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Diagnosing ADHDAt this time, diagnosing ADHD, or for that matter any neurological or mental disorder, is not as simple as we would like it to be. There are no blood tests or scans that will give us a quick and simple answer. Unfortunately, this is also one of the reasons, that some people still question the very existence of ADHD. The more scientific research that is done, the more overwhelming the evidence that ADHD is a legitimate disorder, that for some can be quite devastating if not diagnosed and treated. The diagnostic procedure for children, adolescents or adults should be comprised of a medical history, an extensive interview with the patient and parents or significant other and the administration of various symptom rating scales. Usually more than one scale if used to confirm the results.
The process is one of evaluating symptoms and defining their inclusion into the typical ADHD symptoms while at the same time excluding any other possible reasons for these symptoms. For a diagnosis to be made, symptoms need to be seen in more than one setting. This is necessary, because symptoms may be due to conditions in a particular environment, rather than being due to a medical condition. The diagnosis also requires that symptoms be present before the age of seven, although this has come under some scrutiny lately, especially when adults are being assessed. If symptoms are less severe and coping strategies are extensive, ADHD may not be detected early on. This may occur more frequently if hyperactivity is not a symptom.
It is not uncommon for a diagnosis of ADHD to be missed on the first and even second assessment, especially if the symptoms do not present in the typical manner. If the child if not visibly hyperactive or displaying other symptoms that parents and teachers find annoying they can often be missed. This can be very common for girls or women. (Please see symptoms for girls and women on "School" dropdown page)
ADHD in children who are very bright can often cope at school by relying on their sheer intelligence. However, not only does their ADHD frequently go undiagnosed, their giftedness often goes undetected as well. These children can end up feeling extremely frustrated, bored and rarely end up working to their potential. They may be able to make it through elementary and even high school without too much trouble, but when good executive functioning skills are required at the post secondary level, they often crash and burn.
During a complete diagnostic procedure, other conditions that exist with ADHD or, 'comorbid conditions', should also be screened for. Only one in five people have 'ADHD simplex', or ADHD without any other co-existing conditions. Some of the conditions that we routinely see with ADHD are: learning disabilities, anxiety, depression, and Oppositional Defiant Disorder (ODD). On the flip side, ADHD is also a comorbid disorder of (or often seen with) many other disorders such as Tic Spectrum Disorders, Bipolar Disorder, Conduct Disorder, Mental Retardation, Mood Disorders and possibly Autistic Spectrum Disorder. For this reason, it is very important to have a thorough assessment to accurately diagnose everything that may be going on. Unfortunately, some of these conditions do not present or are difficult to diagnose until a child is older. The longer ADHD goes undiagnosed and untreated and the longer it persists into adulthood without treatment, the more likely comorbidities will occur.
For a detailed description of diagnostic procedures that are recommended by The Canadian ADHD Resource Alliance (CADDRA), in their published Canadian ADHD Practice Guidelines, click here or visit www.caddra.ca and select Guidelines under the Physicians dropdown.
These guidelines were produced to inform physicians on proper assessment procedures and good clinical practice. The guidelines are also an excellent source of information on the newest rating scales, and the latest scientific data on studies and new medication. These guidelines are geared for physicians and are not meant to be used for self-diagnosis or treatment.
For some, reaching the final diagnosis of ADHD may be a long and difficult journey. It may take many medical professionals and many assessments over multiple years to finally reach an accurate diagnosis. With the increase of knowledge and the push to train more medical professionals and educators about ADHD, it is hoped that this will decrease in the future. Unfortunately, while misinformation and stigma still surround ADHD both children and their parents will continue to go undiagnosed, misdiagnosed and untreated.