I am often asked why
it is necessary to do such a comprehensive assessment for the evaluation
of ADHD. It seems like an easy diagnosis - why does it involve so
many tests and so much time? In order to answer that question, we
need to look at the reasons that a parent would want an assessment
in the first place. There are five main reasons for getting an assessment:
To identify the ADHD behaviors and determine their magnitude.
To be honest, this is the easiest part of any assessment. In fact,
most parents already know if their child is not paying attention
at home or in school, if the child's behavior is impulsive, or
if she seems overactive or forgetful. Of course, it is important
to see how that child compares to other kids her age to determine
whether the extent of the problem is unusual. To do this we rely
on parent reports and teacher reports and compare their assessment
of the child to other kids. But, again, this is not particularly
difficult and is often something the parent or teacher can tell
the psychologist before any testing is done at all. The primary
symptoms of ADHD are available on the internet: look them up,
and if your child fits the criteria you do not really need to
spend a lot of money to find this out. It makes no sense to pay
a professional money to find out what you already know, so an
assessment should not just tell you that your inattentive child
is not paying attention. That's like going to a doctor to find
out that your leg is hurting because of the pain in your leg.
If your leg hurts, you don't need to go to a doctor to find out
that it hurts. You need to go to a doctor to find out why it hurts
and what to do about it. Even if you know that your child is behaving in ways that fit
the ADHD criteria, you really do not know why. There are many
reasons that a child can appear to be inattentive, hyperactive
or impulsive, and many of them are not immediately apparent to
parents and teachers. For example, many kids are overly sensitive
to background noise, which is common in most classrooms. Such
a child might be very verbally able and understand everything
that is said to him but may be "spacing out" in class
because the background noise interferes with what the teacher
is saying and he is struggling to understand. The same child might
be acting out at home because of the stress of a frustrating schoolday.
Other children may have hidden processing problems that make schoolwork
so difficult that they quickly wear themselves out and have problems
concentrating. They appear tired or inattentive or resistant,
not because they have ADHD but because they have been working
too hard. Some kids react to depression or anxiety by exhibiting
exactly the symptoms that describe ADHD. Thus, the diagnosis becomes
a bit more tricky. For example, since depression or anxiety are
experienced by many kids who are having problems at school, we
are faced with a problem of "which came first, the chicken
or the egg?" Is ADHD causing anxiety, or is anxiety causing
attentional problems? It is very important for a professional
to look at all the possible reasons for ADHD behaviors and to
rule them out as causes or to tease out the interaction between
the symptoms. It is also important to note that research indicates
that as many as 50% to 70% of children with ADHD also have some
other learning disorder or diagnosable emotional problem. For
this reason, to diagnose ADHD without looking at these other factors
is simply irresponsible. (Incidentally, the same degree of thoroughness
is necessary for the diagnosis of learning disorders. Clearly,
the fact that many learning disorders are not immediately apparent
means that every attempt should be made to look at all aspects
of a child's cognitive development. Just knowing that a child
can't read, for example, does not tell you why he can't read.) A good assessment does not just tell you what is wrong with
your child. A good assessment also measures her strengths. It
is important that you, your child, and your child's teachers all
have a good understanding of your child's gifts, as well as her
weaknesses. Not only is this essential to the child's self-esteem
and acceptance of problem areas, but it also is useful because
a child (and a good teacher) can use those strengths to compensate
for the areas of difficulty. All too often, a child is very aware
of what she can not do as well as her peers, but doesn't realize
how well she compares in other areas. An assessment should reflect
the child as a whole human being, not simply report on her deficiencies.
A good teacher will focus on each child's unique learning style,
which includes both strengths and weaknesses. For many kids with ADHD, medication is one very effective strategy
for addressing the problems. But research has shown that medication
alone never completely solves the problems associated with ADHD.
At best, medication is only one of a number of things that should
be looked at when a child has ADHD. A good report should include
a number of specific recommendations for home and for school,
including other strategies that can be used by the child, his
parents and his teachers to make the problems associated with
ADHD more manageable. Educational and emotional success may depend
just as much on the child developing a repertoire of strategies,
the parents helping to foster a positive attitude, and the teacher
implementing specific structures, as it does on a certain dosage
of psychotropic medication. Unfortunately, children are often
being put on medication to "cure" ADHD without addressing
these other very necessary strategies. One of the most pragmatic reasons to have a child assessed is
to be able to present information to a teacher, school or doctor
in the future. Thus, other professionals will be looking at the
report to determine its credibility. A report that has diagnosed
ADHD based on slim evidence and without examining other possible
causes for the ADHD behaviors will not be very convincing, especially
to professionals who understand the complexities of the diagnosis.
If you plan to use the report to inform, educate or convince other
professionals, you will need a report that is believable and complete.
It may seem cheaper and easier to get an assessment from someone
who will spend a couple of hours with your child and give you a
diagnosis. But this is no substitute for a good assessment. You
are often left with the necessity of getting a complete assessment
later, either because problems persist or because the first report
is not accepted by a school or another professional. In the meantime,
possible other factors such as processing problems or emotional
distress may not have been appropriately addressed and may have
become more serious. Even if it seems more cumbersome, it makes
much more sense to get all the information you need to address the
problems that exist now, and a good report to use in the future
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