Your child is having difficulty focusing and seems constantly distracted by the smallest things. Homework and morning routines take hours to complete. Your child is rarely able to stay seated at dinner or at 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 teachers, you finally make the decision to seek out an evaluation and treatment for attention-deficit/hyperactivity disorder (ADHD). However, after a quick google search in your area for specialists who diagnose and treat ADHD, it becomes clear that there are too many options. Hello, overwhelm and confusion! In this blog post, I am going to provide you with a little information on ADHD, why a comprehensive evaluation is important, and advantages/drawbacks of various specialists who diagnose and treat ADHD.
What is ADHD?
Before I get into 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/or 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 5 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 need to be present across different settings (home and school are the most common) and must have a negative impact on 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 3 types of ADHD:
ADHD, predominately inattentive presentation – children who have difficulty paying attention, focusing, listening to instructions; they may daydream or demonstrate distractibility, etc. (Note: in the past this was referred to as simply ADD).
ADHD, predominately hyperactive/impulsive presentation – children who often have difficulty controlling impulses, such as interrupting, blurting 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. In fact, 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, there is no one test that 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 in comparison to peers your child’s same-age. Sometimes, observations in school or home-based settings are used. Due to the fact that 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 be helpful in providing 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 often 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 at school.
Who Diagnoses and Treats ADHD? Advantages and Drawbacks of Each Specialist.
Now that you know a little bit more about the diagnosis of ADHD itself, let’s talk a little about some of the providers who diagnose and treat it. Again, you have a number of different options and there can be advantages and drawbacks to each one. Below are some general guidelines regarding specialists.
1) Pediatrician
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 arises. Many pediatricians have training in 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 to this type of testing is that 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 are able to 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 are often, but not always, covered by insurance. The drawback to this type of testing is that developmental pediatricians typically do not provide comprehensive evaluations of learning disorders and testing is often limited. For children with more complex autism or learning challenges, they may be unable to make the diagnosis and refer 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 are also able to 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 are also able to provide behavioral therapies, parent training and support, family therapy, social skills interventions, and individual therapy. Testing psychologists are usually able to assess for additional co-occurring diagnoses, including anxiety, depression, learning disorders, and autism. Testing with a psychologist is usually very comprehensive and appointments usually 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. The drawback to this type of testing is that the cost can be high due to the thorough nature of the evaluation. Also, psychologists are not able to prescribe medication and would need to refer back to the child’s pediatrician or psychiatrist for this type of treatment.
5) Therapists (counselors, social workers, family therapists)
Therapists can provide individual therapy, family therapy, parent training, and social skills interventions. They are usually able to assess for additional diagnoses, including anxiety, depression, etc. The drawbacks to an evaluation by a therapist is that 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 are not able to prescribe medication and would need to refer back to the child’s pediatrician or psychiatrist for this type of treatment.
There are additional specialists who 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 important 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, so if you want further information on how testing occurs in the schools, check out our School Testing Guide here! If you want more free resources and information about how to support your child, sign up for our email list and follow us on social media.
And, if your child has ADHD (or suspected ADHD), you do not want to miss our FREE ADHD Parenting Guide, which 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 own home… in your pajamas!
Have a fabulous week!
Lori, Katie, and Mallory
[…] your child is struggling to stay focused and finish tasks across home and school, it may be time to find a specialist to do an evaluation. When considering Inattentive ADHD, it is also important to find out if your […]