Diagnosis is Not as Easy as It Seems

Luke Dalfiume, PhD

By Luke Dalfiume, PhD, Licensed Clinical Psychologist

It would seem that diagnosing attention deficit hyperactivity disorder would be simple: if the person has a longstanding pattern of either inattention or hyperactivity and impulsivity, or both, then they must have ADHD, right? It is possible, but not necessarily so. There are other factors to consider:

• Did the person have symptoms before the age of 12? Many adults come in to my office with attention problems, but no childhood history of either inattention or hyperactivity or impulsivity. This is problematic, but suggests the issue must be related to something other than ADHD.
• Do the symptoms occur in more than one setting? If not, then it is likely more of an environmental problem (e.g., in the home, school, or work setting) than an ADHD issue.
• Is there another mental health issue contributing to the symptoms? This is the most significant area that a professional must rule in or rule out prior to a diagnosis. The most common problems looking like ADHD include anxiety disorders and post-traumatic stress disorder, in which inattention and hyperactive, impulsive behaviors are common. A common feature of depression is difficulty concentrating, and in this way depression mimics ADHD. Less common are schizophrenic-spectrum disorders, in which a person frequently experiences auditory or visual hallucinations. Hallucinations involve a person hearing (auditory) or seeing (visual) things that are not really there. Many who are experiencing hallucinations will appear to be distracted. This experience was once described to me as being similar to having “two TVs” (real, objective reality and subjective, hallucinatory experience) at the same time.
• Is there a physical problem? Auditory problems, such as hearing loss or ear infections, should be ruled out. A seizure disorder, in particular petit mal seizures, which may not be visible but can cause one to be inattentive for periods of time, should also be ruled out.

Diagnosis of ADHD should include several sources of data. A thorough history to rule in or rule out the factors noted above should be obtained. If there are concerns about another mental health issue contributing to the symptoms, an objective measure to assess for these should be used. Behavior rating scales should be completed by the person (if they are an adolescent or adult), parents, and teachers. A performance-based measure, such as the Conners Continuous Performance Test or the Test of Variables of Attention is useful, too, allowing a live, computer-based assessment of capacity to attend. When a younger child is being assessed, a classroom observation prior to the evaluator meeting the child in the office can be helpful.

Ideally, all the data gathered will provide convergent data (everything suggesting the same diagnosis). In that case, a definitive diagnosis can be given. However, sometimes things are not that clear, and a plan of progressive interventions needs to be developed until the symptoms are adequately addressed.

For more information, contact John R. Day & Associates, Christian Psychological Associates, located at 3716 West Brighton Avenue, Peoria or their locations in Normal, Canton, Pekin, Princeton, or Eureka. Call us at 309-692-7755 or visit us online: christianpsychological.org.

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