What are early signs of Attention-Deficit/Hyperactivity Disorder?

• Parents or caregivers who have a child with ADHD often notice early differences in their child’s behavior, such as excessive energy and/or a high level of physical movement. However, it is challenging to differentiate potential symptoms of ADHD from highly variable normative behaviors seen in toddlerhood. While children can be diagnosed as early as 4 years of age, most receive diagnoses during their elementary school years.

• In preschool, symptoms of ADHD are usually most clearly manifested through symptoms of hyperactivity (e.g., excessive and often impulsive physical activity, restlessness, difficulty in remaining still or calm). Symptoms of inattention (e.g., difficulties in maintaining focus, sustaining attention, and staying organized) may become more prominent when the child reaches elementary school.

What if my child is older?

Some individuals with ADHD may not show clear impairment until they are older. This can occur for a variety of reasons:

• A changing school environment: The transition to middle school or high school often involves a more structured and demanding educational environment. This change can place greater expectations on students to focus and self-regulate, making ADHD-related challenges more evident.

• Academic struggles: Adolescence is a period when academic demands intensify, and students are expected to manage multiple subjects, assignments, and responsibilities. As a result, students with undiagnosed ADHD may start to struggle academically, prompting closer examination.

• Increased independence: As adolescents gain more independence and autonomy, they may experience greater difficulties in managing their ADHD symptoms. This can lead to more noticeable challenges in daily life.

• Gender Differences: Symptoms of ADHD may present differently in boys and girls. Often, girls with ADHD are underdiagnosed due to their symptoms being less overt or disruptive.

• Social and behavioral challenges: Adolescence is a time of increased social complexity and peer interactions. Adolescents with ADHD may face difficulties in forming and maintaining friendships, controlling impulsivity, and following social norms, which can raise concerns.

• Coexisting conditions: ADHD can coexist with other conditions, such as Anxiety, Depression, and Learning Disabilities. These comorbid conditions can complicate the diagnostic process, as their symptoms may overshadow those of ADHD.

When should I seek assessment?

Parents should consider seeking assessment for their child when they observe persistent symptoms of ADHD that interfere with the child's daily life, relationships, and overall functioning. Here are some indicators of when parents should seek an assessment:

• Symptoms are observed across multiple settings: If a child consistently exhibits ADHD symptoms at home, school, during extracurricular activities, and in social settings, it suggests that the symptoms are not isolated incidents but are affecting various aspects of the child's life.

• Symptoms persist over time: When symptoms of inattention, hyperactivity, or impulsivity persist for six months or longer and are not a temporary phase or related to a specific life event.

• Academic performance is impacted: If a child's ADHD symptoms are significantly affecting their academic performance, including difficulties in completing assignments, following instructions, staying organized, or focusing on classroom tasks.

• Challenges in social interactions are observed: When ADHD symptoms interfere with a child's ability to form and maintain age-appropriate friendships, follow social norms, or control impulsive behaviors that can lead to conflicts.

• Behavioral concerns are present: If there are behavioral concerns, such as frequent temper outbursts, difficulty following rules, impulsivity, or defiance, that go beyond what is typically expected for a child's age.

• Family and caregiver concerns: When parents or caregivers consistently notice symptoms that cause concern, frustration, or disruption within the family dynamic.

• Educator and teacher concerns: If teachers or school staff express concerns about a child's behavior, attention, or academic progress, it may indicate the need for an assessment.

• Safety concerns: If a child's impulsivity or hyperactivity poses safety risks, such as running into traffic or engaging in risky activities without considering the consequences.

• Quality of life: When ADHD symptoms negatively impact a child's overall quality of life, including their self-esteem, self-confidence, and emotional well-being.
  

Why should I seek assessment?

There are many reasons why assessing an individual for ADHD is critical:

• Accurate diagnosis: An accurate diagnosis is the first step in effectively managing ADHD. A psychological assessment conducted by a trained professional helps to confirm whether a person meets the diagnostic criteria for ADHD or if there are other underlying issues contributing to their symptoms.

• Differentiating from other disorders: ADHD symptoms can overlap with those of other conditions. A comprehensive assessment can differentiate between conditions, ensuring that individuals receive appropriate treatment and support.

• Understanding coexisting disorders: ADHD may coexist with other conditions. Identifying these comorbidities through assessment allows for a comprehensive treatment approach.

• Tailored treatment plans: An ADHD assessment provides valuable information about the individual's specific strengths and challenges. This information is critical for developing a personalized treatment plan that may include behavioral interventions, psychoeducation, medication, and other supports tailored to the individual's needs.

