I’ve hinted throughout this series about the importance of a thorough ADHD assessment. So now let’s talk about what that looks like! I’ll speak from my own experience. After 7+ years of graduate training, coursework, clinical supervision, assessment rotations, and countless hours reading assessment reports – this is what I think of when I think about a thorough ADHD assessments…
Psychological assessment (sometimes also called psychological evaluation or testing) is a broad term, and in general it is a process that involves integrating multiple sources of reliable information to answer specific questions. Within the scope of ADHD testing, these sources often include a combination of psychological and neurological tests as well as structured clinical interviews.
First, I like to begin the assessment process by gathering information from parents and caretakers. This includes everything from just a basic history, to mental health evaluation and some history on family (e.g., basic mental health history, relationships) and social dynamics. We especially talk about early developmental markers, any recent environmental changes and integrate other relevant demographic information. We also work together to explore questions related to symptoms and concerns: Are there times when the symptoms or behaviors are better? Worse? Does anything seem to help once they’ve started? Does it happen everywhere, or usually at “these” times.
At this point, I’ll often ask parents to complete assessments that are either paper-and-pencil or done online and ask them to consider their child’s behavior and rank things such as how frequent or severe the behaviors are, or how the child functions in everyday life. These don’t take long, but they are extremely informative! They provide another vantage point for similar information, and rating scales also allow us to see things a bit more objectively.
I typically request to consult with people like teachers, coaches, or Sunday School teachers to gather collateral information about how the child presents in these different settings. If the child’s been in therapy, I will always ask permission to talk with that provider and see how the child has responded to treatment. Things like what’s working well, and where does the therapist see room for growth would be typical for us to discuss. As an aside, it’s extremely common (and very helpful) for a therapist and assessor to collaborate and work together here… and it adds such depth to the assessment process when we can. All of these various sources are needed during a ADHD assessment, so we can better understand the child as a whole-person. This multidimensional perspective allows us to better understand the questions we are aiming to answer.
After all this, I FINALLY get to what someone might think of as the “actual” assessment. Of course that’s not true. All the previous time was surely “actual” assessment, but during this next phase, this is when I would sit down with the child. Depending on the developmentally appropriate practice for their age, I will typically engage with the child in some sort of structured interview to explore their self awareness and understanding of their struggles. Just as an example, questions like, “Tell me about school- what are your favorite parts and what are some not so favorite parts?” and “Does it seem like you get in trouble for lots of things?” or “Gosh, seems like it might be hard to pay attention sometimes?” are great ways to get kids to open up.
The rest of the assessment time consists of what your child would probably describe as games. One that is commonly used is conducted over computer and asks them to pay attention and respond to certain stimuli over the course of several minutes. Other “games” we might play use blocks to manipulate and follow directions. I also always include some tests of visual-motor functioning and visual perception (to help rule out other possible issues). If it is testing for ADHD only, the session with the child usually ranges from 2 to 4 hours. If we are also exploring psychological or intellectual/academic concerns, the time may be much longer. In that case, I request that we break it up into two sessions. Nobody can sit still much longer than 3 or 4 hours… including me 🙂
Once I have all of this information, then I kind of hunker down and try to understand what it means. How do all the pieces of the puzzle fit together? What is the most clear diagnosis based on the information? And then, I use all of that to do what I find to be the most important and exciting part of assessment work… I provide detailed suggestions on how to improve or move forward! These can range from anything from suggestions to changes in the home or school environment, approaches to therapy, recommendations for medication, or accommodations at school.
Finally, no good ADHD assessment is complete without a feedback session. It’s so important that you understand what all of this means, and so I have a feedback appointment to explain the findings, clarify any last minute uncertainties (on either of our ends), and answer any of the client/parent’s questions about the information. It’s important to me that you leave feeling like you have an idea of what’s going on and where you might be headed! Providing feedback could also include circling back to the teachers or treating therapist working with the child, helping them understand and integrate the report findings into whatever their interactions may be with the child. After this, I give you a report with it all typed up and clearly explained that you can use as a reference and/or in seeking specific services.
“But Dr. Morel- what if you determine that it’s not ADHD?” If I have ruled out ADHD, it’s usually for one of two reasons.
#1 The symptoms do not meet the diagnostic threshold (see part 1 of this series) or
#2 because I have clear evidence that something else makes more sense as a diagnosis (see part 2 of this series).
In either case, I’ll have enough information to provide relevant feedback and suggestions about how to work on those issues.
And there ya have it! After doing this for sometime, it makes me so wary of anyone who would hand out a nine-item questionnaire and then diagnose ADHD. A nine item questionnaire might be a great screener, or highlight the need to do further assessment, but it really shouldn’t be used as the sole basis of a diagnosis. While it may not be simple, I hope this explanation was straightforward enough…. yet highlights how complex a thorough assessment can and should be.
Now that we are done discussing ADHD Assessment, we have two more posts in the series to go- Treatment and some ADHD Fun Facts!
– Dr. M
P.S. – If you are ready to take next steps to get ADHD Assessment for your Child, Contact Me.
Samantha Morel, Ph.D.