Module 3 – The Diagnosis of ADHD and its First Treatments

Estimated Time: 60 minutes

In this module, you will learn:

·    The initial symptoms to look out for

·    How ADHD is diagnosed

·    Current ADHD treatment options

·    How to tell if the treatment is making a difference

The Diagnosis of ADHD and First Treatments – 5m24s

3.1 The Initial Symptoms to Look Out For

We can now move on to something that is of the utmost importance – the diagnosis of ADHD.

Getting a diagnosis is the first step towards improving the life of the person with ADHD. In this module, we will explain when it’s appropriate to seek an ADHD diagnosis, how to go about it and what the process involves.

We also introduce treatment options and how they might initially be approached. While ADHD is a chronic condition, there are effective treatments out there that can help, and we will explore them in detail throughout the entire course.

Exploring this information regarding ADHD symptoms does not mean that you are able to make a diagnosis. Instead, this is merely to provide you with guidance on identifying possible symptoms, before seeking professional advice and support from a qualified medical practitioner.

There are several symptoms that you should be looking out for if you suspect ADHD. We have already touched on those symptoms, but it is worth briefly reviewing them.

Symptoms will vary depending on the subtype of ADHD, but some of the main symptoms experienced by people with the condition are as follows:

• They often fidget and are restless
• They often act impulsively
• They often lose things
• They often don’t appear to be listening
• They are very easily distracted
• They are often unable to finish tasks

Children with ADHD may forget things, leave tasks incomplete, rush through things, and play roughhouse when they should be sitting still. Although they don’t mean to, they often disrupt other children as well as teachers and parents.

They may often do things without permission, rush, jump, pull or grab without control. Many of them often display intense emotions that may seem disproportionate to the situation at hand. Children with ADHD may also display oppositional or defiant behaviours.

Please keep in mind that young children are often naturally curious, restless, impatient and fidgety, and this doesn’t mean all of them have ADHD.

However, if the behaviour is having a significant negative impact on their life, it is worth getting them assessed. Start taking notes on their behaviour, as they will be vital in the diagnosis process. This is also a good time to start discussing your concerns with the child’s teachers if they are at school.

A child can be diagnosed as having ADHD if they display six or more symptoms of hyperactivity, impulsivity or inattention, for at least six months before their assessment. In addition, these symptoms must have appeared before the age of 12. The symptoms need to be present in more than one setting, so for most children, this will generally mean at home and at school.

For adults to be diagnosed with ADHD they must meet the same general criteria, but they only need to exhibit 5 symptoms. For them, the different settings could be home, work and social life, and their symptoms must have a negative impact on their life – for example, they lost a job because of their inattention symptoms, or they consistently forget to complete important tasks such as paying bills. The symptoms must not be attributable to any other mental health conditions.

We must stress one very important point – there is no set or single test that has been designed that can help with the diagnosis of ADHD. It has to be done as an accumulation of symptoms and patterns of behaviour over a minimum of six months, so there is no intelligence test, blood test, or anything else that can be done to reach this particular conclusion.

FACT

ADHD symptoms tend to appear at an early age, and they often become more noticeable when circumstances change, such as when a child begins going to school.

Source: National Health Service

3.2 How ADHD is Diagnosed

If the symptoms that were listed above resonate with you, it does mean that getting yourself or your child assessed for ADHD is something to give some serious consideration to.

However, a number of people are unsure as to how they go about this. Do they go to their GP? Do they go to a specialist?

In most instances, a GP is unable to make a formal diagnosis of ADHD. However, an appointment with them to discuss the issues that you are facing would be an important first step.

Your GP will ask questions about the symptoms and may refer you to a specialist for assessment if they think it necessary. In some cases, they may instead ask you to monitor the situation for a few months to see if there’s any improvement, and then refer you if there is no change.

The actual assessment would be made by a child psychiatrist or paediatrician in the case of a child, or a psychiatrist in the case of an adult. In either case, the assessment could also be made by any medical professional who has ADHD expertise.

A diagnosis of ADHD will be made following a comprehensive clinical evaluation, which can include, but is not limited to:

• Physical examination
• Clinical interviews
• Parent/teacher/self-reports, by use of validated rating scales – such as SNAP Questionnaire
• Objective ADHD assessments such as QbTest/QbCheck

Assessment examples: Qb Test. SNAP Questionnaire.

It’s crucial that a full examination is performed by a doctor to rule out any other possible underlying causes of the symptoms. The kind of things they will be looking for are sleeping problems, anxiety, depression or thyroid problems. These different issues could significantly affect the way that someone behaves – and that is why they have to be ruled out at the earliest opportunity.

Another important part of the process for getting a child diagnosed is inviting parents and teachers to fill out detailed checklists regarding the child’s behaviour, activities and responses. These reports are an invaluable resource for health professionals when trying to make a diagnosis, which is why it’s important to start making notes of any symptoms and issues as soon as they are noticed.

Based on the information gathered during the evaluation, a diagnosis is made when the child or adult’s ADHD symptoms meet the criteria as set out in a medical classification system such as the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders – 5th edition).

According to the DSM, the following has to apply to an individual for a diagnosis of ADHD to be reached:

• A child must have displayed six or more symptoms of inattentiveness or hyperactivity-impulsivity continuously for at least six months. An adult must have presented with 5 or more symptoms over the same time period.
• The symptoms must have been observed before the age of 12. This can be problematic in ADHD diagnosis for adults simply because of the amount of time which has passed.
• The symptoms must have been present in at least two different settings, to eliminate the possibility that it is something in the environment that is leading to the emergent symptoms. For children, this is normally home and school, and for adults, it could be home, work and/or social life.
• Evidence shows that these symptoms actually impair the way in which the individual is functioning, whether it be in their social life, academic life, or family life.
• The symptoms that are identified are not linked to any other form of mental disorder.

