Your child has difficulty focusing and seems constantly distracted by the smallest things. Homework and morning routines take hours to complete. Your child can rarely stay seated at dinner or a desk, interrupts constantly, blurts out funny comments at the most inconvenient times, and climbs literally everything in sight. After years of concerns from yourself and your teachers, you finally seek an evaluation and treatment for attention-deficit/hyperactivity disorder (ADHD). However, after a quick Google search in your area, it becomes clear that there are too many options when it comes to providers. There is probably a long list, but which specialists diagnose and treat ADHD? Hello, overwhelm and confusion!
Let’s look at ADHD, why a comprehensive evaluation is essential, and the advantages/drawbacks of various specialists who diagnose and treat ADHD.
What is ADHD?
Before answering the question of which specialist to choose, let’s first discuss ADHD. ADHD is a neurodevelopmental disorder whereby a child has difficulty paying attention and has hyperactive/impulsive behaviors that impair functioning across multiple settings. According to the CDC, 9.4% of children are diagnosed with ADHD. The diagnosis of ADHD is rarely given until a child is around five years of age, as these symptoms are often a normal part of development in young children. The majority of children are diagnosed between the ages of 6-11 years old. Additionally, these symptoms must be present across different settings (home and school are the most common). Also, they must negatively impact your child’s functioning in these settings.
The name ADHD can be confusing, as it assumes by the title that a child has hyperactive symptoms; however, this is not always the case. In the past, there were different terms for ADHD, such as simply ADD for those without hyperactive symptoms. These labels are no longer used. We now use the term ADHD for all individuals with the diagnosis. However, there are three types of ADHD:
ADHD, predominately inattentive presentation – children who have difficulty paying attention, focusing, or listening to instructions; they may daydream or demonstrate distractibility, etc. (Note: in the past, this was referred to as ADD).
ADHD, predominately hyperactive/impulsive presentation – children who often have difficulty controlling impulses, such as interrupting, yelling out, difficulty staying seated, running and climbing excessively, etc.
ADHD, combined presentation – children who show symptoms of both inattention and hyperactivity/impulsivity
Why is a Comprehensive Evaluation of ADHD Helpful?
To make the ADHD evaluation process even more complicated, ADHD often occurs along with additional diagnoses. The CDC indicates that approximately 50% have an additional behavioral or conduct diagnosis, 30-50% have a learning disorder diagnosis, 33% have an anxiety diagnosis, 17% have a depression diagnosis, and 14% have an autism spectrum disorder diagnosis. Based on this information, you can see why it is important that the evaluator be knowledgeable in these additional diagnoses. When a specialist evaluates for ADHD, no one test can be used to make the diagnosis.
Many specialists will use behavior checklists to examine the severity of your child’s symptoms across different settings and compared to peers your child’s same age. Sometimes, observations in school or home-based settings are used. Because so many other diagnoses can also be present, tests to further evaluate your child’s academic skills, intellectual functioning, memory, executive functioning, motor skills, speech and language, and social skills can also help provide additional information about your child’s current functioning and needs.
As a child psychologist specializing in testing and evaluation, I often see children who received an initial diagnosis via a relatively quick evaluation (just behavior checklists by a parent and teacher). These children usually had additional challenges that were not identified and went unaddressed. For instance, some children also had dyslexia and would have benefited from additional early intervention in a multisensory reading program.
Other children actually had a diagnosis of an autism spectrum disorder and would have benefited from intervention tailored to their needs. Other children had co-occurring symptoms of anxiety or depression that also continued to go unaddressed and untreated. Why is a comprehensive evaluation important? Because sometimes, our kids act out, are defiant, or show very big emotions, and we need to understand how to provide the right interventions to help them cope. As you can see, there are many reasons why a comprehensive evaluation can be very valuable in helping you understand your child better and provide appropriate interventions at home and school.
Who Diagnoses and Treats ADHD? Advantages and Drawbacks of Each Specialist.
Now that you know about the diagnosis of ADHD itself, let’s talk a little about some providers who diagnose and treat it. Again, you have several different options, and each can have advantages and drawbacks. Below are some general guidelines regarding specialists.
