What are the key elements of a comprehensive assessment & evaluation required to establish an AD
After several years of research and study, scientists have labeled ADHD (Attention Deficit Hyperactivity Disorder) as a range of behaviors for which there might be various underlying causes. ADHD cannot be diagnosed simply by talking to the person or deduced from a brief office observation.
There is no particular physical, medical, or genetic test for ADHD. However, a diagnostic evaluation can be performed by a qualified psychologist, physician or clinician who collects data from multiple sources. These sources can include a detailed report of past and current functioning, standardized behavior rating scales, ADHD symptom checklists, and data gathered from family members, parents/caregivers, teachers, and colleagues, etc.
In the assessment and diagnosis of ADHD, a wide range of qualified clinicians may be involved, such as psychologists, behavior analysts, or counselors who have the required expertise and training. Some clinicians will also conduct tests of academic performance and cognitive (thinking/reasoning) ability in order to rule out the possibility of learning disability.
An evaluation for ADHD varies to a certain degree depending upon specific issues, presenting problems, and assessment aims. However, there are some key components to a thorough ADHD evaluation that are important to consider.
Let us look at some important components of a comprehensive evaluation for ADHD:
Observations and History
Observing the child’s functioning directly in various settings is critical for making a diagnosis. The behavior of the child during an office visit is often not indicative of how that same child behaves and performs in his/her house, classroom, playground, mall, or any other natural setting. That’s why direct observations are made in natural environments where the child spends most of his/her time (example, school, playground, or home).
A thorough study of the history of the child is important for ADHD evaluation, as well. It provides significant insight into the child’s behavior. Historical data can be acquired by interviewing parents using questionnaires (generally filled out through an interview with the parents), and a review of former school and medical records.
Clinical Testing & Interview
Clinical interviews and testing aim to identify the existence of other ailments with symptoms that overlap with those of ADHD.
A clinician will spend time talking with the child, parents, any relevant family members, and school professionals. The interview is crucial in ascertaining perceptions and to understand his/her family and the environment in which the child engages. Apart from this, current concerns, history of those concerns, academic and medical history, developmental and psychiatric history, psychosocial functioning, and family history, will all be explored and discussed thoroughly.
Behavioral Rating Scales
One of the most important components involves the use of behavioral rating scales which helps in assessing ADHD symptomatology, general behavior, and psychological functioning. Such scales consist of extensive checklists and rating scales which serve to objectify observations made about the child’s behavior across a variety of settings. This scale may be given to the child (depending on the child’s age), parents, teachers, and other relevant adults in contact with the child, to complete.
Rating scales indexes many items that the parent or teacher can rate according to the frequency they observe the child displaying those specific behaviors. These scales are helpful in determining the degree to which various ADHD-related symptoms or behaviors are observed in different basic environments (school/home). Along with parents and teachers, rating scales can be answered by people who spend a significant amount of time with the child (e.g. relatives, neighbors, childcare providers, etc.)
The rating scales and questionnaires come in wide variety of use by evaluators in gaining data from teachers and parents. Some examples are: ADD-H Comprehensive Teachers’ Rating Scale (ACTeRS), Vanderbilt Assessment Scale, Child Behavior Checklist, Conners' Parent and Teacher Rating Scales, etc.
Gathering Important Information
School: Another fundamental part of the diagnostic process involves reviewing data provided by the school. This will shed light on past and current student performance-- socially, behaviorally, and academically. Information gathered by teachers on the child's school performance as compared to other children of the same age, is a key element.
Teachers may be requested to report their observations about the child, through questionnaires, rating scales, interviews, narrative statements, or other related methods.
Academic & Medical Records: As part of data collection steps of the evaluation, it is crucial to provide the treating behavior analyst or clinician with relevant medical records, academic records, and results of any former psychological testing or evaluation.
A thorough review of the child’s report cards, classroom work samples, standardized test scores, and teacher/parent/student report can give a rough estimate about the child’s cognitive ability.
If the child experiences difficulties in learning and struggles academically, a full psycho-educational evaluation needs to be done. This helps in determining academic performance levels and understanding how the child learns more accurately.
To establish whether the child has a learning disability, a psycho-educational assessment must be administered. This typically involves assessment of thinking and reasoning abilities, an array of individualized performance tests to deduce academic strengths and weaknesses, and various processing tests (such as visual-motor integration, measuring memory, sequencing skills, etc.). More often than not, a communication assessment measuring language skills is required as well.
Psychological & Neuropsychological Testing
Neuropsychological testing helps in excluding any potential coexisting psychiatric conditions. Such testing provides information that helps in understanding learning style, academic performance, cognitive strengths and weaknesses, intelligence, and emotional functioning.
Here are several clinicians who are trained in the diagnosis and treatment of ADHD in children. In seeking their services, it is important to be attentive and ask questions related to their specific expertise in working with people with ADHD. Before making an appointment for your child, it is wise to ask the clinician/evaluator about their assessment procedures and be sure that they engage in a comprehensive ADHD evaluation process.