Diagnosis of ADHD


Attention Deficit Hyperactivity Disorder, Fidgety Philipp Syndrome, Psychoorganic Syndrome (POS), Attention Deficit Hyperactivity Disorder


In contrast to Attention Deficit Hyperactivity Disorder (ADHD), Attention Deficit Hyperactivity Disorder (ADHD) involves inattentive and impulsive behaviour that may be very pronounced. In order not to principally diagnose impulsive children or adults with ADHD, a so-called observation buffer/observation period is provided, in which certain behavioural patterns are shown. This means that, in order to prevent misjudgements, the abnormalities should appear repeatedly in a similar or approximately the same form over a longer period of time, about six months in several areas of life (e.g. kindergarten/school, at home, leisure time).

ADHD, just like ADD or a mixture of both, is a clearly defined clinical picture characterised by different symptoms. Persons with ADHD or ADHD cannot focus their attention in a targeted manner and therefore show deficiencies in their ability to concentrate. The two forms vary greatly from each other: While ADHD sufferers tend to be introverted or even absent, people with ADHD are more impulsive.

Both variants, but also the mixed form of both variants of the attention syndrome, have in common that the lack of concentration usually runs through all areas of life of the affected person. In both forms of ADHD, an incorrect transmission and processing of information between the two brain sections (brain hemispheres) is evident. This in turn does not mean that those affected are less gifted, because people with ADHD may also be highly gifted.

It is also possible that ADHD is accompanied by other illnesses (see differential diagnosis below). Since people or children with ADHD can only concentrate in very variable ways and at times, and their ability to build up attention is therefore greatly reduced, other school subjects are often affected by the problem, for example German and/or mathematics. It is therefore not surprising that many children with ADHD also develop LRS (= reading and spelling difficulties) and/or arithmetic difficulties.

At what age is the diagnosis typically made?

At what age ADHD is diagnosed depends on the form and severity of the symptoms. In most cases, children first become aware of ADHD in early school and teachers and parents become aware of it. Thus, most of those affected are diagnosed in early school age. However, less conspicuous forms of ADHD, especially without hyperactivity, can be overlooked and the diagnosis is often not made until adulthood, when the patients are under medical treatment due to accompanying problems.

Diagnosis of ADHS in children

The diagnosis of ADHD is rarely easy. As with all diagnoses in the field of learning, a specific warning must be issued against a diagnosis that is too quick and too one-sided. However, this does not mean that we should adopt a “blinkered” attitude and hope that the problems will grow.

IF problems are there, they should have appeared in the different areas of a child’s life over a period of about six months. In addition to a hasty categorisation of the child, a warning must also be given against describing all negative phenomena and activities of the child with the remark “He/she simply suffers from ADHD. It is nobody’s fault… “…for it.

Erroneous behaviour in stressful situations or even overactive behaviour are classic manifestations, but one must learn to classify and assign this behaviour. Many forms of therapy are ultimately only successful because they recognise, interpret and do not accept the children’s behaviour, but work specifically on changing ingrained behaviour. As mentioned above, precise observations are indispensable in advance and should be assessed by the mother over a period of about six months.

It is important that the persons involved in the upbringing who express the first suspicion “initiate” the others into the suspicion after a certain period of time. One thing is certain: the observations must always relate to all areas of life (kindergarten/school, home environment, leisure time) in order to be able to make meaningful judgments and think about further steps. Educationalists are particularly important in this respect, as abnormalities sometimes appear quite early.

A diagnosis should always be made comprehensively and thus cover the following areas:

  • A survey of the parents
  • An assessment of the situation by the school / kindergarten
  • The preparation of a psychological report
  • A clinical (medical) diagnosis

The paediatrician is responsible for the child. Usually teachers or parents express the suspicion of an ADHD disease and initiate the diagnosis. The children may already be in treatment with a psychologist or psychiatrist due to psychological problems associated with ADHD, in which case the diagnosis of ADHD is often made by the treating psychologist.

As the parents are usually the most important caregivers of a child, they have an important role in the possible observation of their child. It is not always easy to recognise and above all to admit possible deficits and “norm differences”. It is important to know that children who undoubtedly suffer from ADHD do not do so because parents may have made mistakes in their upbringing.

