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How Does A Doctor Determine if a Child or Teen Has a SubType of ADHD?

Children mature at different rates (in different domains - cognition, social, motor, etc.) and have different personalities, temperaments, and energy levels. Most children get distracted, act impulsively, and struggle to concentrate at one time or another. It is quite easy to mistake these normal factors for ADHD-Primarily Hyperactive, AD/HD Combined: Hyperactive and Inattentive, or ADHD Primarily Inattentive.

However, there are specific characteristics for this disorder, an age of onset for specific subtypes, and consistency of symptoms across environments, situations, and age.

ADHD symptoms normally appear early in life, often between the ages of 3 and 6, but because symptoms vary from person to person, the disorder can be hard to diagnose. Inattentive subtypes may be more likely to develop symptoms in middle childhood. Parents may first notice that their child loses interest in things sooner than other children, or seems perpetually "out of control.” Sometimes it is teachers who notice the symptoms originally, when a child has trouble abiding by rules, or frequently “zones out" in the classroom or on the playground. Again, the symptoms depend on the individual and the subtype of this condition.

To date, their is no specific test for diagnosing a child (or adult) as having ADHD. Instead, a licensed health professional needs to gather information about the child, and his or her behavior and environment. A family may want to first talk with the child's pediatrician.

Some pediatricians can assess the child themselves, but many will refer the family to a mental health specialist, such as a neuropsychologist, with experience in childhood neuro-biological disorders such as ADHD. The pediatrician or mental health specialist will first try to rule out other possibilities for the symptoms. For example, certain situations, events, or health conditions may cause temporary behaviors in a child that seem like ADHD.

The referring pediatrician and/or specialist will determine if a child:

  • Is experiencing undetected seizures that could be associated with other medical conditions - these type of seizures look much like ADHD-primarily inattentive
  • Has a middle ear infection that is causing hearing problems
  • Has any undetected hearing or vision problems
  • Has any medical problems that affect thinking and behavior
  • Has any learning disabilities
  • Has anxiety or depression, or other psychiatric problems that might cause ADHD-like symptoms
  • Has been affected by a significant and sudden change, such as the death of a family member, a divorce, or parent's job loss.

A specialist will also check school and medical records for clues, to see if the child's home or school settings appear unusually stressful or disrupted, and gather information from the child's parents and teachers. Coaches, babysitters, and other adults who know the child well also may be consulted.

The specialist also will ask:
  • Are the behaviors excessive and long-term, and do they affect all aspects of the child's life?
  • Do they happen more often in this child compared with the child's peers?
  • Are the behaviors a continuous problem or a response to a temporary situation?
  • Do the behaviors occur in several settings or only in one place, such as the playground, classroom, or home?
A specialist who does a very good job of accessing a child, teen, or adult for ADHD pays close attention to the child's behavior during various situations. Some situations are highly structured, some have less structure. Others would require the child to keep paying attention.
Most children with ADHD are better able to control their behaviors in situations where they are getting individual attention and when they are free to focus on enjoyable activities. These types of situations are less important in the assessment.

A child also may be evaluated to see how he or she acts in social situations, and may be given tests of intellectual ability and academic achievement to see if he or she has a learning disability. (NOTE from Spectrum of Minds: Many of these traditional I.Q. and academic achievement tests are not as reliable as they claim to be in specific cases. Always get a second opinion or more, if possible,(we know it is costly - look for free or other sources).

Finally, if after gathering all this information the child meets the criteria for ADHD, he or she will be diagnosed with the disorder. 

BEWARE of the doctor or clinician who asks a few simple questions and hands over a quick prescription!!! THERE MAY BE A LOT MORE THAN ADHD GOING ON ! 


Let me give you a very true, but cautionary story. My brother-in-law's daughter was very impulsive