Is It Really ADHD?

Getting the Right Diagnosis

he truth is, ADHD can be difcult to diagnose accurately.Your clinician has no shortcuts, no quick blood tests, nobrain scans, no fve-minute questionnaires, and no brie interviews to use with your child, you as a parent, or you asan adult that have acceptable levels o accuracy in thediagnosis o ADHD. Nevertheless, accurate diagnosis is certainlyachievable, and when you select a proessional clinician whoknows not only ADHD but other disorders that commonlymimic ADHD, accurate diagnosis becomes the norm. In thischapter we will teach you why getting the diagnosis right is soimportant as well as what to look or in getting a proper evalu-ation, which will always (a word we do not like to use!) be acomprehensive evaluation to determine the right diagnosis whensymptoms that could be ADHD are at issue. We have reviewedthe diagnostic criteria or ADHD and the various subtypes in aprevious chapter, and we will try not to repeat that inormationhere. Rather, we ocus on the diagnostic process and how andwith what tools diagnostic inormation is gathered when the jobis done well.

the energetic brain

Wy AccAt DAnoss s so ctcAl

Eective treatment o any disorder depends upon accuratediagnosis. This statement is absolutely the truth—the relativeimportance o the level o detail and specifcity o an accuratediagnosis, however, is not the same or every disorder. Take, orexample, the diagnosis o most common inectious disorders byprimary care physicians. You probably recall getting ill, perhapswith a sore throat, and going to your doctor. Following a brie physical examination, she tells you this has been going aroundand prescribes a particular antibiotic, but you were also probablytold that i you were not better in 48 to 72 hours, to call thedoctor’s ofce. In about 7 to 14 days, you are well. In this case,diagnosis o a general class o disorder, a “throat inection,” istypically sufcient and specifc enough or successul treatment.There are reasonably broad spectrum antibiotics that kill mostbacteria residing in airways that cause such inections, and it isnot necessary to know exactly which bug is causing yours.However, i you do not improve quickly, your doctor will needto move to a more accurate diagnosis. She will likely need toculture or grow the bacteria so it can be identifed specifcally sothat an antibacterial agent that will kill this particular bacteriumcan be identifed and prescribed. There are presentations whereimmediate culturing and identifcation are urgent, such as in thecase o bacterial pneumonia, which could prolierate into a lie-threatening illness i the wrong antibiotic is used initially ortreatment.In the case o ADHD, just as with the bacteria above thatwere not identifed correctly, very specifc, accurate diagnosis isrequired so that we can abide by the frst guiding principle o allhealth care providers: First, do no harm! I we diagnose ADHDwhen it is not present, especially when we mistake another dis-order or ADHD, we run the risk o doing great harm. There aremany emotional and behavioral disorders, some o which are also

is it really adhd?

disorders o brain unction, that look like or mimic ADHD onthe surace. That is to say, many o the behaviors we see in thesedisorders look similar to those we see in ADHD. In some cases,as we will explain later, the medicines or ADHD can makepeople with certain other disorders not only worse, but poten-tially more difcult to treat once the correct diagnosis has beenascertained. Just as a ever does not always mean a bacterialinection, problems with attention do not always mean ADHD!I these behaviors and their history and the environments inwhich they occur are not assessed careully and in detail, we mayjust get it wrong and call it ADHD when it is not. We will comeback to this crucial issue later in this chapter. First we want tolook at the issue o normal levels o inattention, impulsivity, andbehavioral activity or anyone at any age. As you probably havenoticed, everyone commits impulsive acts, everyone has momentso inattention, and everyone can be hyperactive at dierenttimes. How do you know when it has reached beyond the levelo normal and has become an indication o a disorder? How doyou know that your physician is not just creating psychopathol-ogy rom what are typical variations in behavior?

What’s Typical Behavior?

When diagnosticians o various types (psychologists, psychia-trists, neuropsychologists, physicians) attempt to answer thisquestion in the realm o disorders that aect behavior and emo-tions (such as ADHD), they typically look at the three aspectso the behavior listed in Figure 4.1.Once we answer these questions, we can make a sensible andoten empirical scientifc judgment about whether the behavior(or more likely, the cluster o presenting behaviors) represents avariation o normal behavior or whether it has risen to a levelo severity and impact on your lie that qualifes it or the diag-nosis o a disorder. The frst two questions are answered by