Diagnostic assessment of childhood ADHD

Question 1

What is the utility of psychological tests in diagnosing ADHD in children?

Answer 1

Screening test of academic achievement and intelligence to determine if there is likely to be a comorbid LD or ID.

Neuropsychological tests (e.g. working memory, executive function, attention) are not accurate enough to warrant their use in clinical practice as diagnostic tools. Sufficient information can be gained from parent and teacher rating scales at lower cost. (Barkley, ADHD Handbook for Diagnosis and Treatment 2014)

Question 2

What is the utility of direct classroom observation for ADHD diagnosis in children?

Answer 2

A number of studies support this practice but benefits may not justify the time and expense. (Barkley, ADHD Handbook for Diagnosis and Treatment 2014)

Question 3

How long should a child assessment of ADHD take?

Answer 3

Approximately 3 hours (Barkley, ADHD Handbook for Diagnosis and Treatment 2014)

Question 4

What evaluations should be done on parents of children being assessed for ADHD?

Answer 4

Screening for ADHD (e.g. with Barkley Scale), Martial Discord (Locke-Wallace scale), parental depression (BDI), Parental stress (Parental Stress Index) are useful especially when parental training is being considered. (Barkley, ADHD Handbook for Diagnosis and Treatment 2014)

Question 5

Utility of child self-report for behaviour problems.

Answer 5

Children below ages 9-12 do not provide reliable self-report of their own disruptive behaviour. Self-report is never used to diagnose ADHD in children. However, self-reports of internalizing symptoms are reliable. (Barkley, ADHD Handbook for Diagnosis and Treatment 2014)

Question 6

Utility of parental interview in diagnosis of childhood ADHD.

Answer 6

This is the single most important method for psychological evaluation of a child. (Barkley, ADHD Handbook for Diagnosis and Treatment 2014)

Question 7

Validity of the diagnostic criteria for preschool age children.

Answer 7

The diagnostic criteria were only validated in children ages 4-16; therefore preschool age children with primarily hyperactive-impulsive type may reflect a typical developmental pattern rather than true ADHD (often remits before adolescence) (Willcutt et al 2012). However, in children 3 and under, if symptoms persist for at least 12 months or beyond age 4, this is highly predictive of the behaviour’s persistence into school-age.