The first signs of an existing attention deficit syndrome are often recognized by the pediatrician in charge. The visits to the doctor are then particularly chaotic and the changed behaviour of the children becomes apparent in contact with the parents as well as with the doctor himself. The paediatrician can then express his or her suspicions and hope that the parents will agree to further examinations if there is a justified suspicion.
Even if ADHD is a disease that is not due to a faulty upbringing or comparable circumstances, it is still negatively affected in society. Parents should not see such a suspicion as an attack against themselves or their child, but should agree to the well-meant advice of further diagnostic tests. Only in this way, if ADHD is indeed present, can the child have the optimal conditions for a goal-oriented treatment.
If the suspected diagnosis is confirmed, the paediatrician can consult a child and adolescent psychiatrist or a psychologist. In many cases, the young patients are admitted to a child and adolescent psychiatric ward as inpatients as part of the initial treatment, in order to provide them with intensive training in dealing with their disease. In some cases an attention deficit syndrome is not recognized until young adulthood.
This is often an additional psychiatric problem, such as a social behaviour disorder, an anxiety or obsessive-compulsive disorder or depression. This problem leads the person to consult a psychiatrist, who may also be able to diagnose ADHD. In adulthood, when attention deficit disorder is present, psychiatrists and psychologists are involved in the treatment of the disorder.
Both kindergarten and (primary) school offer a wide range of opportunities to observe a “conspicuous” child. Both the educators and the teachers only express suspicions, but not the actual diagnosis. The assessment of the situation by the school (Kiga) is only one – albeit important – component of a comprehensive survey.
Important observations, especially with regard to frustration tolerance, over- or underchallenge, but also problems in other areas, such as a reading, spelling or arithmetic weakness, should be recorded in an observation sheet. It seems important that all educators or teachers who care for the child work together on the observation. However, it is also important to have a consistent and honest exchange with the parents and to talk to the school psychology service or the therapists caring for the child.
There are different procedures, depending on the age of the child. While pre-school children are subjected to so-called developmental diagnostics, (primary) school children are usually also subject to intelligence diagnostics. In both surveys, in addition to the actual observation criteria of a test procedure, special attention is paid to how the child behaves in the test situation.
If you would like to take a closer look at the topic of intelligence and intelligence diagnostics, please click here: High Gifted. Which diagnostic test procedures are used varies in detail. Well-known methods for measuring intelligence, development and partial performance disorders are for example: HAWIK (Hamburger Wechsler Intelligenztest Kinder), the CFT (Culture Fair Intelligence Test) and many more.
The HAWIK tests via various subtests, such as picture complements, general knowledge, arithmetical thinking etc. the practical, verbal and general intelligence. The CFT measures the individual ability of a child to recognize rules and identify certain characteristics.
It also measures the extent to which the child is capable of non-verbal problem recognition and solution. Altogether, the test consists of five different subtests. In addition to the measurement of intelligence, which can also determine a child’s possible high aptitude, there are possibilities for testing attention (e.g. DAT = Dortmund Attention Test), for measuring the ability to solve problems and for measuring the ability to concentrate.
It has already been mentioned that a diagnosis should consist of several observation moments. This is important in order to avoid misdiagnosis, because many children are lively and curious or calm and introverted without a “disorder” in the sense of ADHD or ADHD. Parents, teachers, or educators and also psychologists play an important role in making an appropriate diagnosis, but do not make it themselves.
In most countries the pediatrician is responsible for making the diagnosis. This means that – based on the observations – specific examinations are also carried out. These are usually of a neurological and internal medicine nature.
They all aim primarily to exclude organic problems as the cause of the conspicuous behaviour (= exclusion diagnosis). As a rule, the paediatrician first arranges a comprehensive blood count (exclusion of thyroid diseases, iron deficiency, etc.) and also subjects the child to a physical examination (exclusion of eye and ear diseases, allergies and their accompanying diseases (asthma, possibly neurodermatitis; see: differential diagnosis).
The child’s U – examinations are often insufficient with regard to the exact examination of the sensory organs, especially the ear and eyes. More specific examinations are necessary to exclude the possibility that the problems are due to a child’s poor sight or hearing. In both cases, problems in this area may mean that a child is unable to concentrate and cooperate sufficiently.
. An EEG (electroencephalogram) is used to determine potential fluctuations in the brain and allows conclusions to be drawn about possible functional disorders of the CNS (= central nervous system). The ECG (Electrocardiogarmm) examines the heart rhythm and heart rate.
Thus, within the framework of ADS diagnostics, it serves more as a differential diagnostic measure to determine possible heart rhythm disturbances, which may require special medication or do not allow for typical ADS medication. . The Achenbach scale, named after its developer, provides a possibility to record an actual condition from different points of view.
Besides the consideration of the age and the sex of the child, the Achenbach – scale offers the possibility to consider the overall situation of the child as objective as possible by separate questionnaires for parents, educators/teachers and children. This is in a special way always dependent on the honesty of the interviewed persons. There is no special test for the diagnosis of ADHD.
The disorder is an exclusion diagnosis: if all other possible causes could be excluded, the diagnosis of ADHD is made. In order to be able to get a picture of the condition of the alleged patient nevertheless, simple questionnaires are used. These include questions about attention (Can you concentrate poorly when something is important but not fun?
), mood (Do you often have mood swings? ), critical faculties (Are you able to deal well with the fact that someone has something to criticise about you or your work? ), impulsiveness (Are you able to control yourself well when provoked?
), social behaviour (Do you often interrupt other people?) and many other aspects of everyday life. The questionnaire should always (if possible) be answered by the patient himself and by a close reference person (in most cases the parents).
The comparison of the perception of others and self-perception can already give the first indications of conspicuous behaviour. The problem of diagnosing ADHD is always that supposed behaviour is automatically assigned to this disease. Many symptoms of ADHD, such as lack of concentration, occur without an automatic basis for such a syndrome.
At the same time, a lack of concentration can also be an indication of other clinical pictures that are similar in their symptoms to ADHD. For this reason, a differential diagnosis of the symptoms is necessary. In particular, profound developmental disorders, affective disorders and a home environment that reinforces the symptoms should – if possible in advance – be clarified by differential diagnosis.
As can already be seen from the diagnosis (see above), it is particularly the task of the physician to examine the causes of metabolic disorders, visual and/or hearing disorders, neurological diseases and, if necessary, to assign exhaustion states to their cause. These include Tourette’s syndrome, depression, anxiety disorders, mania, compulsions, autism and bipolar disorders (= manic-depressive disorders). In the cognitive area, reduced intelligence, partial performance disorders such as dyslexia or dyscalculia should be excluded, as well as giftedness or partial lack of concentration.