ADHD Diagnosis: Children and Adolescents

*I am not a doctor or healthcare professional, I am a teacher and adult with ADHD and this post is based on information I have taken from the NHS website and my own experience. This post is for information only and anyone seeking an ADHD diagnosis should ALWAYS contact their GP.

I really wanted to write one blog post about diagnosis information for both children and adults, but when that blog post was at four thousand words- I thought it prudent to cut it down a bit for fear of scaring any readers off!

So, I have divided my original post into two; ‘ADHD Diagnosis: Children and Adolescents’ and tomorrow’s post, ‘Me and My Adult ADHD Diagnosis.’

While information about ADHD diagnosis should be simple with an A-Z, step by step, procedure and some helpful links… like everything ADHD, nothing is simple- even diagnosis!

Given the abundance of often conflicting information available on the internet, I have decided to use the NHS information about diagnosis as a framework for this post and have added in guidance about what we can do in schools if we suspect a child has ADHD- based on my experience.

Doctors- like teachers- are limited to their training or the cases they experience regularly and if a GP is cautious with a potential ADHD diagnosis- that is perfectly normal. Whilst that can be frustrating, their caution benefits us all, and I would be doing a great disservice to everyone, especially my ADHD family, if I didn’t emphasise how challenging obtaining that diagnosis can be.

Role of a teacher

Firstly, teachers are not doctors and we cannot diagnose children with ADHD, even if we are convinced they may show several symptoms, and it is important that we remember that when in conversation with parents.

Secondly, we MUST have parental support if we want to make referrals in relation to ADHD.

For children to receive a diagnosis of ADHD, both parents and the school need to agree that symptoms should be explored further and these symptoms should be apparent in more than one setting i.e. at school AND at home.

Children are in school for a small proportion of their time and spend far more time with their family at home, that is why parental input is essential and the symptoms displayed at school are not all that will be considered.

In the past, I have heard teachers frustrated because some parents have put their child’s symptoms down to “just being boys” or “normal childhood” and while I understand that it is challenging when you see a set of symptoms in the classroom that are not backed up at home, knowing what I do about ADHD and how the difficulties can affect the entire family, they WILL be on board if things are difficult at home.

Please note though:

  • In some cases, there may be a period of denial as no parent wants their child to be ‘labelled’ and ADHD does often carry an unfair stigma.
  • In other cases, parents from some communities find it particularly difficult to accept ADHD, particularly if they come from a country where there is little research into the condition or there is a stigma attached.

BUT, if symptoms at school are genuinely problematic, you have used a variety of suitable strategies to support the child (see my later post about strategies) and you can explain to parents how troublesome symptoms are in school- in a gentle and tactful way- you may get them on board to explore symptoms further.

An excellent tool for teachers that I cannot praise highly enough is the ‘Circle Document’ which was given to us by our local authority ASN team. I was recently talking to a friend who works in a Language and Communication Unit in another local authority who hadn’t heard of this document and let her see my copy, she agreed it was excellent and wants to use it in her setting too. Unfortunately, I have had a look around the internet and cannot seem to find a way of ordering it online, so if you are interested see the link below and speak to your local authority ASN team.

Essentially the Circle Document has questionnaires for you to answer about your classroom set up and really gets you thinking about whether you have an inclusive classroom or not. There are also proformas to complete for children that you have a concern about which are broken down in such a detailed manner that you really think about the child’s needs in the class and how you can support them further.

This document then forms the basis for your evidence of strategies that you have used to support the child and can be used to form a discussion with your Support for Learning teacher and parents around the needs of the child.

Parents who wish to take a diagnosis further can go to their GP, as I will describe below, or in some cases the Support for Learning teacher can make a referral to CAMHS (Child and Adolescent Mental Health Services), though this may vary across the country and depend on school policy.

No matter the route taken, evidence is key and the process of ADHD diagnosis is long and hard.

The information below is taken from the NHS website on ADHD diagnosis and I have altered it slightly to make it child specific- I will post the adult version tomorrow. Please see the link posted at the bottom for more information from the NHS website and ALWAYS speak to your GP for accurate information.

