I’ve been offering psychological assessment in private practice for a while now and I would say ADHD evaluations are one of the most common reasons people call me for testing. Add to this 4 plus months of COVID-19, between the new routine, being cooped up at home, and parents shouldering a great deal of the burden associated in at-home learning, I am seeing a rise in parents asking about ADHD in their children. With that, I wanted to write a series of short blog posts about ADHD, what it is and isn’t, how we diagnose and treat ADHD, and what some other possible causes of these symptoms may be.
Let me start with this, I am very clear that having a child with attention issues, who doesn’t seem to follow directions well, or settle down very often, is super taxing and exhausting for parents! It’s stressful, confusing, or perhaps even elicits a bit of shame or guilt in your parenting methods. Please hear me when I say that this is a complex struggle, and your feelings are totally valid. As a professional, I want to help! For that reason, I am a proponent of ADHD diagnoses only after a very thorough evaluation so we can really get it right! Yes, a good evaluation helps us know what the diagnosis is, but more importantly, a good evaluation helps us understand how to best treat it.
I wanted to start this series by talking about what Attention-Deficit/Hyperactivity Disorder (ADHD) actually is and how we categorize it. Our big fancy book of mental health diagnoses (DSM-5) says that ADHD is a persistent pattern of either inattention, hyperactivity-impulsivity, or a mix of both, that interfere with a person’s daily functioning in areas like social and academic activities.
Inattentive symptoms are those that result in a child daydreaming, getting distracted from a task, or having difficulty organizing things (beyond what we may expect for their age).
Hyperactive symptoms can look like anything from the stereotypical child running around a classroom during science class to simply having a hard time sitting still and fidgeting in their chair. Excessive talking and difficulty sleeping can also fall into this category.
Impulsivity is what it sounds like, impulsive actions or decision-making. That being said, we want to distinguish between levels of impulsiveness that are expected and those that may be severe or socially inappropriate, and causing a significant issue in functioning. Things like making dangerous choices without thinking or repeatedly interrupting others while they are talking may be common for those with impulse control struggles.
In children, we look to see several symptoms of inattention or hyperactivity (6 symptoms to be exact) that have been around for at least 6 months… and that show up in more than one setting (e.g., not just at school or not just with friends). Another important caveat is that in ADHD, symptoms must be present prior to the age of 12-years-old. Even when I’m doing a diagnostic evaluation for an adult, when we’re exploring ADHD, I’m going to be asking about what symptoms may have been present from when they were younger than 12! Interesting, right?
I plan to do some “fascinating facts” about ADHD in an upcoming post (at least they are fascinating to me), but for a teaser, we estimate that about 10% of children in the US are diagnosed with ADHD. To put that into some easy math- in a class of 20 children, we would estimate that approximately 2 of these 20 children would meet criteria for clinical ADHD.
Dr. Morel, what do you mean by “clinical” ADHD? Remember earlier when I was talking about the number of symptoms, how long the symptoms have been around, where they are showing up, how impairing the symptoms are? All of these things need to meet a certain set of criteria for a symptom to meet the clinical threshold for diagnosis; clinical is another way to say significant or severe. Here’s another example for you. Someone feeling a bit down or unmotivated for a few weeks (especially if we think about during times of COVID-19) would likely not meet criteria for clinical depression. While we could say they are experiencing some symptoms of depression, the diagnosis of major depressive disorder is probably not warranted. Or, you may experience high blood pressure for a few weeks while taking a certain medication… or when you get very angry at the football game on TV, but your medical doctor would likely not categorize you as someone having chronically high blood pressure.
In the mental health profession, we look for very specific things and when it comes to an ADHD diagnoses, this can be complicated by so much (more to come soon on this). That’s one of the reasons that I highly recommend a formal ADHD evaluation prior to beginning treatment, be it medication or therapy, and why it’s extremely common for medical doctors and mental health providers to collaborate closely on this issue. We want to truly understand what’s going on for you or your child, diagnose it appropriately, and move quickly towards effective treatment.
In my next post later this week, I plan to share about some things that can disguise as ADHD. This is perhaps the topic I’m most passionate about in ADHD evaluations, because if we miss them, we risk ineffective or even possibly harmful treatment decisions! Yikes. Let me know in the comment what questions you may have about ADHD and I will address them in an upcoming post.
– Dr. M
P.S. – If you are ready to take next steps to get ADHD Treatment for your Child, Contact Me.
Samantha Morel, Ph.D.