Arguments that ADHD is Underdiagnosed in Some Children.
- Some evidence suggests that many girls with ADHD may go underdiagnosed. Research indicates that girls with ADHD are often inattentive but not hyperactive or impulsive. In fact, older girls with ADHD tend to have social problems due to withdrawal and internalized emotions, showing symptoms of anxiety and depression. The inattentive subtype, in any case, may first show up in older children and adolescents.
- Doctors may fail to diagnose children with ADHD because they often behave normally in the quiet doctor's office where there are no distractions to trigger symptoms.
- In spite of the fact that there seems to be no differences in response to treatment among population groups, African American, Hispanic, and Asian children with ADHD are half as likely to be diagnosed and treated as Caucasian children. By high school, the racial disparity increases to the level that the medication rate for blacks is one-fifth of that for whites.
- ADHD may also be underdiagnosed in adults. Some experts, in fact, believe that ADHD may be the most common chronic undiagnosed psychiatric disorder in adults.
History of Behavior
The doctor will first require a detailed history of the child's behavior. Doctors will match this against a standardized checklist to define the disorder.
The parents should describe the following:
- Specific problems beginning as early as possible they have encountered during the child's development -- school reports are very helpful.
- Sibling relationships
- Recent life changes
- A family history of ADHD
- Eating habits
- Sleep patterns
- Speech and language development
- Any problems during the mother's pregnancy or during delivery
- Any history of medical or physical problems, particularly allergies, chronic ear infections, and hearing difficulties
The health professional will want to know how the parents handle different situations, and may want to observe them interacting with the child.
Physical Examination
The child should also be given a general physical examination to determine if any medical conditions are present. The child should be given a hearing test to rule out hearing abnormalities as a source of behavioral problems.
Screening Tests
Continuous Performance Test. A test called the Continuous Performance Test is sometimes helpful in evaluating sustained attention and impulsivity. The child sits in front of a computer screen and is asked to press or not press certain keys in response to images on the screen.
Other Screening Tests. Other tests are available to test neurologic, intellectual, and emotional development problems. Most involve learning and problem solving tasks that help define the particular areas that are most disabling. Blood or other laboratory tests are currently recommended only if the doctor suspects lead toxicity or other medical problems.
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