Should I get tested for ADHD?

How do you diagnose ADHD / ADD?

An unequivocal and one hundred percent Secure diagnosis is still considered difficult to carry out today and, as we shall see, it is also quite complex. Therefore, a quick or, as some parents or those affected sometimes imagine, a "quick diagnosis" is impossible to carry out.

In this country, ADHD diagnostics can only be carried out by a child and adolescent psychiatrist or child and adolescent psychologist who is familiar with the subject, and in the case of adult sufferers by a resident clinical psychologist or a neurologist / psychiatrist familiar with the subject. Differential diagnoses and any accompanying diseases (comorbidities), such as B. a disorder of social behavior, anxiety disorders, borderline personality disorder (in adolescence and adulthood) should be taken into account.

However, it has often turned out to be difficult for those affected to find a competent specialist for ADHD in their area. This can prove to be tedious, especially because a single short visit is not enough: Answering and discussing the standardized questionnaires and tests in any case takes several hours (on average 3 - 6). The fact is that either because of the currently relatively thin distribution of "ADHD specialists" or because it is difficult to diagnose, many of those affected are only diagnosed at a relatively advanced age.

Diagnostic criteria

For a serious diagnosis several »levels« must / should be considered, which of course complicates the process.

A common diagnostic system called DISYPS-II is based on three assessment levels:

  • The clinical level (diagnostic checklists, DCL)

  • The level of external judgments by parents, teachers or kindergarten teachers / educators (external assessment sheets, FBB)

  • The level of the child's self-assessment, but usually only from the age of eleven (self-assessment questionnaire, SBB)

It is important that the individual symptoms observed as "disturbing" are not only present to an extent that is already appropriate for the child's level of development, but rather go beyond this level. The medically correct formulation in most diagnostic manuals is: "An abnormally increased" or. »A significantly increased« Behavioral originality, better formulated: »a significantly increased one Suffering«. After all, this is what matters. Whatever may be "abnormally exalted" in a person's life; as long as this person does not actually suffer from it, one should under no circumstances "make" a disease out of it.

X-ray image & Co

One of the most frequent questions asked of the experts at KONZENTRUM in relation to diagnostics and the "reliability" of the statements is something like this:

"Is there no technical procedure with which ADHD can be clearly proven or excluded?"

CONCENTRUM: Unfortunately this doesn't exist yet! At least not for "serial diagnostics"!

For a more precise medical diagnosis there are hardly any technical developments available at the moment, since for the vast majority of »disorders« there is still no standardized imaging representation in the human brainIf you disregard the scientific and very promising experiments with the extremely expensive PET scan and, more recently, the so-called QEEG. The two methods can use different colors to make the special features of the ADHD-specific brain activities in the affected regions visible. The latter method could actually soon find broader application due to its relatively low cost.

anamnese

Since there are still no real alternatives, it becomes clear that for a clarification of whether or not ADHD is present, the Anamnesis in the foreground stands. Various diagnostic methods are available to the doctor. However, the anamnesis is almost always the first priority. When it comes to ADHD and other behavioral deficits, the first one will be Family situation observed, mental illnesses as well as alcohol and drug abuse observed and analyzed. The anamnesis also includes criteria such as pregnancy and childbirth as well as previous illnesses. To get this information parents, teachers and other caregivers are interviewedas KONZENTRUM will show you in the next section. The diagnosis also includes extensive behavioral observation and, in some cases, video recording in order to be able to show the parents the results of the examination based on reactions and gestures as well as facial expressions and later to be able to show a comparison to demonstrate the success of the treatment.

survey

In order to get closer to a justified suspicion of ADHD or its exclusion, as already mentioned, even the best diagnosticians must do one thing above all: Ask questions! But for a multifactorial disorder like ADHD, this diagnostic method is particularly important.

Doctors, whose consultation there is probably no way for parents to take a serious approach, are now using quite complex but standardized survey methodologies: With many questionnaires and tests that are standardized according to international criteria (e.g. DSM IV manual), e.g. paediatricians, child and adolescent psychologists or child psychologists narrow down the causes of the symptoms. Ideally, this takes place in three phases:

1) Interviewing the child, parents and caregivers about the specific symptoms (anamnesis)

2) Intelligence and performance diagnostics. The background to this is that intellectual overload often results in school problems

3) Clarification of the relationship situation within the child's nuclear family (the psychosocial factors already indicated). In modern terms: the »systemic approach« in the core family and the environment. Here are important starting points for later therapy.

For the mentioned psychosocial components in this appearance, however, going to a sensitive family or educational advisor or child psychologist should also be considered.

A number of questionnaire procedures are available for external judgments (teachers, parents). This includes, for example, the screening questionnaire for attention deficit / hyperactivity disorders (ADHD questionnaire), with the help of which information on ADHD or ADD and their accompanying symptoms are to be recorded. The two areas of life, family and kindergarten or school, are considered separately on a four-level response scale.

It has been shown that it is extremely helpful for a later diagnostic procedure and also abbreviates this if you first start with a small one "Collection" of direct observations of the child invest in school and at home. It is certainly easy to understand that this watch list can be helpful in the event of a later detailed anamnesis.

Testing

A test psychological examination should last at least two to three hours in order to ensure a thorough behavioral observation in the test situation. Pure concentration tests such as the d2 test (Brickenkamp) or the Esser BP concentration test are not enough on their own to make a statement about a child's ability to concentrate in everyday life. B. the thinking skills are carried out. Intelligence diagnostics should also be carried out.

Manfred Döpfner, G. Lehmkuhl and H.-C. Steinhausen provided the diagnostic checklist for attention deficit / hyperactivity disorder (DCL-ADHD).

Also of interest in this context is the DCL-ADHD (Diagnostic Checklist for Attention Deficit / Hyperactivity Disorders).

Requirements

A diagnosis should be based on information from different sources, as a single test cannot cover the complete differential diagnosis (see next paragraph). In addition to questioning the child concerned, the parents / educators and teachers, the basic diagnosis also includes a thorough psychological test diagnosis, a neurological examination and behavioral observation.

Must be a prerequisite for diagnosing ADHD the symptoms have been present for at least six months and first occurred before the age of seven be (see here).

According to Krause (»ADHD in adulthood«, 2005), ADHD can only manifest itself in women during puberty. In any case, the symptoms must have a significant impact on the daily life of the person concerned. In many drug compendia and study documents, for example, a medical indication is only in the foreground if, as already mentioned in the introduction to diagnostics, formulations such as "Abnormally increased symptoms" or "Significant psychological stress" are applicable.

Differential diagnosis (exclusion)

Exclusion of possible other disorders that would better explain the hyperkinetic symptoms is essential at every diagnostic level. For example, there must be no profound developmental disorder, no schizophrenia or no other psychological disorder.

In order to differentiate ADHD from other clinical pictures, a clinical examination result is indispensable, as are other psychological examinations that are supposed to separate ADHD from, for example, reduced intelligence.

In clinics or medical practices, an additional MRI is rarely performed for reasons of cost. An EEG is done to provide information about whether there are other diseases. In this way, especially in the case of medication, it should be excluded that epilepsy is present.

Appearances

Finally, it must of course be mentioned that no two ADHD pictures are really alike. As is the case with all other human diseases. It even goes so far that one now assumes three fundamentally different symptoms and then determines the severity of ADHD:

  • ADS, combined type with all three main symptoms
  • ADS, predominantly hyperactive-impulsive
  • ADS, mostly inattentive