ADHD Diagnosis (Attention Deficit Hyperactivity Disorder)

The Centers for Disease Control and Prevention (CDC) emphasize that a diagnosis of ADHD should only be made by trained health care providers, as many of the symptoms may also be part of other conditions, such as bodily illness or other physical disorders, such as hyperthyroidism or Obstructive sleep apnea. Further, it is not uncommon that physically and mentally nonpathological individuals exhibit at least some of the symptoms from time to time. Severity and pervasiveness of the symptoms leading to prominent functional impairment across different settings (school, work, social relationships) are major factors in a positive diagnosis.

Analytical Testing

Due to the lack of objectivity that surrounds the critical factors, many question the reliability of ADHD diagnosis. The American Academy of Pediatrics Clinical Practice publishes guidelines to aid providers in making an objective diagnosis, but even if strictly adhered to, doubt still remains among some patients, as well as providers. Other diagnostic methods, such as those involving magnetic resonance imaging (MRI), may detect the presence of ADHD by analyzing images of the patient's brain, are usually not recommended (see brain scans). In a majority of cases, diagnosis is therefore dependent upon the observations and opinions of those who are close to the patient; in many patients, especially as they approach adulthood, self-diagnosis is not uncommon.

Publications that are designed to analyze a person's behavior, such as the Brown Scale or the Conners Scale, for example, attempt to assist parents and providers in making a diagnosis by evaluating an individual on typical behaviors such as "Hums or makes other odd noises", "Daydreams" and "Acts 'smart'"; the scales rating the pervasiveness of these behaviors range from "never" to "very often". Connors states that, based on the scale, a valid diagnosis can be achieved; critics, however, counter Connors' proposition by pointing out the breadth with which these behaviors may be interpreted. This becomes especially relevant when family and cultural norms are taken into consideration; this premise leads to the assumption that a diagnosis based on such a scale may actually be more subjective than objective.

Clinical Testing

The American Academy of Pediatrics Clinical Practice Guideline for children with ADHD emphasizes that a reliable diagnosis requires

1. The use of explicit criteria for the diagnosis using the DSM-IV-TR.
2. The importance of obtaining information about the child’s symptoms in more than one setting (especially from schools).
3. The search for coexisting conditions that may make the diagnosis more difficult or complicate treatment planning.

A proper diagnosis is dependent upon a physician fulfilling all three of these criteria. The first criteria can be satisfied by using an ADHD-specific instrument such as the Conners Scale. The second criteria is best fulfilled by examining the individual's history. This history can be obtained from parents and teachers, or a patient's memory. The requirement that symptoms be present in more than one setting is very important because the problem may not be with the child, but instead with teachers or parents who are too demanding. The use of intelligence and psychological testing (to satisfy the third criteria) is essential in order to find or rule out other factors that might be causing or complicating the problems experienced by the patient.

Computerized tests

Computerized tests of attention are not especially helpful in providing a further independent assessment because they have a high rate of false negatives (real cases of ADHD can pass the tests in 35% or more of cases) (Barkley, 2006) they do not correlate well with actual behavioral problems at home or school, and are not especially helpful in determining treatments. Both the American Academy of Pediatrics and American Academy of Child and Adolescent Psychiatry have recommended against the use of such computerized tests for now in view of their lack of appropriate scientific validation as diagnostic tools. In the USA, the process of obtaining referrals for such assessments is being promoted vigorously by the President's New Freedom Commission on Mental Health.

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