4. Other components to be considered as part of an assessment for ADHD:
- Information about the child's appetite, dietary intake and sleep pattern. Where there appears to be a clear link between intake of certain foods or drinks and hyperactive behaviours, parents/carers should be asked to keep a diary and can subsequently be referred on to a dietician if this seems appropriate;
- Physical examination including height, weight, and head circumference. The child's vision and hearing should be also be checked and the child should be screened for co-ordination problems. Other medical causes which might account for the presenting symptoms should be excluded. Also necessary is examination of the cardiovascular system with enquiry about exercise syncope, undue breathlessness and past medical or family history of serious cardiac disease or sudden death in young family members. Where there is a clinical indication based on history or abnormal finding on cardiac examination, an ECG is recommended. Such a physical examination also serves to assess the child for potential contraindications to pharmacological interventions;
- Where there is a clinical indication only, neurological examination to include brain scan or EEG.
- Referral to paediatric occupational therapist or in line with local referral arrangements for assessment of developmental co-ordination disorder (DCD) if there are concerns about the child's fine and gross motor skills;
- Referral to speech and language therapist where there is concern about language development.
- Referral for educational psychology assessment (if not already undertaken) where learning difficulties are suspected. A short WISC (Wechsler Intelligence Scale for Children) or equivalent is better than no assessment at all in these circumstances.
N.B. laboratory assessments e.g. the Continuous Performance Test do not distinguish children and young people with ADHD from psychiatric controls or normal peers and should therefore not be used routinely.
