So you have just returned home from your third meeting with your child's teacher. She tells you that your child is not getting his work done, he cannot sit still, and he is simply not going to have any success in school unless something changes. She suggests that you talk to someone to see if he has ADHD. What do you do next?
This can certainly be a difficult time in any family, so we would not want you to be uninformed as you take the next important steps. Here are the things that we recommend if you have a child that ought to be looked at for possible Attention Deficit Hyperactivity Disorder.
First, there should be an "adequate" physical exam by the child's pediatrician or family practice doctor. This doesn't have to be an extensive, expensive exam, but should be able to rule out possible problems like Mononucleosis, Thyroid problems, lead poisoning (if it is common in your area), and potential attention problems caused by medications, such as allergy medications. Then, with a clean bill of health, we move on to step two.
Second, get an evaluation for attention deficit hyperactivity disorder. Usually a psychologist or other mental health professional will do this evaluation for ADD ADHD. But please, only get counseling or therapy from professionals who have a lot of experience treating attention deficit hyperactivity disorder. Therapists who do not have a lot of experience with ADD ADHD will just take your money and then probably blame you, the parents, for the child's disorder. Find experts on attention deficit hyperactivity disorder in your area. Ask around at your local CHADD chapter. Call you local Psychiatric Hospital and ask for the Child or Adolescent Unit. Then ask for the "Charge Nurse." Ask the Charge Nurse who the best psychiatrists and therapists in your town are. They know.
The Evaluation
When you get an evaluation for attention deficit hyperactivity disorder, there should be a good parent interview. It's absolutely essential that somebody sits down with the parents and spends 45 minutes to an hour with them. The psychologist or therapist needs to find out what's going on now, why did the parents pick up the phone and call now instead of last week, and so on. A good developmental history on the child must also be taken. Important questions are:
How did mom do during pregnancy?
Were there any problems at all during pregnancy?
Was there any exposure to drugs or alcohol prior to birth?
When did he learn to walk or crawl?
How about speech development, any problems?
Did he have very many ear infections?
Have there been any head injuries, high fevers, or seizures?
Head injuries and seizures can look just like attention deficit hyperactivity disorder, but aren't. They may require different treatment options.
Then a good family history is great. The family trees of Attention Deficit Disorder kids are often very similar. Look at one and you may say, "Gee, there's no wonder this kid has it," because most of the time, about 80 percent of the time, you can trace the impact of this gene as it runs through families causing things like depression, obsessive-compulsiveness, alcoholism, attention disorders or learning disabilities throughout the family.
The clinician must also know:
Is child depressed?
Does he have anxiety problems?
Is he hallucinating?
Is he delusional?
Is it a head injury?
Is it a seizure disorder?
Parent rating scales are very good and should be given. The ADHD scales we like are by Ned Owens out of Texas. Keith Connors has a fine tool that you have probably seen if you are involved with attention deficit hyperactivity disorder children at all. It is very important for the parents to fill out these behavior rating scales. Ideally the teachers will fill them out also. You want the teacher's input because they see 30, 32, or 35 kids every single day, year in and year out, and they know what is normal behavior and what is not.
Note: One of the things we have noticed is that lately we are having more trouble with the teacher rating scales because the teachers ten years ago, eight years ago, five years ago used to rate the kids pretty reliably compared with the "normal" kids in the class, the non-ADD kids in the class. But what we are seeing lately is very often the teachers are comparing the child that we want rated against the "worst kid" in the class, who might be totally off the wall. And so the rating scale comes back reporting that the child we want rated isn't much of a problem at all. We have to give directions to the teachers to rate them versus "normal kids," not against the "worst kids" in the class.
Also, an in-depth clinical interview with the child is important. This interview is needed to determine the child's reality testing, his degree of maturity, his degree of verbal skills, and so on. Ask the child if he's hallucinating. Sometimes he is, but he hasn't told anyone. Ask the child if he's anxious. Some kids have tremendous fears, but have not shared them with anyone. There is a lot going on with kids that their parents are not aware of.
Psychological Testing for Attention Deficit Hyperactivity Disorder - ADHD
Psychological testing as part of an evaluation for Attention Deficit Hyperactivity Disorder can be helpful. We used to give tests such as the WISC-R, an IQ test, the Wide Range Achievement Test (WRAT), and the Bender-Gestalt test, which is a visual motor integration test. Bored already? Well, they are boring things. But they can be helpful. There are certain patterns that one might expect on these tests if the subject had attention deficit hyperactivity disorder of some type. But it's art, not science at that point. The patterns are not "diagnostic" for Attention Deficit Hyperactivity Disorder. It's also important to know if the kid has a real low IQ, or a major learning disability. It could be a clue that there is something else going on instead of attention deficit hyperactivity disorder.
What we find to be very valuable is the Test of Variables of Attention (TOVA).
The TOVA is an extremely boring computer test that requires the kids to respond to a target stimulus by pressing a button, or to not respond when there's a non-target stimulus. The fact that it is so boring is a work of genius because it helps to differentiate between kids who have trouble with "boring," and kids who do all right with "boring."
The TOVA is really a terrific tool, but it should never be given just by itself. It needs to be given in the context of the whole diagnostic workup. Also, the TOVA can be given with no medication, and then if medication is going to be used down the road, given again with medication in their system. This can tell the clinician if the subject is at the right dosage or not, or how well he responds to that particular dose of that particular medication. The TOVA is a very helpful tool.
Clinical observation of the child is very important. If possible, ideally, somebody observes the child in the classroom. In the real world, we don't know anybody in private practice who can go out in the classroom to observe a child these days, but if a school nurse or school psychologist can go observe them, it can be very, very helpful.
