ADHD Diagnosis - How an Expert Makes a Diagnosis
For adults diagnosing ADHD requires a thorough assessment by a specialist in the disorder. They'll likely inquire about your past and perform a physical examination. They'll also rule out any conditions that can mimic ADHD such as mood disorders, learning disorders or thyroid issues.
The doctor will ask you about your childhood behavior, since the American Psychiatric Association's guidelines stipulate that ADHD in adults cannot be diagnosed unless there is evidence of childhood symptoms. This could include finding your school records and contacting previous teachers and coaches or religious leaders.
Symptoms
If you or someone you love struggles to keep up with school, work, or home, has difficulties remembering important dates and appointments, or can't seem to get organized it could be that you suffer from ADHD. A health care provider's evaluation can help you determine if this is the case and, if so what the treatment options are.
The symptoms must be present in at least two settings (school and at home, for instance) and for at least six months to satisfy the criteria for an ADHD diagnoses. The symptoms should also be impacting your ability to perform for instance, in class, in forming close relationships or in working in a group. It's crucial to understand that everyone struggles to stay organized and paying attention at times, but these problems are more severe in the case of ADHD.
To make a diagnosis, your provider will interview you and ask you questions about your behavior and how it's affected your life. The providers will also examine your family history and any previous medical or psychological tests you've taken. They will look for health issues, such as thyroid disorders and seizure disorder, which can cause similar symptoms to ADHD.
Your doctor will ask you whether you've had symptoms in your childhood (technically before age 12). They'll also be interested in how your symptoms impact you today and how they have affected you in the past. They'll also be interested in knowing whether you've been diagnosed with ADHD before.
It's helpful to bring a list of symptoms to the appointment, particularly if you've written them down. This will help you remember them and give your physician a an accurate description of how your symptoms affect you. You may also bring in old records, such as old reports or performance evaluations. Having these records can help your provider determine whether ADHD has been a problem for you throughout your entire life or if it began just recently. These records can help your provider determine if there are other issues, such as anxiety and depression that have similar symptoms as ADHD.
History
In the past, ADHD has been viewed as a flaw in character. However, with advances in diagnosis and treatments, more children are being diagnosed and the stigma surrounding the disorder is fading away.
Sir George Frederick Still gave a series of lectures in 1902 at the Royal College of Physicians. He shared his observations of children who were unfocused or who were unable to focus. He also noted that the symptoms were more common in boys than girls, and were not related to the quality of education or home environments. The report is often credited as the beginning of the formal recognition of ADHD.
The initial version of the psychiatric manual published in 1952 by the American Psychological Association (APA), did not include ADHD. In 1955, however, the US FDA approved stimulant drugs which were prescribed as the primary treatment for ADHD. The APA published its second edition in 1968, and listed several mental health conditions. It included the symptoms of ADHD even though they were still classified as hyperkinetic reaction in childhood.
In 1994 the fourth edition of psychiatric book was released. This led to a greater understanding and acceptance of ADHD. Its name was changed to Attention Deficit Disorder with or without hyperactivity and the standard definition of three types of ADHD symptoms was established: mostly inattentive, mainly hyperactive-impulsive, and combined. The current DSM-5 defines these as presentations, not distinct types, and says that they could change over a person's life.
NICE (National Institute for Clinical Excellence) has released guidelines on ADHD in adults in 2008. It was the first time that the UK as an entire recognized adults suffering from ADHD by providing them with funding, healthcare assistance and guidance. SIGN (Scottish Intercollegiate Guidelines Network) has also released guidance on ADHD among children. These two documents are the sole official NHS recommendations regarding the condition in Scotland. Read Home and non-profit organizations have also developed guidelines. In recent times there has been a growing interest in the biological causes of ADHD, and researchers have begun to find the genes that cause it. This knowledge will help in the future to develop more targeted and effective treatments.
Physical Exam
A specialist in ADHD conducts an extensive assessment to make a diagnosis. It doesn't matter if they are a physician who specializes in mental health (such as a psychologist or psychiatrist) or an individual doctor who is trained in child and youth health (a paediatrician) They will need to gather details about the person's past including the family, educational, work and social histories. They may review old school records or talk to coaches, teachers, and other professionals that know the person. They will inquire about the symptoms and how they interfere with life. They will also look at how symptoms have changed over time.
The Diagnostic and Statistical Manual of Mental Disorders Fifth Edition of the American Psychiatric Association defines the criteria to diagnose ADHD in children and adults. To meet these criteria, the symptoms of inattention and hyperactivity-impulsivity must be present in multiple settings, cause significant impairment and have started before age 12. A customized questionnaire to the particular situation will be administered by the specialist to interview the patient about their symptoms. They will also use different ratings scales to assess different aspects ADHD symptoms. Some of these ratings will be built on the Brown Attention Deficit Disorder Symptom Assessment Scale For Adults, while others will be based on different criteria, including questions like "Do you find it difficult to sit still?" and "Do you struggle to manage your activities or work?"
They will conduct a physical exam. They will look to determine whether there are any medical issues that could be causing or making the symptoms worse for example, thyroid dysfunction or vision and hearing issues. They will also inquire with the person about their dietary and lifestyle habits to determine if these may be contributing to the symptoms.
Anyone who is being assessed for ADHD as an adult may be asked to fill out an assessment with their partner or another close friend. This will allow for a greater understanding of the person that checklists and questionnaires can't provide. This is especially beneficial for people with comorbid conditions such as depression or anxiety which are often associated with ADHD and make the symptoms harder to identify.
Psychological Evaluation
If a health care professional who is evaluating a child or adult for ADHD begins by interviewing them, they ask a series of questions regarding how the symptoms impact their daily lives. They also go over the patient's mental health as well as family history.
They may ask for an original copy of the student's report cards or school records, especially those from kindergarten through high school. They can also request copies of any previous psychological or neuropsychological tests, including the results of IQ tests and assessments for learning disabilities.
Typically the psychologist, psychiatrist or a social worker conducts the interview portion of an evaluation of the severity of adhd. In addition, they might interview friends, family members and teachers as well. It is important to have thorough evaluations because those who are not treated for ADHD can experience serious problems, including financial issues (impulsive spending), marital difficulties or failure at college or other educational institutions.
During an interview, the provider may ask the patient to complete standardized behavior rating scales which are designed to help identify ADHD symptoms. These questionnaires are based upon research that compares the behavior of those suffering from ADHD to those of people who do not suffer from the disorder. These ratings are not an indication of ADHD but they play an important aspect of the evaluation process.
It is crucial to examine the person to determine if they have other conditions that could have similar symptoms as ADHD. These include sleep disorders, mood disorders and substance abuse as well as medical illnesses such as thyroid disease or brain injuries. These conditions are more likely to respond to certain treatments, therefore it is crucial that a proper diagnosis is made and the appropriate treatment is provided.
To be considered to have ADHD, either a child or an adult must meet the criteria in the Diagnostic and Statistical Manual of Mental Disorders. They must show symptomatic behavior in two or more environments like school, home and work, and the symptoms must be affecting their life functioning. The symptoms must have appeared in childhood and a psychiatrist must verify that the disorder was not caused by an illness of the mind or other co-occurring conditions.