ADHD may be indicated in the case of a child if it’s clear that the observed symptoms of impulsivity-hyperactivity and/or inattentiveness go above and beyond what’s normal for their age, and meet the requirements above.

For adults, diagnosis can be more difficult, because under current guidelines it’s not enough to be experiencing the symptoms in adulthood – they must have been present since childhood. It can be helpful to get supporting information about any childhood symptoms from past teachers or friends/family members.

It’s worth noting that if you’re not happy with the initial diagnosis, then do not give up. It can often be the case that insufficient information has been provided for the evaluation, or a doctor has just not realised the importance of what they are being told. It’s perfectly reasonable to ask for a second opinion if you’re not satisfied with the outcome.

Next, we turn our attention to what happens after the diagnosis has been made, and this means taking a look at some of the treatments that may be offered.

3.3 Current ADHD Treatment Options

We will look at the range of treatments in more detail in later modules, but at this stage, we introduce some of the treatments and how they can be used in the first stages after diagnosis.

The main recognised treatments for ADHD are medication and therapy. They can be very effective, especially if used in combination with each other.

However, there is no guarantee that initial treatments are going to be an immediate success, as there is a certain amount of trial and error involved. ADHD medications in particular are unlikely to work perfectly on the first try, and a certain amount of adjustments to the dosage or even the type of medication is to be expected in the early stages.

Like all medications, ADHD treatments come with potential side effects, such as sleep problems. These may also make it necessary to modify the treatment plan.

Likewise, it could be the case that further underlying issues come to light during these early days, for example, learning disabilities or mood disorders. Any ADHD medication will not treat these conditions, so they also need to be addressed before significant improvements can be observed.

The most common types of treatment are as follows:

Medication

Medication is widely used for the treatment of ADHD and it has been shown to be effective in treating both adults and children. There are several different types of medication out there that could be used and are usually either stimulants, selective noradrenaline reuptake inhibitors (SNRIs) or alpha agonist drugs.

Treatment plans may be different depending on the individual or the type of medication taken. For example, some medications can be taken only on school days, while others should be taken every day.

A typical approach is to start with small doses of any medication, and then make adjustments based on efficacy and any side effects. It will be necessary to have multiple check-ups with your doctor during this process.

We will look at medication in much more detail in a later module.

Therapy

Therapy plays a key role in helping a child to not only better understand their behaviour and the feelings that they have but also allow them to gain better control over them. In addition, tailored education programmes for parents can be very beneficial, as they help parents to support their children with ADHD more effectively.

Types of therapy offered include Cognitive Behavioural Therapy (CBT) and social skills training. We will look at these and other therapies in more detail in a later module.

Support from others

This is not a treatment as such, but it is crucial. Anyone with ADHD will benefit from having supportive people around them who understand their condition. If you are a parent of a child with ADHD, this is where your own education is going to be invaluable, as you play such a significant role in helping them manage their condition.

3.4 How to Tell if Treatment is Making a Difference

So what happens once this initial treatment has commenced? How can you tell if it’s working?

If an ADHD treatment is working, the patient should expect to have improved focus, better memory and less impulsivity. They should be sleeping well, and have a better mood overall.

If the ADHD treatment is not working well, the patient might find that the improvements are not strong enough or sustained, or alternatively, they could be experiencing severe side effects.

In the case of severe side effects, it’s most likely that the type of medication is not a good fit, and it would be beneficial to try a different type. If there are no significant side effects but the improvements are not enough, it could be that the dose needs to be changed.

Whether the medication appears to be working or needs some alterations, it can be helpful to track progress in an organised, scientific way. The symptoms of ADHD are varied, and it can be hard to tell if the treatment is working for all of them. For this exercise, it is best to focus on a core set of symptoms.

Your ADHD specialist may ask you to come up with a list of up to 5 symptoms. Here are some examples:

• Impulsivity, acting or speaking without thinking
• Emotional overreactions
• Restlessness, fidgeting
• Difficulty sticking with boring activities
• Losing things
• Procrastination
• Distractibility

It is important that the symptoms chosen are only the ones that medication is known to help with. All of the symptoms above fit into this category.

Other symptoms, such as having poor organisation and/or no sense of time, are not known to be improved significantly by medication, and as such would be poor choices to use as markers of the effectiveness of the treatment. Your doctor will be able to guide you in making choices for the list of symptoms.

Once treatment has commenced, the symptoms can be tracked and logged to see if there are any improvements. This is especially useful if the dose needs to be altered because, using this method, you can see at which point further changes in medication stop having any effect.

It can take time to get an individual’s ADHD treatment right. Careful observation and continued monitoring are key to this, both in the early stages and going forward.

Assignment

The Diagnosis of ADHD and First Treatments

Time: 30+ minutes

Now it is time to put what you have learnt in this Module to the test. Work your way through this worksheet and do your best to fully participate in every activity set.

Download the worksheet below, print out and complete.

Download Worksheet

SUMMARY

In this module, we have looked at the criteria that medical professionals use to diagnose ADHD and some of the methods used to assess people for the condition.

We touched on the differences between diagnoses made in childhood and adulthood. While subtle, they are significant and can make it harder to get an ADHD diagnosis as an adult.

Getting that all-important first diagnosis is a huge step for anyone affected by ADHD. The next step is considering a treatment plan. For most people, this will mean medication, therapy, or a combination of both.

In the next three modules, we explore how ADHD affects the individual in more detail, starting with its impact in childhood.

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