Diagnosing ADHD in Children, an Introduction

Everyone in a private practice setting who works with children or adults is going to have their own opinion on how Attention Deficit Hyperactivity Disorder - ADD or ADHD - should be diagnosed. Some clinics take the perspective that "more is good," and will recommend a large battery of tests, often costing many thousands of dollars. Other clinics, typically with hurried physicians, will simply give a brief rating scales to the parents and then make a quick diagnosis and prescribe treatment, usually a medication.

Unfortunately neither of these extremes is in the patient's best interest. 

Over-diagnosis of Attention Deficit Hyperactivity Disorder is a big problem. There are some children who are diagnosed as having ADHD that do not have it. It is not uncommon for someone with depression, or anxiety, specific learning disabilities, early onset bi-polar disorder, or Tourette's Syndrome, to be diagnosed as Attention Deficit Hyperactivity Disorder. This is often the result of a diagnostic "work-up" which is too brief and does not take into account the many reasons why a child might be inattentive, impulsive, or over-active.

But over-diagnosis of Attention Deficit Hyperactivity Disorder is not the only problem.

Under-diagnosis of Attention Deficit Hyperactivity Disorder is also a problem. This happens most often in the school setting where the school psychologist writes his report perfectly describing an individual with ADHD, then refuses to use the label "Attention Deficit Hyperactivity Disorder" in his report anywhere.
 
It also often happens in therapist's offices where the therapist is not familiar with the neurological aspects of Attention Deficit Hyperactivity Disorder, and only sees the characteristic behaviors as "acting out behaviors" due to family problems, rebelliousness, and so on. Therapists operating entirely from a "Family Systems" orientation are especially at risk for making this mistake, as I admit I did for my first two years in practice.

Some studies suggest that only one out of three people who have Attention Deficit Hyperactivity Disorder will ever get help. Two out of three people who have ADHD will never receive a diagnosis or treatment. They will never really know what it is that's bothered them through their life. So we have two problems. One is the over-diagnosis and the other is the under-diagnosis of Attention Deficit Disorder.

You can learn more about Attention Deficit Hyperactivity Disorder, its diagnosis and treatment, at the ADHD Information Library.

Douglas Cowan, Psy.D., is a family therapist who has been working with ADHD children and their families since 1986. He is the clinical director of the ADHD Information Library's family of seven web sites, including http://www.newideas.net, helping over 350,000 parents and teachers learn more about ADHD each year. Dr. Cowan also serves on the Medical Advisory Board of VAXA International of Tampa, FL., is President of the Board of Directors for KAXL 88.3 FM in central California, and is President of NewIdeas.net Incorporated.