Assessment and Diagnosis of ADHD in Children and Adolescents
The 6 principle components of ADHD assessment - Key learning points
- Information gathering
- Interview with child and parents/ carers
- Physical examination to exclude other medical causes for the symptoms
- Consideration of co-morbid disorders and associated functional difficulties
- Information sharing and psycho-education
The European Clinical Guidelines for Hyperkinetic Disorder - first upgrade (Taylor et al, 2004) recommend that children suspected of having ADHD are first assessed in the primary care setting before referral on for a specialist assessment within a CAMHS or developmental paediatric setting. It is suggested that standardised behaviour checklists completed by parents backed up by reports from teachers are helpful in differentiating the presenting symptoms of ADHD from those of sleep or conduct disturbance. It is also recommended that before referral to the secondary sector, the child should have a physical examination including a hearing check and that epilepsy should be considered. The National Institute for Health and Clinical Excellence guidelines on diagnosis and management of ADHD in children, young people and adults (2008, p17. www.nice.org.uk/CG072) state that children and young people with behavioural problems suggestive of ADHD can be referred by their school or primary care/practitioner for parent-training/education programmes without a formal diagnosis of ADHD. If however the child’s behaviour/ symptoms suggestive of ADHD are associated with severe impairment, referral to secondary care for assessment should occur without delay.
The American Academy of Child and Adolescent Psychiatry have also published a practice parameter for the assessment and treatment of children and adolescents with Attention-Deficit/Hyperactivity Disorder (2007) which gives up to date recommendations. Additional information on the assessment of ADHD relevant to UK practitioners is now available from the National Institute for Health and Clinical Excellence who have produced guidance for the assessment and management of ADHD (see www.nice.org.uk/CG072).
Examples of ADHD service developments and care pathways within CAMHS settings in Wales and Scotland are described by Salmon et al (2006) and Coghill (2006) respectively.
Following on from this work up, only a paediatrician with expertise in this area, or a child and adolescent psychiatrist or other appropriately qualified healthcare professional should make a formal diagnosis of ADHD. The assessment process often involves a multidisciplinary team approach and an appropriately trained CAMHS worker may undertake the initial stages of the assessment.