ADHD Diagnosis Requires Comprehensive Evaluation
comprehensive evaluation that includes objective testing is essential in
accurately diagnosing attention deficit hyperactivity disorder (ADHD),
particularly when there is a concern regarding the presence of other comorbid
The Multimodal Treatment of ADHD (MTA) study, sponsored by the National Institute of Mental Health (NIMH), found that nearly 70 percent of the participants with ADHD also had another mental health diagnosis.
“Oppositional defiant disorder and mood/anxiety disorders are the most common comorbid conditions,” says Lindsey Corr, MD, child and adolescent psychiatrist at Children’s Behavioral Health in Omaha. While studies indicate about three-quarters of children with ADHD are diagnosed before age 9 and one-third of those by age 6, “symptoms and impairments can often be seen as early as age 3,” she says.
At Children’s Behavioral Health, evaluations of children and adolescents are typically conducted by Kimberly Levering, PhD, a licensed clinical psychologist who started the ADHD Clinic at Children’s in 2008 and serves as its coordinator. Children must be at least five years old to be evaluated.
“Many of the behaviors associated with ADHD can be developmentally appropriate in preschool, when they are less likely to have had to sit and focus for longer periods of time in a structured environment like school,” says Dr. Levering “That is why I am more inclined to refer families with preschoolers for outpatient behavior therapy to try to treat symptoms first.”
At Children’s Behavioral Health, children and adolescents undergo a full clinical evaluation, including a review of collateral information and consideration of the developmental context. The team of child and adolescent psychiatrists and therapists collaborate not only with each other, but also with pediatricians and other specialists to provide comprehensive, evidence-based treatments, including medication management and behavior therapy.
Dr. Corr says more medication administration options are available today, such as the methylphenidate patch and long-acting liquid and chewable stimulant formulations. Long-acting, non-stimulant ADHD medications are available as well.
“One exciting ADHD medication option on the horizon is a delayed- and extended-release methylphenidate capsule which the child could take at bedtime and experience the effects upon awakening,” she says.
For children and adolescents with multiple diagnoses, Children’s provides a wide range of treatments targeting various symptoms that may affect functioning. These can include medication management, cognitive behavioral therapy, trauma-focused therapy and parent-child interaction therapy.
If a pediatrician questions whether a child meets the criteria for ADHD, Dr. Levering says, Children’s can help.
“Our psychiatrists are always willing to consult with primary care physicians if they have questions regarding medication management of symptoms,” says Dr. Levering. “If the physician has tried managing medication and the child is non-responsive, or is having too many side effects, they can refer to one of our psychiatrists directly.”