ADHD is a long-term medical disorder that might continue to prevail even in adulthood. This might create difficulties at college and workplace too. According to a research, 60 percent of victims carry ADHD even in adulthood. However, despite this fact, some children do come out of it before they enter their adulthood.

The first step is to consult your GP in case you suspect that your child is the victim of ADHD. Next, are the school and medical specialists who would help in diagnosing ADHD.

Visiting the GP

When you first visit your GP and tell him/her about your suspicion, he/she will do the following:

• Enquire about the medical history of your child and family, because ADHD can be hereditary.
• Ask about your child’s behavior at home and school and about his/hers low performance in school.
• Question about any disorders in the past and its medications along with side effects, if any.
• Assess the child’s hearing and sight either at the clinic or by referring specialists for these to be done. This will let the GP ignore those problems/behaviors caused by not hearing or seeing properly.
• Find out symptoms of autism, epilepsy, intellectual disability, or depression.

The referral of a medical specialist is dependent on the local health authority. Usually, the GP refers a community pediatrician or a specialist of the ADHD team. In some cases, other specialists that can be involved are:

• Psychologist
• Psychiatrist
• Pediatrician (especially skilled in dealing with behavioral problems)
• Occupational therapist
• Speech and language therapist

Visiting the School

Do not be surprised if I tell you that child’s school has already realized that there is some problem with the child. Yes! Before you notice, sometimes, the teacher might call you and ask you to visit him/her to discuss about the problems. Not only this, the school will also ask you to get the child medically checked before referring your child for the verification for a statement of special educational needs. Practically, the medical and educational referrals take place simultaneously.

Visiting a Medical Specialist

Once you get a referral, you need to take time from that specialist for the appointment and assessments. This waiting is dependent on the how busy the specialist is and the area in which his/her clinic is to judge the amount of patients. Sometimes, this waiting can be so long that you need to wait until a year. Actually, this waiting time can be between three months to a year. Such a long waiting time is usually for speech and language, occupational health, and mental health specialists.
However, you need not be in a state of despair. Even though your child name is far beyond in the long waiting list, you can ask whether the specialist can provide advice or certain tips on managing the child’s behavior that can be implemented before your child is diagnosed.

One more hope is to get an early appointment, if you can manage to obtain a cancelled session of some other patient.

Lastly, you can ask your GP or school to recommend private specialists where there is more possibility of short queues. However, such specialists charge more comparatively for the assessment.

Assessing Your Child

A child having ADHD will never exhibit a consistent behavior. This means that if your child with ADHD behaves properly in a specific situation today, it is not wise to think that he/she will be the same the next time. So, due to such uncertainty, the specialist will first ask you about your child’s behavior in different situations and what you did to tackle with it.

According to the type of specialist and the behavior you describe, the assessments would differ. Listed below are some of the assessments that a specialist can undertake.

• Analysis
  This involves observing your child and his/her reactions in a school, home, or at the specialist’s clinic.
• Observation
  This involves going through the written proofs such as teachers’ comments and home diary of the child’s behavior. In this, a brief history of the child’s problems, situations faced, factors that triggered the behavior, behaviors exhibited, effects on the child is recorded.
• Physical Tests
  If the referral is for an occupational therapist, he/she tests your child’s skills or talent to do something. This involves testing gross motor skills such as catching a flying ring or skipping and fine motor skills such as writing or creating a chain of gems.
• Written or Oral Tests
  This is especially undertaken by a speech and language therapist who verifies how well your child can express on what he/she has heard and understood.
• IQ Test
  This is the most common test taken by an educational psychologist to check the intellectual ability of a child.

Diagnosis

The specialist along with the GP basically performs the diagnosis, as it is difficult for a GP alone to detect ADHD. The reason for this is that ADHD has symptoms similar to other disorders. So, the referred specialist plays an important role in confirming that the symptoms are due to ADHD. Further, he/she will also detect:

• The type of ADHD
  It can be a combination of hyperactive, impulsive, and inattentive; primarily hyperactive; or primarily inattentive.
• The intensity of ADHD
  It can be mild, moderate, or severe.
• Other Disorders that Tend to Exist with ADHD
  This can include conduct disorder, anxiety, depression, and learning difficulties.

Treatment for ADHD

The treatment is based on the individual, its age, the type of ADHD he/she has, and other medical conditions he/she is suffering from. Listed below are the treatments for ADHD.

• Psychologist counseling for child and parents.
• Behavior management therapies.
• Cognitive behavior therapy.
• Simple tricks to learn how to deal with social problems such as bullying.
• Plan to boost self-confidence and self-esteem of the child.
• Personal help by the school.
• Medication (for children above six, except for severe cases). Mostly, these medications function by acting on the brain chemicals called neurotransmitters. This results in increased concentration level and better behavior.

