How Do I Get My Child Assessed for ADHD?

Distraction and attention issues at school could be cause for concern, but Parents Ask Your Mom columnist, Emily Edlynn, Ph.D., says a thoughtful approach to ADHD assessment is the right place to start.

How do I get my kid assessed for ADHD?
Photo: Parents | Zoe Hansen

-Attention Issues

My daughter's seventh grade teacher brought up some focus issues that she's having in class—daydreaming and distraction, to the point where it's interfering with her work. The teacher suggested an ADHD assessment, but I am wary of medicating my daughter. But I also don't want my child to struggle. Where do I begin to start the process?

—-Attention Issues

I'm so glad the teacher recommended an assessment rather than concluding that your daughter has ADHD due to daydreaming and distraction. These types of focus issues can have other causes, such as anxiety, and a professional assessment is the best first step.

Disorder of What?

Before we talk about the assessment process, let's address the fact that Attention Deficit Hyperactivity Disorder (ADHD) is one of the most misunderstood childhood diagnoses. Although ADHD affects 5 to 8% of children around the world, the label itself has suffered from bad marketing since it was first named in the Diagnostic Statistical Manual (DSM) in 1980. (Interestingly, records of descriptions of ADHD can be traced back to Hippocrates in BC Greece!)

Part of its bad reputation is due to how misleading the name is. Decades of research reveal two main problems: 1. Attention is just one representation of the real area of deficits—executive functioning. 2. Many children with ADHD are not hyperactive. The most recent version of the DSM now lists three possible types of ADHD: ADHD—Inattentive type; ADHD—Hyperactive type; and ADHD—Combined type. However, experts have called for re-naming the diagnosis for greater accuracy, such as Disorder of Self-Regulation or Disorder of Executive Functioning.

What Is Executive Functioning?

If you're not familiar with the term, executive functioning refers to a whole group of abilities in our frontal lobes. These include planning, organizing, problem-solving, remembering, initiating and completing activities, shifting between activities, managing strong emotions, making decisions, slowing down impulses, paying attention, using good judgment, and self-monitoring.

Executive functioning is being refined and polished in the brain for the duration of child and adolescent development, so being unorganized, forgetful, and distracted can be age-appropriate. But kids with ADHD struggle even more. A professional assessment evaluates all areas of executive functioning for comparison to what is typical for each child's age group. These assessments are called neuropsychological evaluations and only psychologists with specialized training can give them.

Finding a Neuropsychologist

To find a qualified neuropsychologist, I recommend starting with word-of-mouth. I know in our community Facebook group when a member poses your very question, the same few neuropsychology practices are repeatedly mentioned. This gives a sense of where many families have had good experiences. Depending on where you live, you can also check a pediatric medical center. Many children's hospitals have outpatient psychiatry and psychology programs that include neuropsychological services. You can also look up your geographical area in the American Academy of Clinical Neuropsychology's national directory.

What to Expect

First, there's often a wait for an appointment, so even if you are unsure about proceeding, I suggest you at least put your daughter on a waitlist. Once you have an appointment, the process typically includes the following steps: 1. An initial interview with parents and child. 2. One or two days of testing, which can be 2-3-hours at a time. 3. A feedback session once the report has been written to review the results, including any diagnoses. Like I mentioned, these evaluations look at other possible reasons for distractibility and problems focusing, such as anxiety or a learning disorder.

The testing itself can be tiring and challenging, but a lot of kids I know actually think some activities are fun. Parts of the testing will feel like school, but others are puzzles and computer-based tasks that feel novel and interesting. Older children like your daughter often think it's pretty cool to figure out how their brain works.

These evaluations always highlight individual strengths, so it's not all about what's wrong! In fact, I love referring kids to these evaluations when we are struggling in therapy because the results give so much insight into each child's unique way of experiencing the world. This understanding leads to shifting both what school environments need to do for maximizing a student's learning, and to what parents can do more effectively in the home.

Medication

In the case that your daughter is diagnosed with ADHD, I want to share what we know from the science about ADHD medication, which has a stronger evidence base than most psychiatric medications for children and teens. Psychologist Russell Barkley has dedicated his career to researching ADHD, and shares many reassuring findings from science. For example, medication for ADHD has been found to be twice as effective as any other treatment, and is some of the safest on the market. Because of risky and impulsive behaviors often part of ADHD, medication actually extends the lifespan of those with ADHD by 13 years!

Targeting specific executive functioning weaknesses, ADHD medication is not a cure-all. However, when someone is taking medication for ADHD, they can better learn strategies to accommodate their executive functioning weaknesses that may be able to replace medication when they are older. In fact, 60% of kids with ADHD will still meet the criteria as an adult, but 40% neurologically mature to no longer meet the diagnosis.

More Than Medication

Although ADHD is a biological condition that responds well to medication in most cases, that doesn't mean medication is the only treatment. Other essential interventions include parent support and education, an educational plan with accommodations appropriate for your child's learning needs, and therapy to help your child learn and practice behavioral and coping strategies that can serve them for their lifetime of having some degree of executive functioning differences.

The Bottom Line

If your daughter has ADHD, a professional evaluation is the critical first step to obtain an accurate diagnosis and treatment recommendations. Take time to increase your own knowledge and comfort with medication, but I hope you are reassured that this route can be beneficial and safe. Whether or not your daughter ends up with an ADHD diagnosis, the process of finding out underlying causes of daydreaming and distraction will teach you and your daughter about the inner workings of her brain. This can lead to not only her improved focus in the classroom, but a better understanding of what she needs to succeed at school and in life.

Submit your parenting questions here, and they may be answered in future 'Ask Your Mom' columns.

Emily Edlynn, Ph.D., is the author of The Art and Science of Mom parenting blog and the upcoming parenting book Parenting for Autonomy. She is a mother of three from Oak Park, Illinois, and a clinical psychologist in private practice who specializes in working with children and adolescents.

Read More Ask Your Mom columns here.

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