According to the CDC, about 50% of children are first diagnosed by their pediatrician. Most parents have a good relationship with their pediatrician, trust them, and are the first person they go to when concerns with their child’s development arise. Many pediatricians have training in the assessment of ADHD and will provide checklists to parents and teachers. Pediatricians are also typically familiar with your child’s development and have known them since birth. Pediatricians are able to provide treatment with medication, as they are medical doctors; however, they do not provide behavioral treatments or counseling. These appointments are also usually covered by health insurance. The drawback is, pediatricians cannot evaluate commonly occurring diagnoses, such as autism, learning disorders, or anxiety/depression. They also may have limited training and experience evaluating and treating ADHD in children.
2) Developmental pediatrician
Developmental pediatricians are similar to pediatricians but typically specialize in working with children with a range of developmental diagnoses. They can assess for additional co-occurring diagnoses, including autism, anxiety, depression, etc. They can also prescribe medication for treatment, as they are medical providers; however, they typically do not provide behavioral treatments or counseling. The appointment for developmental pediatricians is often, but not always, covered by insurance. The drawback is that developmental pediatricians typically do not provide comprehensive evaluations of learning disorders, and testing is often limited. Children with more complex autism or learning challenges may be unable to make the diagnosis and referred out for more in-depth testing.
3) Psychiatrists or psychiatric nurse practitioners
Psychiatrists have in-depth knowledge regarding all child and adolescent mental health diagnoses. As such, they can also assess for additional co-occurring diagnoses, including anxiety, depression, etc. They can also prescribe medication for treatment, as they are also medical providers; however, they typically do not provide behavioral treatment or counseling. The appointment for psychiatrists are sometimes covered by insurance. The drawback to this type of testing is that psychiatrists are often less familiar with autism spectrum or learning disorders. They also provide short and limited appointments and typically rely on interviews with parents and children for the evaluation.
4) Psychologists and/or neuropsychologists
Psychologists have in-depth knowledge regarding most child and adolescent mental health diagnoses. They can also provide behavioral therapies, parent training and support, family therapy, social skills interventions, and individual therapy. Testing psychologists can usually assess for additional co-occurring diagnoses, including anxiety, depression, learning disorders, and autism. Testing with a psychologist is usually very comprehensive; appointments typically take 4-8 hours and occur across multiple days. The reports families receive often include detailed recommendations for interventions, accommodations, and therapies. This type of testing can be covered by insurance but often is not. This type of testing is that the cost can be high due to the thorough nature of the evaluation. Also, psychologists cannot prescribe medication and would need to refer back to the child’s pediatrician or psychiatrist for this treatment.
5) Therapists (counselors, social workers, family therapists)
Therapists can provide individual therapy, family therapy, parent training, and social skills interventions. They can usually assess for additional diagnoses, including anxiety, depression, etc. The drawback to evaluations by a therapist is they often have limited training in assessment, particularly related to autism and learning disorders. Thus, the evaluation is typically limited to behavior checklists or interviews with parents and children. Additionally, therapists cannot prescribe medication and would need to refer back to the child’s pediatrician or psychiatrist for this treatment.
Some additional specialists serve important roles in the evaluation and treatment process. These individuals do not diagnose ADHD, but they are often needed in evaluating and treating commonly occurring challenges in children with ADHD. These individuals include speech language pathologists (hi Katie! Katie will be filling us in later on why speech and language testing is essential for children with ADHD), occupational therapists (they specialize in sensory challenges and fine motor/handwriting issues we often see in children with ADHD), behavior therapists (they specialize in more detailed analysis of specific behaviors and help develop plans to support behaviors at home and school) and educational therapists (they provide specialized academic interventions for children with ADHD who have co-occurring learning challenges).
We did not discuss school-related testing for children with ADHD. If you want further information on how testing occurs in the schools, check out our School Testing Guide here! If you need free resources, sign up for our email list and follow us on social media.
And, if your child has ADHD (or suspected ADHD), you NEED our FREE ADHD Parenting Guide. This guide gives you Six Keys to Raising and Happy and Independent Child with ADHD! We also have an ADHD parenting course, Creating Calm, which you can do from the comfort of your home!
Have a fabulous week!
Lori, Katie, and Mallory
The contents of this site are opinions of The Childhood Collective PLLC partners unless otherwise noted. The information on this site is not intended to diagnose, treat, or prevent any type of medical condition and is not intended as personalized medical/psychological advice. Any decision you make regarding your and your family’s health and medical treatments should be made with a qualified healthcare provider.