ADHD is not the result of an educational deficit, even if it often seems so, but it can be negatively influenced by it. The acceptance of the problems is an important aspect not only in terms of a more objective diagnostic assessment, but above all in terms of therapeutic success. Parents who accept the problem will probably also be more positive about ADHD therapy.

While the parents are able to describe and assess the domestic situation in a special way, the kindergarten or (primary) school is responsible for the assessment in the field of education outside the home. Here, too, there are numerous possibilities for the observation of an ADS child. Even if educators and/or teachers observe and assess the behaviour of the children, they are not responsible for the actual diagnosis.

However, the results of the observation are the basis for a diagnosis that is as comprehensive as possible. The actual diagnosis is made by the treating (paediatric) doctor, who will take further diagnostic measures in addition to the observation criteria by parents and school or kindergarten. What does situation observation in school and/or kindergarten include?

On the one hand, the observations should be recorded in writing. In addition, all educators or teachers involved in the education of the child should carry out these observations. Furthermore, a consistent and honest exchange with the parents and also a conversation with the school psychological service, possibly also with the supervising therapist, is very important.

As already mentioned, parents must have previously released the therapist or the educational counsellor from the duty of confidentiality. – How does the child react to frustration (lost games, bans)

  • Does the child seem over or even under challenged? – Does the unfocused behaviour already have an effect on other areas, or are they conceivable.

This is particularly important for the prevention of a reading, spelling or arithmetic weakness. – …

How and in which form a psychological expert opinion is drawn up varies and depends in particular on the age of the child. While pre-school children are subjected to a so-called developmental diagnostic, (primary) school children are also subjected to an intelligence diagnostic.

This has the advantage that a possible high talent, which is difficult to find out in everyday school life, has the chance to be discovered. Both in the context of developmental diagnostics and in the area of intelligence diagnostics, attention is paid to how the child behaves in the test situation. During HAWIK, various subtests are carried out, such as: picture complements, general knowledge, computational thinking, etc.

which tests practical, verbal and general intelligence, the CFT measures a child’s individual ability to recognize rules and identify certain characteristics. It also measures the extent to which the child is capable of non-verbal problem solving. This test also consists of various – a total of five – different subtests.

In addition to measuring intelligence, there are various tests that measure the child’s attention (e.g. DAT = Dortmund Attention Test), or the ability to solve problems and to concentrate. A special test for the diagnosis of ADHD is currently in preparation. KIDS 1 was developed by, Lehmkuhl and Steinhausen with the intention of obtaining the most comprehensive diagnostic statement possible using five different procedures, which also makes it possible to choose an appropriate individual therapy line.

The test can be used by paediatricians, child and adolescent psychologists as well as child and adolescent psychotherapists. As already mentioned above, a diagnosis should consist of many moments of observation in order to be as meaningful as possible. This reduces the probability of a false diagnosis, because not every lively, curious or extroverted child is at the same time an “ADHD child”.

The already mentioned authorities such as parents, teachers, educators and psychologists play an important role in making a suitable diagnosis, but do not issue it themselves. In most countries the pediatrician is responsible for making the diagnosis of ADHD. In addition to the various observations and psychological testing procedures, specific examinations are also carried out.

These are usually of a neurological and internal nature and are primarily aimed at excluding organic problems as the cause of the abnormal behaviour. As a rule, a comprehensive blood count is carried out to exclude thyroid diseases, iron deficiency, general deficiency symptoms, etc. A physical examination will also be carried out to exclude eye and ear diseases, allergies and their accompanying diseases (asthma, possibly neurodermatitis; see: differential diagnosis).

. As a rule, the medical diagnosis also includes an examination by means of EEG (electroencephalogram). This examination serves to register potential fluctuations in the brain and thus allows important conclusions to be drawn regarding functional disorders of the CNS (= central nervous system). The ECG (Electrocardiogarmm) allows, among other things, statements about the heart rhythm and heart rate. With regard to the diagnosis of ADHD, it serves to exclude cardiac arrhythmias that may require special medication or exclude certain forms of therapy.