Attention deficit hyperactivity disorder (ADHD) is one of the most common behavioral disorders affecting both children and adults. American and Canadian studies confirm that ADHD rates are on the rise. A recent study by Université de Montréal1 revealed an increase in the number of children taking prescribed ADHD medication. According to the study, the number of children who were assessed to have ADHD increased to 59% in 2007 from 43% in 2000. Moreover, the authors of the study suggest that the consumption of ritalin increased significantly since 1994 when the rate was 1.3%. What could account for the increase in the ADHD diagnosis?

There are several reasons for this. For one, the ADHD diagnostic criteria as defined in the Diagnostic and Statistical Manual of Mental Disorders (DSM) has changed over time and fairly recently acknowledged adult presentation. Also, there is greater societal awareness of ADHD and the behavioral, social and academic challenges it may pose. As such, parents, educators, students and professionals are more familiar with symptoms of ADHD, and therefore, are in a better position to question the possible presence of the disorder.

Much more troubling and adding to the increase in prevalence rates, is the fact that ADHD diagnosis is generally based on subjective reports only. Rating scales, such as the Conners, SNAP IV, or the Brown’s Attention Deficit Disorder scales are typically used. Based on observations, parents, educators and/or individuals are asked to complete these questionnaires. Although these rating scales do have a place in the overall conclusion, they simply cannot be used solely as the main source of information.

In order to avoid a possible misdiagnosis, a comprehensive and objective evaluation is necessary, as the symptoms of ADHD are not specific only to ADHD. ADHD symptoms frequently overlap with other disorders and conditions. Mood disorders, language disorders and learning disabilities to name a few, may share the same behavioral manifestations or symptomatology. Therefore, a proper diagnosis must exclude any other possible conditions or disorders that might mimic and account for the presence of ADHD-like symptoms.

A comprehensive evaluation should include a clinical and family history, behavioral observations, cognitive assessment, behavioral rating scales, as well as measures that provide more objective information of the individual’s attention and executive functions. Such measures include tests of attention and other neuropsychological tests.

ADHD is not always simply a problem of sustaining attention, distractibility, impulsivity or hyperactivity. It is rather a syndrome of various elements that comprise what is called executive functions. These skills are a set of neurologically based processes that help us manage and control all kinds of life tasks and emotions. In short, these skills provide a sense of readiness, flexibility, persistence, planning and organization. They also provide information on the individual’s ability to adjust to new rules and new situations, delay gratification, inhibit automatic responses, and make decisions, especially in times of uncertainty. Deficits in one or more of these areas can result in a number of difficulties which are typically seen and labeled as laziness, procrastination, forgetfulness, oppositional behaviors, difficulty paying attention and completing assignments or chores, and so forth.

Common ADHD treatment approaches usually include pharmacological intervention, parent training and behavior management techniques, while information about the status of the higher level thinking skills or executive functions are too often ignored. It is only with an understanding of the specific thinking skill or skills that are in need of support will a more precise intervention plan be possible, thus making living with ADHD somewhat easier for the individual, family and/or educators.

In summary, given the ambiguous behavioral manifestations of ADHD, a proper and accurate diagnosis can be problematic. A simple but effective approach to the problem of ADHD evaluation is through a comprehensive evaluation performed by a professional who has the capacity to make a differential diagnosis. Although such an assessment can be time consuming and quite costly, it is a prerequisite to ensuring an accurate diagnosis. When choosing to work with a professional, it is important that you ask specific questions about the evaluation process and what it consists of, as well as the costs. By doing so, you will ensure receiving a more objective rather than a subjective ADHD diagnosis simply based on observable symptoms, along with individualized information on the type of supports and accommodations needed in order to achieve personal success.

About the author
Elizabeth Shoiry, B.Sc., B. Sc., M.Ed OPQ
Licensed Neuropsychologist

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