Questions to the Specialist

Listed below are a few common questions that you might ask the specialists.

• If there is counseling, where and when it will be?
• What will be my role in the strategy of bringing my child back to normal?
• What role does the class teacher have to play during the treatment?
• Who will review the treatment plan, where it will be reviewed, and who will be present?
• What if the plan does not work?
• Until when will the medication need to be taken?
• What about the side effects and how to handle them?
• Will the medicine need to be given in the school? If yes, how the school will support this?

A specialist will obtain the necessary information from the child’ parents and school reports.

Questions to the Parents

A specialist will ask certain questions regarding your child. Listed below are the topics on which parents will be questioned.

• Child’s medical past, including even mental health problems
• Family history of ADHD and mental health problems
• Child’s development and temperament
• About ADHD symptoms and the time when you started observing them in your child
• Other problems that the child might have
• Relationship with your child (also of your partner)
• Parenting problems, if any

In rare cases, parents will need to examine their child’s behavior through a rating scale. This scale is similar to a questionnaire to detect the severity of symptoms.

Information from the Child’s School

After obtaining information from the parents, the specialist will need information from your child’s school teachers. The information will be collected about:

• Class behavior
• Academic achievements
• Relationships with other students
• Reaction to discipline and authority

Similar to parents, the teachers might be asked to use the rating scales to evaluate the behavior of your child.

Going Ahead with the Assessment

The specialist might need to assess your child to seek whether he/she is suffering from a physical disease that is the cause of the symptoms or making them severe. The other purpose of the assessment is to examine the mental state and find out the minute details required for identifying effective, but suitable medication. Gathering such details also aids the specialist to identify the need of other assessment, for instance, by a speech therapist or hearing expert.

Another type of mental examination might be conducted wherein the child’s mental abilities are assessed. This type of assessment is known as ‘psychometric’ assessment and measures certain mental abilities such as IQ, speech, and reading ability. More tests can also be conducted that measure attention, impulsiveness, depression, autism, learning disability, and dyspraxia (affects co-ordination). These tests are required because they can tend to hide the presence of ADHD symptoms in your child.

Rules for Diagnosing

During the process of diagnosis, the medical experts need to follow two unique sets of criteria. These are ICD-10 and DSM-IV-TR. However, there is no direct method of indicating that a person has ADHD. Therefore, although the two criteria are required for the diagnosis, the specialist must give his/her medical opinion.

ICD-10

ICD-10 refers to a collection of criteria laid down by the World Health Organisation (WHO) for diagnosing hyperkinetic disorder (ADHD is much more than this).

DSM-IV

The American Psychiatric Association has laid down the DSM-IV-TR criteria to diagnose different types of ADHD, such as hyperkinetic disorder (a severe one).

ICD-10 versus DSM-IV

Table 1.1 lists the differences between ICD-10 and DSM-IV

Fewer children who exhibit severe symptoms are diagnosed with ICD-10. This would indicate that these children who are diagnosed as having ADHD are not provided with the treatment. While, some experts are of the opinion that a broad range of people are diagnosed with DSM-IV.

Age of Diagnosis

It is quite difficult to diagnose ADHD in pre-school children, because they are commonly active, which cannot be counted as abnormal behavior.

Children at primary school are suitable for the diagnosis of ADHD. The diagnosis is done between the age periods of 5-11 years. During this period, the symptoms of ADHD are apparent and clear, as the rules and routine of a school make the symptoms come out very easily, which can be noticed immediately.

If a young child exhibits extreme hyperactiveness, this can be a green signal of a medical condition already persisting and negatively affect his/her development, for example, autism.

But remember, even teenagers and adults can have ADHD that needs diagnosis.

After Diagnosis

The first step after diagnosing a person as having ADHD is to devise a treatment plan. This might include medicines to be given, educational methods, behavioral therapy, and psychotherapy.

After assessing your child, the specialist will work with you, your child, and his/her teachers prior to initiating the treatment. During this period, he/she might give a score for different characteristics of your child’s behavior. This rating/assessment acts as a base or a parameter based on which the specialist can determine how much your child has improved in the near future due to the treatment. Actually, for each characteristic of the behavior, a target is specified by the specialist for you child. To measure the effectives of the treatment, the child is again scored on each aspect and this is compared with the figure/grade your child had scored before the treatment. For instance, you might be asked how many times your child beats his/her younger sister.

During the treatment, your child will be monitored regularly to:

• Measure the effectiveness of the treatment for the important symptoms
• Identify how much dose of a medicine is suitable
• Detect any side-effects of the medicines given
• Determine how well your child is integrating emotionally, educationally, and socially