Whatever the specialist's expertise, his or her first task is to gather
information that will rule out other possible reasons for the child's behavior.
In ruling out other causes, the specialist checks the child's school and
medical records. The specialist tries to sense whether the home and classroom
environments are stressful or chaotic, and how the child's parents and teachers
deal with the child. They may have a doctor look for such problems as emotional
disorders, undetectable (petit mal) seizures, and poor vision or hearing. Most
schools automatically screen for vision and hearing, so this information is
often already on record. A doctor may also look for allergies or nutrition
problems like chronic "caffeine highs" that might make the child seem overly
excerpted from Attention Deficit Hyperactivity Disorder
National Institute of Mental Health
NIH Publication No. 96-3572, Printed 1994, Reprinted 1996
Next the specialist gathers information on the child's ongoing behavior in
order to compare these behaviors to the symptoms and diagnostic criteria listed
in the DSM (Diagnostic and Statistical Manual of Mental Disorders). This
involves talking with the child and if possible, observing the child in class
and in other settings.
The child's teachers, past and present, are asked to rate their observations of
the child's behavior on standardized evaluation forms to compare the child's
behaviors to those of other children the same age. Of course, rating scales are
subjective--they only capture the teacher's personal perception of the child.
Even so, because teachers get to know so many children, their judgment of how a
child compares to others is usually accurate.
The specialist interviews the child's teachers, parents, and other people who
know the child well, such as school staff and baby-sitters. Parents are asked
to describe their child's behavior in a variety of situations. They may also
fill out a rating scale to indicate how severe and frequent the behaviors seem
In some cases, the child may be checked for social adjustment and mental
health. Tests of intelligence and learning achievement may be given to see if
the child has a learning disability and whether the disabilities are in all or
only certain parts of the school curriculum.
In looking at the data, the specialist pays special attention to the child's
behavior during noisy or unstructured situations, like parties, or during tasks
that require sustained attention, like reading, working math problems, or
playing a board game. Behavior during free play or while getting individual
attention is given less importance in the evaluation. In such situations, most
children with ADHD are able to control their behavior and perform well.
The specialist then pieces together a profile of the child's behavior. Which
ADHD-like behaviors listed in the DSM does the child show? How often? In what
situations? How long has the child been doing them? How old was the child when
the problem started? Are the behaviors seriously interfering with the child's
friendships, school activities, or home life? Does the child have any other
related problems? The answers to these questions help identify whether the
child's hyperactivity, impulsivity, and inattention are significant and
long-standing. If so, the child may be diagnosed with ADHD.
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