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ADHD Evaluation

By: Mark Bertin

Dr. Mark Bertin is a developmental pediatrician and the author of The Family ADHD Solution. He attended UCLA School of Medicine, trained in general pediatrics at Children's Hospital Oakland, and completed fellowship at Albert Einstein School of Medicine.

Dr. Bertin is an assistant professor of pediatrics at New York Medical College, on the editorial board for Common Sense Media, and on faculty for the Windward Teacher Training Institute. He also leads mindfulness based stress reduction classes, frequently for parents.

Picture a child with severe language delays. Eight years old, they have the expressive language abilities of a four year old. It may be upsetting, frustrating, and not what any of us hope for our children. We'd set up an intensive intervention to teach them the language skills they need. But on any given day, we wouldn't expect them to suddenly use more language than they know — it would be impossible.

Now picture a child with ADHD. ADHD can be seen as a developmental delay of executive function, the capacity to regulate our behavior and actions through the day. Eight years old, this child has the self-regulatory and organizational abilities of a four year old. It is incredibly frustrating, demanding on parents, and requires a long term plan to catch up. And yet, today, if they have the ability of a four year old to keep track of their homework or get out the door in the morning, what expectations make most sense? How might we best meet them where they actually are in their development, right now?

Seeking ADHD evaluation is not, as many people fear, a decision about treatment or applying a diagnostic 'label.' A skilled evaluation is an integral step towards fully and compassionately understanding a child's experience. We attempt to gauge a child's actual abilities, particularly around executive function. A well-coordinated evaluation is nothing more than a way to gain the knowledge we need to move skillfully forward.

ADHD, or not ADHD?

While not overtly life threatening like asthma or diabetes, ADHD is no less real. As with any medical condition, it stems from a concrete biological problem — although ADHD manifests with emotional and behavioral, rather than physical, symptoms. Though we know this about the cause of ADHD, we do not yet have a proven test for it. Instead, we're left with clinical diagnosis — evaluators attempt to prove through observation and a set of behavioral criteria that ADHD symptoms are an intrinsic and impairing set of cognitive traits.

Even though the biology of ADHD is well defined, there is no one examination or piece of information that defines ADHD with accuracy. In spite of what we know about how the brain grows and functions, the diagnosis remains subjective — an expert evaluation based on a set of research-driven criteria. No single test, medical or behavioral, is accurate on its own. Familiarizing yourself with the process can help you advocate for your child along the way.

There are four broad steps towards making an ADHD diagnosis. Evaluators strive to prove that whatever symptoms they find match the underlying biology of ADHD. Through gathering various information, such as behavioral rating scales, report cards, parent interviews and a review of educational test scores, they try to determine if a consistent pattern exists in life attributable to ADHD. To prove that these ADHD symptoms reflect a person's underlying neurology as accurately as possible, evaluators check to see if the ADHD symptoms they've identified:

  • in multiple settings,
  • persist over time,
  • not being caused by some other medical or emotional challenge, and
  • create significant impairment in the life of a child.

Kids will be kids?

Impairment is perhaps the most important word towards making the diagnosis. Without impairment, ADHD symptoms can be considered more like character traits. It is, on some level, a manner of degree. Someone who is a little fidgety and active is nothing more than fidgety and active. Someone who daydreams and is distractible is simply distractible if it is not causing difficulty somewhere. The entire reason to intervene, behaviorally or otherwise, is to help with an individual's ADHD-related struggles. Through identifying ADHD and addressing its widespread impact, families and children will thrive.

Adapted from "The Family ADHD Solution" by Mark Bertin M.D. Copyright © 2011 by the author and reprinted by permission of Palgrave Macmillan, a division of Macmillan Publishers Ltd.