Obtaining an EEG from a neurologist is rarely helpful.
EEGs will show differences from non-ADD children. Typically there is excessive slow brainwave activity, particularly in the Theta band (4-7 Hz.). However, ninety-five percent of all Attention Deficit Hyperactivity Disorder kids have "normal" EEGs. What we mean by "normal" is they don't have big epileptic spikes, or things like that, that a neurologist would say are "abnormal." But when you compare them side by side with a non-ADD kid, they are much different.
An EEG may be helpful if the child is going to be treated with EEG biofeedback, but in terms of being helpful for a diagnostic work-up, it is rarely helpful. However, if the parent interview revealed that the child had some potential neurological problem, as seen in sleep walking, or a history of seizures, and so on, then an EEG would be a good idea.
In summary, then, an adequate diagnostic interview, designed to give an accurate diagnosis a very high percentage of the time, while not costing the family thousands of dollars, would look like this:
Physical Exam - Office Visit
Clinical Interview - Parents (45-60 minutes)
Clinical Interview - Child (45-60 minutes)
TOVA test
Parent and Teacher Rating Scales
Office visit to review information and develop a treatment plan
Begin Treatment
That's it! If there are further diagnostic questions, then more testing would be required. But in the majority of cases, this is all that is needed to make a highly reliable diagnosis. Except for the physician's examination, the cost for this should be about $500-$700. You can learn more about Attention Deficit Hyperactivity Disorder by visiting the ADHD Information Library.
Douglas Cowan, Psy.D., is a family therapist who has been working with ADHD children and their families since 1986. He is the clinical director of the ADHD Information Library's family of seven web sites, including http://www.newideas.net, helping over 350,000 parents and teachers learn more about ADHD each year. Dr. Cowan also serves on the Medical Advisory Board of VAXA International of Tampa, FL., is President of the Board of Directors for KAXL 88.3 FM in central California, and is President of NewIdeas.net Incorporated.
![]() |
|
![]() |
|
![]() |
|
![]() |
"Setting the alarm on Sunday mornings is inhuman?..God should know... Read More
Many parents struggle with solutions to put their child on... Read More
A learning disability is defined as a permanent problem that... Read More
According to the American Sleep Association 70% of all babies... Read More
In the last few years, parents started getting more and... Read More
What's hard for teenagersHaving people who don't understand you trying... Read More
When my oldest daughter was born, I walked the floor... Read More
Reading is the most important skill that a child must... Read More
Although, not a well publicized statistic, childhood obesity has more... Read More
Non-compliance is the family therapist's big word for your child... Read More
Have you ever watched your teenager make a mistake (that... Read More
Every parent wants their child to develop positive character traits.... Read More
Parents of hyperactive children know the "Would you please just... Read More
When it comes to exams, or indeed any academic work,... Read More
Recently, a much-anticipated game of mini-golf with my children soon... Read More
It used to strike me as odd - but really,... Read More
I hear from many parents that their child is stressed... Read More
As the new school year begins, parents play a pivotal... Read More
Drivers 16 years of age have little driving experience, putting... Read More
Is there a way to build a robot to help... Read More
As Mother's Day approaches I would like to give a... Read More
As a parent there are lots of things that you... Read More
For any parent, learning that a convicted sex offender lives... Read More
All babies cry, but if yours cries a lot, isn't... Read More
Why are more people, especially parents not outraged?I call it... Read More
In theory, working at home is an ideal situation. But... Read More
No matter how old your children are, you have an... Read More
Q: My husband and I are at a loss as... Read More
Any parent whose baby has suffered from colic can tell... Read More
Anorexia nervosa is a serious medical disorder that is statistically... Read More
I have been a single mom for almost 20 years.... Read More
Parents of teenagers frequently ask what can be done to... Read More
It's that time of year when mom and dad look... Read More
In June, elementary school children across North America cheered as... Read More
Do any other reality TV junkies remember a show on... Read More
The older my daughter gets the more it's sinking in... Read More
"Where did he come up with that?" Kids often amaze... Read More
Giving advice to a teenager is very easy; getting a... Read More
Search for Assurance: The Power of BelongingThe job hunt is... Read More
Former students would probably attest to the fact that few... Read More
It's no surprise that the self-image and self-esteem of overweight... Read More
There are only two ways to get more money:1) Increase... Read More
I know as a single parent or even with 2... Read More
When David was nine and Laura was twelve, the battles... Read More
I still remember the scene vividly. I was getting out... Read More
As parents, we love our children and want to do... Read More
Dads, please let me encourage you to change some things... Read More
As the new school year begins, parents play a pivotal... Read More
The citizens of the early Roman Republic enjoyed an education... Read More
Those of you that have children know what an excursion... Read More
Tripping over the shoes and toys that seem to clutter... Read More
Why are more people, especially parents not outraged?I call it... Read More
According to researchers, most children enter school with a good... Read More
Is it hard to communicate with your teenager about issues... Read More
Bearers of life, wipers of noses, givers of unconditional love... Read More
Now I know that is not how the song goes,... Read More
There may really be a real monster under your kidâ??s... Read More
For over fifty years, public-school officials and politicians have tried... Read More
An Awesome Dad in by no means perfect. But that... Read More
the woes of being a parent of an ADHD child.....Like... Read More
As I sit here and reflect on the past two... Read More
Many people consider plush toys great for children. They say... Read More
Although nothing anybody says can ever completely prepare a woman... Read More
Q: Whenever we tell my daughter "no," she just bugs... Read More
I have three children, ages 19 and 16 (yes, the... Read More
Isn't the technology of today is amazing?! Between the speed... Read More
Parenting |