Diagnosing ADHD

When a parent has concerns about inattention or hyperactivity, they may seek an ADHD evaluation. The first question they might have is “Who is the best person to complete this evaluation?” There are different schools of thought on this, but in my opinion, the most important question is not “What type of professional should complete the evaluation?” Instead of looking at the title of the person, consider looking at the thoroughness of the evaluation they would complete. Medical doctors, School Psychologists, Clinical Psychologists, and Psychiatrists are all qualified to diagnose Attention Deficit Hyperactivity Disorders. It is my opinion that one group is not better than another. It’s the methods of the individual evaluator that is most important to consider.

With that being said, some will say that a medical doctor should diagnose ADHD, because it is a medical condition. The medical doctor can rule out other medical conditions. However, I can give you a list of doctors that I personally know will give an ADHD diagnosis after a 15 minute interview with the parent. I know a doctor who will give medication to a child and if it works, then give a diagnosis and if it does not work, say “it must not be ADHD.” I also know of a practice that works collaboratively with the school and a Clinical Psychologist in their office as part of the process of the evaluation. Within the medical profession, as any profession, there is a large spectrum in the quality of the type of evaluation completed.

Another school of thought is that the schools should complete the evaluation as it relates to school difficulties. This can be done effectively when a school uses a multidisciplinary approach. When looking at special education services, the student’s disability must cause academic impairment. However, a student can have a diagnosis of ADHD and not be eligible for special education. Schools often approach evaluations as whether they would meet special education criteria. Some schools will do an excellent job of completing an evaluation for Attention Deficit Hyperactivity Disorders, while others do not. In fact some schools will not evaluate for ADHD and require a medical diagnosis instead.

According to the Diagnostic Criteria in the DSM-IV-R, there must be an impairment in two or more settings, not just school or home. Whoever is conducting the evaluation must consider both settings. Doctors can send rating scales to teachers and review previous records. Schools can interview parents and send rating scales home. As a parent, if your child is being evaluated for ADHD, carefully consider whether the evaluator will be looking into all perspectives.

Questions to ask an evaluator prior to agreeing to an evaluation:
1. Will you use multiple sources as informants (teacher, parents, observations)
2. How will you be ruling out medical conditions and other learning disabilities?
3. What types of assessment procedures will you be using?

For more information on ADHD:
Attention Deficit Hyperactivity Disorder
FAQ Parents ask about ADHD and Special Education
Other Health Impairment

9 Responses to “Diagnosing ADHD”

  1. Heather says:

    Hi Erin,
    I love your blog and have referred parents to your site as a resource. In your Diagnosing ADHD blog you mention that school psychologists are qualified to diagnose ADHD. It’s been my experience that most school psychologists are not able to give diagnoses outside of the state criteria unless they have a Ph.D. or are a LP. Does this differ from state to state? My approach with parents has always been to inform them that I don’t have the credentials to diagnose ADHD, but that I can help them gather information by doing observations and interpreting rating scales. I usually advise that a medical doctor or psychologist make the final determination. Can you clarify your statement about school psychologists being able to diagnose? Thanks!

    School Psychologist in MN

  2. It must vary from state to state. School Psychologists do diagnose in VA and I was trained to do so in my training program. In most of the districts in my area, the School Psychologists do diagnose. Do you diagnose Autism?

  3. Ruth Anne says:

    Thank you for the information Erin. My concern is how many parents might be aware that a concern of ADHD might be due to their child’s diet. Have you ever referred them to a nutritionist as well? While I agree it is good to get as many opinions as are available, many medical doctors do not consider that diet may be a factor in behaviors. Just wondering if this is also considered as a determination is made and assistance or education supplied to parents in need.

    Parent of VA school students

  4. Heather says:

    We are very careful with the language we use in MN to avoid saying “diagnose.” Instead, we make “educational determinations” based on the MN state criteria.

  5. Okay, I did some research on the NASP website the School Psychology credentials do vary somewhat from state to state. I’m copying this definition of the Practice of School Psychology in VA from: http://www.nasponline.org/certification/state_info_list.aspx “Practice of school psychology means: 1. testing and assessment (psychological assessment, evaluation and diagnosis relative to the assessment of intellectual ability, aptitudes, achievement, adjustment, motivation, personality, or any other attribute that relates directly to learning or behavior problems that impact education;”

  6. In response to Ruth Ann, diet is something to consider, along with many other factors, such as lack of sleep. To my knowledge, schools in general do not tend to offer nutritional support outside of school lunch/nutrition programs. Not that it wouldn’t be such a bad idea…

  7. Anonymous says:

    I am also a school psychologist in VA working for a large school division and I have heard a different answer to the question “Can the school psychologist diagnose ADHD?” almost everytime the issue has come up. The practice of educationally identifying ADHD even varies from school to school in our division depending on the psychologist there. It’s very frustrating for me because there is just as much confusion outside of schools (with doctors and therapists) as within. Some doctors expect the school to diagnose and then others think we have no authority or qualification to do so. We were told at a meeting today that we were no longer allowed to “diagnose” in our reports under the advisement of one of the county lawyers. I’ve always used the language “demonstrates characteristics of” or “appears consistent with” but do not go so far to say I have diagnosed the student with _______.

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  9. danielthomas says:

    The exact causes of Attention deficit hyperactivity disorder are still unclear, but the disorder appears to involve changes in neurotransmitters, or chemicals, that stimulate the areas of the brain that control attention.