• Educational support: In educational settings, a formal ADHD diagnosis can lead to the development of an Individualized Education Plan (IEP) or a 504 Plan, which outlines specific accommodations and support services to help the student succeed academically.

• Access to services: Many individuals with ADHD may be eligible for support services and accommodations in school or at work, but these often require a formal diagnosis. Accessing these services can be crucial for academic and occupational success.

• Family and caregiver support: Psychological assessments can help parents and caregivers better understand their child's needs and challenges. This understanding can improve family dynamics and interactions.

• Self-awareness and coping strategies: For older individuals with ADHD, a formal diagnosis can promote self-awareness. It can help them understand why they experience certain challenges and provide them with strategies to manage symptoms and succeed in various aspects of life.

My child already receives special education services as a child with Autism at school – why do I need an outside evaluation?

If you have a child who has received a school-based assessment of ASD, you may wonder why additional assessment is necessary. You should know that a school-based assessment is used to determine the child’s educational eligibility for services at his/her school (requirements may vary by state). However, even if your child meets criteria for special education services under the disability eligibility category of Autism, this does not equate to a medical diagnosis of ASD. A medical diagnosis of ASD (typically given by a psychologist or a developmental pediatrician) is based on diagnostic criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). This medical diagnosis will help to qualify your child for services, such as Applied Behavior Analysis (ABA) therapy.

How is Attention-Deficit/Hyperactivity Disorder assessed?

An experienced professional, such as a psychologist, should gather information from multiple sources. A good psychological assessment should include:

• A parent/caregiver interview,

• Parent/caregiver and teacher questionnaires, including behavioral rating forms,

• A review of any relevant paperwork, 

• Behavior observation of the child,

• and direct testing with the child, including various neuropsychological tests.

What should I do to prepare for an assessment?

• A critical component of the assessment process includes an interview with the family. For young children, the psychologist speaks with the parent(s) or caregiver(s). Older children may be included in the interview process. The psychologist will want to know about your child’s behaviors when he/she was younger, as well as his/her current behaviors. Many families choose to write down questions or topics they want to bring up in preparation for their appointment.

• If your child has received any previous evaluations or has a history of services (e.g., therapies or school services, such as an Individualized Education Program or 504 Plan), your psychologist will want to review this information. Bring in relevant copies on the day of your assessment.

• The psychologist will want to do direct testing with your child. Make sure your child is prepared for the day. Try to make sure they get a good night’s sleep beforehand, and do not bring them in hungry. You may want to bring in other items to keep them comfortable throughout the appointment (e.g., snacks, drinks, preferred toy(s), a jacket in case the office gets too cold).

• You will have a follow-up appointment with the psychologist. During this appointment, results of the evaluation will be discussed in detail. This will include a description of the tests used, testing results, a discussion about diagnoses, and recommendations. Remember, the psychologist is there to answer any questions you have, so you are encouraged to ask questions.

Resources for families

Families can access a variety of resources to support their child. While the following resources are offered, remember that each child with ADHD is unique, and what works best for one may not work for another. It's crucial to work closely with professionals and adapt strategies based on your child's individual needs and strengths. 

• Build your team: Once your child has received a diagnosis of ADHD, work with a team of medical professionals, which may include your child’s pediatrician, a developmental pediatrician, or a child psychiatrist. These professionals can provide treatment recommendations, medication management, and ongoing support.

• Seek therapy: Psychotherapy or counseling can be beneficial for children with ADHD and their families. Work with your provider to determine what type of therapeutic approach would work best for your child. For young children, approaches should include a parent training component.

• Educational support: Collaborate with the child's school to access special education services, such as an Individualized Education Plan (IEP) or 504 Plans. These services can provide academic accommodations and support.

Websites that may be helpful on your journey

• www.additudemag.com

• chadd.org

• www.understood.org 

• www.ldonline.org 

• www.aacap.org/AACAP/Families_and_Youth/Resource_Centers/ADHD_Resource_Center/Home.aspx

• www.nimh.nih.gov/health/topics/attention-deficit-hyperactivity-disorder-adhd

• www.addwarehouse.com/parents.html

• www.cdc.gov/ncbddd/adhd/school-success.html

• d393uh8gb46l22.cloudfront.net/wp-content/uploads/2019/12/Educational-Rights-for-Children-2017.pdf

We are here to help

Seeking evaluations can feel like a daunting process for many families. We understand and try to make it as easy as possible for you and your child. We provide ADHD evaluations for children and adolescents in Tucson, Arizona. Our child psychologist has extensive experience in the assessment and diagnosis of ADHD. Reach out today. We keep our waitlist short, and we do not require referrals.