How to Assess ADHD Symptoms in Children

When evaluating individuals for attention-deficit/hyperactivity disorder (ADHD), it is typical to use multiple stages of assessment prior to a formal diagnosis. This typically involves a comprehensive evaluation of information gathered from a number of sources, including parents/carers, family members, teachers, or partners and colleagues, depending on the age of the individual.

In this exclusive MedPage Today video, Zachary K. Blumkin, PsyD, psychologist and a senior clinical director at NewYork-Presbyterian/Columbia University Irving Medical Center in New York City, discusses the two types of symptoms he looks for when trying to observe for ADHD in children, and the importance of treating those patients.

Following is a transcript of his remarks:

The first signs that somebody wants to be looking for when you’re trying to observe for ADHD is the presence of developmentally inappropriate levels of hyperactive, impulsive, or inattentive symptoms. And you’re going to want to make sure that they’re present for at least 6 months and two different settings. So school could be one setting, sports could be another, or camp or art, or in the home. Just we need to make sure it’s in two different settings.

And what we’re looking for is essentially two types of symptoms. One would be categorized as inattentive. And in the inattentive category, we’re looking for kind of careless mistakes, or doesn’t seem to be listening to you when you’re speaking directly to them. Or maybe they’re losing things often or they’re often easily distracted. That would be the inattentive presentation.

Hyperactive impulsive presentation is when children are often fidgeting with things. They might leave their seat in situations when it’s really not appropriate to, they might talk excessively or interrupt others. And then that would be the more hyperactive, impulsive presentation. And of course, you could have children and adolescents that present with both.

So when thinking about assessments, it’s really important to just name it. There is no one objective task that can confirm or rule out a diagnosis of ADHD. We also want to make sure, and my colleague Dr. [Adrian Jacques H.] Ambrose can talk about this, that we’re not using medications to see how folks respond as testing the diagnosis as well. Really to diagnose somebody with ADHD, you want to do a really nice clinical interview. You can use rating scales to help kind of augment that clinical interview. And getting rating scales in multiple settings could be really important.

And again, you’re looking for that impairment in two different settings, as well as possibly doing some behavioral observation in some of these settings as a provider or one of your colleagues who you’re working with.

The last thing I’ll say is neuropsychological testing is not something that’s necessary for a diagnosis of ADHD, and for our straightforward cases, it’s not necessarily something that you’ll need. But certainly for complex cases where there’s multiple comorbidities or maybe some learning issues involved, neuropsych testing can be really helpful. And so in addition to making sure that these treatments are available for minoritized populations and providing them support through psychoeducation and validation and the understanding of what their experience might have been with the health and medical field historically, we want to also convey the message that ADHD is a treatable issue. And the treatment is safe and it’s effective. And when we treat it, we are dramatically reducing the chances that adverse events will occur.

And this list of adverse events is extremely long, but to name a few: accidental injuries, motor vehicle accidents, emergency visits, premature death, suicide, criminal behavior, depression, substance use. These are just a few of those. And really recognizing and empowering the patients that we see to truly engage in this very effective treatment for a really debilitating issue.