Diagnosis

GPs can’t formally diagnose ADHD, but they can discuss your concerns with you and refer you for a specialist assessment, if necessary.

When you see your GP, they may ask you:

  • about your child’s symptoms
  • when these symptoms started
  • where the symptoms occur – for example, at home or in school
  • whether the symptoms affect your child’s day-to-day life – for example, if they make socialising difficult
  • if there have been any recent significant events in your child’s, such as a death or divorce in the family
  • if there’s a family history of ADHD
  • about any other problems or symptoms of different health conditions your child may have

Next steps:

If your GP thinks your child may have ADHD, they may first suggest a period of “watchful waiting” lasting around 10 weeks – to see if your child’s symptoms improve, stay the same or get worse. They may also suggest starting a parent training or education programme to teach you ways of helping your child.

If your child’s behaviour (I prefer the word symptoms but the NHS says behaviour) doesn’t improve, and both you and your GP believe it’s seriously affecting their day-to-day life, your GP should refer you and your child to a specialist for a formal assessment.

(NHS, 2017)

As the NHS guidelines above say, there could be a period of observation or waiting before the child is diagnosed, from my own experience I know this is most common if the child has never presented with any symptoms at the GP before, as they will want to try and ascertain if there is something else causing this change.

It is very important to work with the school and any other care givers in this time to collect evidence that may help the child- this could be school reports, Circle Documents (as described above) letters home, behaviour charts (more on them in another blog) and all other evidence to show that the child’s symptoms really have a detrimental effect on them in more than one setting.

Assessment (from the NHS):

There are a number of different specialists that you or your child may be referred to for a formal assessment, including:

  • a child or adult psychiatrist
  • a paediatrician (a specialist in children’s health)
  • a learning disability specialist, social worker or occupational therapist with expertise in ADHD

Who you’re referred to depends on your age and what’s available in your local area.

There’s no simple test to determine whether your child has ADHD, but your specialist can make an accurate diagnosis after a detailed assessment that may include:

  • a physical examination, which can help rule out other possible causes for the symptoms
  • a series of interviews with you or your child
  • interviews or reports from other significant people, such as parents and teachers

Diagnosing ADHD in children depends on a set of strict criteria. To be diagnosed with ADHD, your child must have six or more symptoms of inattentiveness, or six or more symptoms of hyperactivity and impulsiveness.

To be diagnosed with ADHD, your child must also have:

  • been displaying symptoms continuously for at least six months
  • started to show symptoms before the age of 12
  • been showing symptoms in at least two different settings – for example, at home and at school, to rule out the possibility that the behaviour is just a reaction to certain teachers or parental control
  • symptoms that make their lives considerably more difficult on a social, academic or occupational level
  • symptoms that aren’t just part of a developmental disorder or difficult phase, and aren’t better accounted for by another condition

(NHS, 2017)

When the specialist appointment eventually comes around- it can take months in some areas- the child will usually be assessed by a Psychiatrist who will also want to speak to the parents and look at all of the evidence from teachers (reports, notes, Circle Documents etc.) and any notes from Educational Psychologists if they have been assessed for other things in the past.

They may also want to visit the child at school and at home where they will observe them in class and probably do a task with them, and after this process the child may get a diagnosis of ADHD…

I know that is a lot of information to take in, and I also hope it has shed some light on the diagnosis process for those who are just interested or those who are trying to support children through that process. I cannot stress enough that this is just a rough guideline and a GP is always your first port of call.

I also hope that I have gone some way to dispelling the myth that doctors hand out ADHD diagnoses easily!

Please join me tomorrow for my next blog about adult ADHD diagnosis.

Laura

 

Sources

NHS (2017) ‘Attention Deficit Hyperactivity Diadnosis (ADHD)- Diagnosis’ [online at] http://www.nhs.uk/Conditions/Attention-deficit-hyperactivity-disorder/Pages/Diagnosis.aspx Accessed 28th September 2017

The Circle Collaboration (2011) ‘Inclusive Learning and Collaborative Working’ Page 2 [online at] http://www.asl.scot.nhs.uk/Projects/Documents/circle_collaboration.pdf  Accessed 28th September 2017