Diagnosis & Treatment
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Although individuals with ADHD can be very successful in life, without identification and proper treatment, ADHD may have serious consequences, including school failure, depression, problems with relationships, substance abuse, and job failure. Early identification and treatment are extremely important.
While there are no biological, physiological or genetic markers or independently valid tests that can reliably identify the disorder, the scientific consensus is that the diagnosis of ADHD can be made reliably using well-tested diagnostic interview methods.
Because everyone shows signs of these behaviors at one time or another, the guidelines for determining whether a person has ADHD are very specific. In children and teenagers, the symptoms must be more frequent or severe than in other children the same age. In adults, the symptoms must affect the ability to function in daily life and persist from childhood. In addition, the behaviors must create significant difficulty in at least two areas of life, such as home, social settings, school, or work. Symptoms must be present for at least six months.
Determining if a child has ADHD is a multifaceted process. Many biological and psychological problems can contribute to symptoms similar to those exhibited by children with ADHD. For example, anxiety, depression and certain types of learning disabilities may cause similar symptoms.
There is no single test to diagnose ADHD. Consequently, a comprehensive evaluation is necessary to establish a diagnosis, rule out other causes and determine the presence or absence of co-existing conditions. Such an evaluation should include a clinical assessment of the individual's academic, social and emotional functioning and developmental level. A careful history should be taken from the parents, teachers and when appropriate, the child. Checklists for rating ADHD symptoms and ruling out other disabilities are often used by clinicians.
Regardless of who does the evaluation, the use of the Diagnostic and Statistical Manual IV criteria is necessary. A medical exam by a physician is important and should include a thorough physical examination, including hearing and vision tests, to rule out other medical problems that may be causing symptoms similar to ADHD. In rare cases, persons with ADHD also may have a thyroid dysfunction. Medication can only be prescribed by a physician (MD or DO), a nurse practitioner (NP) or a physician assistant (PA) [As of 2006, two U.S. states (New Mexico and Louisiana) allow psychologists with advanced training in medicine and pharmacology (called "medical psychologists" in Louisiana) to prescribe certain medications for mental health conditions]. Diagnosing ADHD in an adult requires an examination of childhood academic and behavioral history as well as reviewing current symptoms.
What We Know #3 has information on medication management for ADHD in children and adolescents. What We Know #7 has information on psychosocial treatment for ADHD in children and adolescents.
There may be serious consequences for persons with ADHD who do not receive treatment or receive inadequate treatment. These consequences may include low self-esteem, social and academic failure, career underachievement and a possible increase in the risk of later antisocial and criminal behavior.
One of the most difficult challenges that parents and adults with ADHD face is what to do about treatment. Because there is no "cure" for ADHD and no single treatment option that is right for everyone, treatment plans should be tailored to meet the specific needs of each individual and family.
So treating ADHD often requires medical, educational, behavioral, and psychological intervention. This comprehensive approach to treatment is called "multimodal" and, depending on the age of the individual with ADHD, may include the following:
- Parent training
- Behavioral intervention strategies
- An appropriate educational program
- Education regarding ADHD
- Medication, when necessary