How to test for ADHD

I wrote recently about getting started with an evaluation for a child who’s not doing well in school. Don’t rush to just do ADHD testing: There are many reasons for attention problems, and it’s best to not just zero in on ADHD at the start.

Still, there’s a time when confirmation and testing for an ADHD diagnosis is appropriate. What kinds of tests are available?

A clinical history is, well, talking with someone who gets to know your child through an informal interview. This can be done by a physician, psychologist, therapist, counselor, or social worker. Though a clinical interview might not be considered a “test,” I think it’s still the single best way to both rule in and rule out an ADHD diagnosis. Especially when done by someone who’s known your child for years, like a pediatrician you’ve been working with.

There are also standardized forms that are a way of making sure the exact same questions are asked in the same way, so the answers can be compared to answers given by thousands of other children in clinical trials. These are the “forms” often suggested by schools, with names like the “Vanderbilt” or “Conners” forms. Usually more than one person fills them out, including both parents and a few teachers. Some of these forms only ask questions relevant to an ADHD or ADD diagnosis; others ask some questions to screen for anxiety or depression or other problems.

Because they’re standardized and frequently used, many centers seem to rely on these forms to establish a diagnosis. I’m not sure that’s always wise, but I do agree that forms like these can help confirm or refute the impression from an interview and other sources. They’re certainly not the only way, or even the most important way, to establish a diagnosis.

Further testing along similar lines — using standardized questionnaires — can be done through a professional, who administers these tests and then compiles a report. This is often called “school testing” or “psychometric testing” or “neuropsych testing,” and it’s usually done by a psychologist. This kind of testing can be far more in-depth, and can include tests of intelligence, memory, and processing; these tests can also help establish if a learning disability is present. Good, thorough testing can teach parents a lot about their child’s strengths and weaknesses, and will go far beyond just answering if a child has or doesn’t have ADHD. But it can be expensive, and often health insurance does not cover this kind of testing.

There are some more high-tech tests available now, and this can be where we’ll get into some controversy. Many companies are selling computer-assisted testing apparatus. Some of these systems use video and motion sensors to evaluate how jiggly a child is, or how well they look at what they’re supposed to be looking at. Other systems claim to analyze brain waves. There’s very little independent research into these systems, though there’s a lot of anecdotes and testimonials and company-sponsored studies that say these systems are terrific. Not only do they objectively establish a diagnosis (so the claim goes), but medical providers can bill big bucks for the testing. I’ve had sales presentations for these things, and I’m not sure that this kind of testing helps patients quite as much as they say.

There are no blood tests or brain imaging studies that are routinely helpful in the evaluation for possible ADHD. However, if a careful history and physical exam suggest other possible diagnoses, sometimes these kinds of tests are needed not to establish the ADHD diagnosis, but to rule out other things.

It would be great if there were one quick and easy test for ADHD. Instead, we have to rely on the overall picture, starting with a thorough history and physical, including a detailed diagnostic interview. A whole lot of questions, and a whole lot of time to talk. To do it right may take multiple appointments, including time to get feedback from parents and teachers. It won’t be fast, and it won’t be cheap. But in the long run, it’s better to do it right.

Roy Benaroch is a pediatrician who blogs at The Pediatric Insider. He is also the author of Solving Health and Behavioral Problems from Birth through Preschool: A Parent’s Guide and A Guide to Getting the Best Health Care for Your Child.

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