Is It Really ADHD? Why Proper Testing Matters for Your Child’s Future

Attention-Deficit/Hyperactivity Disorder (ADHD) is a common neurodevelopmental condition that affects both children and adults, often making everyday tasks like focusing, organizing, and managing impulses more challenging. While many people have heard about ADHD, there’s still a lot of misunderstanding about what it really is and how it’s diagnosed. 

In this blog post, we’ll explore the process of diagnosing ADHD and discuss why thorough testing with a psychologist is an essential step. Not only for accurate identification, but also for ensuring that individuals receive the right support and treatment.

What is ADHD? 

As mentioned, ADHD is a neurodevelopmental disorder that first occurs in childhood. Research has shown that there is a difference in the brain chemistry of people with ADHD, with one of the main brain areas affected being the frontal lobe and specifically, the prefrontal cortex. The prefrontal cortex controls our executive functioning which includes impulsivity, planning, problem solving, and emotional flexibility and regulation. 

A good analogy for understanding what happens in those with weaknesses in executive functioning is to imagine the prefrontal cortex as the conductor in an orchestra. If the conductor is off on the directions they give to the musicians, the orchestra suffers and doesn’t work in sync. In the same way, a child can have high cognitive skills, but if the prefrontal cortex isn’t regulating these other areas, the result is frustration and behavioral challenges.

ADHD is highly genetic and we know it runs in families. In fact, between 20-35 percent of diagnosed children also have a parent with the disorder. ADHD is more common in boys and is typically first seen in elementary school, when it is often identified as inattention. Difficulty sitting still becomes less visible in tweens and teens, but then we tend to see more restlessness or inability to control impulses.

Is it ADD or ADHD? 

As research has evolved, the most recent version of the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders) categorized the two diagnoses, ADD and ADHD under the same umbrella, but with different presenting characteristics. As a result, they’ve been combined and are officially recognized as ADHD today, but with three subtypes. These subtypes are ADHD with predominantly inattentive presentation, ADHD with predominantly hyperactive/impulsive presentation, and ADHD, with a combined presentation. These similar yet distinct terms can seem confusing at first, however understanding the subtypes is crucial to understanding the disorder. 

For a child to be diagnosed with predominantly inattentive ADHD, they must meet six criteria in the inattentive category, which includes behaviors like being forgetful, losing things, or frequently wandering off-task. Maybe they fail to pay attention or to sustain it. They may have trouble organizing tasks or may avoid tasks that require a more sustained mental effort.

On the other hand, if a child falls into the hyperactive/impulsive category, they must meet at least six criteria from that subtype, such as being restless or squirming a lot, often leaving their seat in class, talking excessively or blurting out answers, interrupting frequently or having trouble engaging in quiet activities. Adults must meet five of the symptoms instead of six to be diagnosed, and children who are diagnosed with a combined presentation must have at least six symptoms each from both categories.

How is ADHD diagnosed?

First, the individual must have displayed some of the ADHD indicators before age 12. Symptoms typically start in the toddler years, but some criteria aren’t generally recognized until age 7 and above - in the early elementary school years when the child is less attentive in class.

To be diagnosed, the symptoms have to have lasted at least 6 months and have to have occurred in more than one setting - for example, both at home and at school. This is because being in different settings can change the child’s responses.

As for the process of diagnosis, a comprehensive evaluation is vital. Diagnosis is based on a thorough history and observation of the child, plus information obtained from parents, teachers, and others. We observe the child in various settings because kids can often pay better attention in a one-to-one setting or with peers or in play, but may have a hard time in school where more concentration is required. 

By watching how the child acts in a structured versus unstructured setting, the psychologist can see behavior differences. Another important factor in the assessment of ADHD is looking at the individual’s executive functioning skills, as those diagnosed with ADHD typically have difficulties in executive functioning.

Is It ADHD Or Something Else?

ADHD can share symptoms with other conditions such as bipolar disorder, which also presents with impulsivity and poor concentration. Bipolar disorder typically involves mood episodes that differ in timing and duration from ADHD and usually has a later onset. Autism can co-occur with ADHD, but is distinguished by social differences, such as a preference for solitary play or difficulty making eye contact. 

In addition, anxiety and depression, particularly in children, can produce symptoms similar to ADHD, such as inattention or distractibility. For example, a child may appear inattentive due to depression or anxiety rather than ADHD. Since ADHD can exist alongside or be mimicked by other disorders, thorough evaluation and observation are essential for an accurate diagnosis.

What happens after diagnosis? 

After an ADHD diagnosis, depending on the symptoms exhibited, treatment options may include medication, such as traditional stimulants or non-stimulant alternatives for children who do not respond well to stimulants or experience side effects. Medication alone is often not sufficient, so behavior therapy is typically recommended. This can involve executive function coaching, behavior therapy focused on skill-building and implementing school interventions or accommodations to support the child during the school day. 

Parent training is also advised to help caregivers understand and manage their child's behavior more effectively. While some children may benefit from behavior modification and skill development alone, others may require medication as part of their treatment plan. Re-evaluation is recommended every two to three years, both to meet school requirements and to address changes in symptom presentation as the child matures.

Dr. Brittany Marino emphasizes the importance of obtaining a professional diagnosis for ADHD rather than self-diagnosing. She notes that a comprehensive evaluation is necessary, as ADHD is a complex condition that cannot be accurately identified based on a few symptoms or information from non-experts, such as social media influencers. Individuals concerned about the possibility of having ADHD should seek a thorough assessment from a qualified professional.

Looking for a Psychologist who offers ADHD evaluations for children and adults? 

If you are wondering whether you or your child may have ADHD, you do not have to figure it out on your own. A thorough psychological evaluation can provide clarity, guide treatment, and help you access the right support at home and at school. 

At Bayview Therapy, our team of psychologists and therapists provide ADHD testing and comprehensive evaluations for children, teens, and adults, as well as counseling and support for families navigating these challenges. We offer services in our Fort Lauderdale, Coral Springs, and Plantation offices for those who reside in South Florida, and we also provide online therapy throughout Florida via our secure telehealth platform. 

Call us at 954-391-5305 for your complimentary consultation so we can discuss how we can help. For more information about Dr. Brittany Marino and her approach to psychological evaluations and psychoeducational testing, click here. 

Remember, you are not alone on this journey, and it is okay to ask for help when you need it. We are here for you.