behavior
• Has any learning disabilities
• Has anxiety or depression, or other psychiatric problems that might cause ADHD-like symptoms
• Has been affected by a significant and sudden change, such as the death of a family member, a divorce, or parent's job loss.
A specialist will also check school and medical records for clues, to see if the child's home or school settings appear unusually stressful or disrupted, and gather information from the child's parents and teachers. Coaches, babysitters, and other adults who know the child well also may be consulted. The specialist also will ask:
• Are the behaviors excessive and long-term, and do they affect all aspects of the child's life?
• Do they happen more often in this child compared with the child's peers?
• Are the behaviors a continuous problem or a response to a temporary situation?
• Do the behaviors occur in several settings or only in one place, such as the playground, classroom, or home?
The specialist pays close attention to the child's behavior during different situations. Some situations are highly structured, some have less structure. Others would require the child to keep paying attention. Most children with ADHD are better able to control their behaviors in situations where they are getting individual attention and when they are free to focus on enjoyable activities. These types of situations are less important in the assessment. A child also may be evaluated to see how he or she acts in social situations, and may be given tests of intellectual ability and academic achievement to see if he or she has a learning disability.
To further complicate the assessment process, some children with ADHD also have other illnesses or conditions. For example, they may have one or more of the following:
• A learning disability. A child in preschool with a learning disability may have difficulty understanding certain sounds or words or have problems expressing himself or herself in words. A school-aged child may struggle with reading, spelling, writing, and mathematics.
• Oppositional defiant disorder. Kids with this condition, in which a child is overly stubborn or rebellious, often argue with adults and refuse to obey rules.
• Conduct disorder. This condition includes behaviors in which the child may lie, steal, fight, or bully others. He or she may destroy property, break into homes, or carry or use weapons. These children or teens are also at a higher risk of using illegal substances. Kids with conduct disorder are at risk of getting into trouble at school or with the police.
• Anxiety and depression. Treating ADHD may help to decrease anxiety or some forms of depression.
• Bipolar disorder. Some children with ADHD may also have this condition in which extreme mood swings go from mania (an extremely high elevated mood) to depression in short periods of time.
• Tourette syndrome. Very few children have this brain disorder, but among those who do, many also have ADHD. Some people with Tourette syndrome have nervous tics and repetitive mannerisms, such as eye blinks, facial twitches, or grimacing. Others clear their throats, snort, or sniff frequently, or bark out words inappropriately. These behaviors can be controlled with medication.
ADHD also may coexist with a sleep disorder, bed-wetting, substance abuse, or other disorders or illnesses. Recognising ADHD symptoms and seeking help early will lead to better outcomes for both affected children and their families.
Finally, if after gathering all this information the child meets the criteria for ADHD, he or she will be formally diagnosed with the disorder.