All “mental health conditions” are diagnosed by examining criterion established in the Diagnostic and Statistical Manual-Fourth Edition (DSM-IV).  This manual provides a sort of checklist that can be used by physicians, psychologists, and other mental health workers to determine if an individual is experiencing clinically significant difficulties related to a certain condition. 

The diagnostic criteria for ADHD are listed as follows:  

1. Either (1) or (2):

(1) six (or more) symptoms of inattention for at least 6 months to a degree that is maladaptive and inconsistent with developmental level:

(2) six (or more) symptoms of hyperactivity-impulsivity for at least 6 months to a degree that is maladaptive and inconsistent with developmental level:       

 

So, essentially, and technically, if a child (or adult) meets these criterion as determined by an appropriate licensed professional than they can be diagnosed with ADHD. 

Consequently, what frequently happens is this diagnosis is given after a brief interview with the parent and observation of the child in the consultation room during the time of an initial appointment.  While this is sometimes sufficient, it can also lead to misdiagnoses.  

A quick look will show that these symptoms are very subjective and are shared by a number of other possible concerns.  For example, a child may “often fidget with hands or feet or squirms in seat” for a variety of reasons.  It is possible that the student is anxious in the classroom.  It is possible that the student is overstimulated.  It is possible that they are bored.  It is possible that they have incomplete early childhood reflexes.  It is also possible that they have an attention-based disorder. 

What this means is that children with a learning disability, anxiety, environmental stress, significant life changes, depression, or above average intelligence or creativity may show some (or many) of the traditional  symptoms of ADHD.  So….just looking at the symptoms may give a faulty impression.  

The best practice is to have the child evaluated by a child psychologist.  A full evaluation will examine all of the above possibilities and include a thorough interview of parents, some form of input from school teachers, behavior checklists from multiple respondents and objective testing. 

Objective testing may include a computerized test of attention, such as the TOVA, IVA, or Conners’ CPT II.  These tests ask the respondent to complete a computerized assessment that measures attention span and impulse control.  The results of their performance are compared to other same-age children who have (and have not) been diagnosed with ADHD. These tests are often an excellent screening tool for ADHD (they can also be useful in determining the best dose for medication if this intervention is pursued). 

Other objective testing might include a Quantitative EEG (Qeeg), or a “mini-qeeg.”  These tests measure the student’s brainwave activity in multiple conditions (e.g., eyes closed, eyes open, while reading, and completing math problems).  The results are compared to research to determine if their brainwave patterns are consistent with ADHD (or another possible disorder).  In short, it has been found that many children (and adults) with ADHD have a higher than normal ratio of slow to fast brain waves when measured in this way.  Research using this technique has been up to 98% accurate in predicting ADHD based on the brainwave pattern.  

Another important reason to consider a thorough evaluation is because the majority of persons diagnosed with ADHD also have at least one other condition.  Meaning, most persons with ADHD also have other diagnoses.  The most common diagnoses co-occurring with ADHD include Learning Disorders, Oppositional Defiant Disorder, Anxiety, Depression, and Tic Disorders.  A thorough evaluation provides a more accurate diagnosis, which in turn can be critical for successful treatment.  

The following chart shows that only 31% of persons diagnosed with ADHD have only that diagnosis.  The remaining 69% have at least one of the other conditions listed.  The reason the percentages do not add to 100% is because some people with ADHD have several diagnoses (e.g., a learning disorder and oppositional defiant disorder).  These facts make it very important that persons with ADHD receive a thorough and accurate assessment.