When and how to have your child evaluated for ADHD (K to 3)

At what age should I have my child evaluated for ADHD?

Most experts agree that it's usually very hard to be sure whether a child has ADHD until he's 6 or 7 years old. The difficulty is that many typical ADHD behaviors, such as having a short attention span and acting impulsively, can be normal in preschoolers and kindergartners, and children change so rapidly during these years. But if you think your child is showing signs of the disordeR, it can't hurt to consult your pediatrician about having him evaluated, even if he's still in preschool. It may be appropriate to assess a kindergartner or even a preschooler if his short attention span is keeping him from learning what he needs to in order to progress. Specialists are getting better at diagnosing this condition earlier and the benefit of an early diagnosis is that you can get your child started in treatment earlier. While medication is rarely appropriate for children under 6, certain behavior modification techniques can help a great deal at any age.

How can I find someone qualified to evaluate my child?

It's a good idea to start with a visit to your pediatrician or family doctor, who can at least do some preliminary screening to rule out any physical conditions, such as vision or hearing problems, that could be contributing to your child's behavior. ADHD is a relatively new condition and opinions differ over what to do next. If your child's doctor knows your child well and has had a lot of experience evaluating children for this disorder, he or she may be the best person to make the diagnosis. On the other hand, some experts think it's important to get a referral to an ADHD specialist, which can be a developmental pediatrician, neurologist, child psychiatrist, child psychologist, or licensed counselor. The key is to find a practitioner with plenty of experience and to make sure it's someone you feel comfortable working with.

What does an ADHD evaluation involve?

Evaluating a child for ADHD is not an exact science. Lots of kids have trouble paying attention, but that doesn't mean they have a disorder. Depression, anxiety, and learning disabilities can all be mistaken for ADHD. Or in some cases, a child may actually be suffering from both ADHD and depression or a learning disability (such as a speech and language delay). About a third of all children with ADHD have some kind of coexisting problem.

According to some experts, the assessment should take a combined total of three hours or more (following the steps outlined below) or it's not an accurate assessment. ADHD symptoms aren't necessarily obvious in every situation or at any given time, so it's important for the expert to observe your child in different settings over a period of time and to talk to others who've done the same over longer periods of time. Here's a rundown of what's involved:

A thorough personal, family, and medical history Your practitioner will start by asking you a lot of questions (or having you fill out a questionnaire) about your child's and your family's health history. ADHD runs in families and it's common for a brother or sister to have the disorder, or for parents to have symptoms even though they've never been diagnosed. She will also want to find out how long your child has been having ADHD symptoms (should be for longer than six months) and whether he's having them in more than one setting, such as at school and home.

Interview with the patient The practitioner will talk to your child while you're present and then again when you're not in the room. Sometimes kids will speak more freely when their parents aren't within earshot. The practitioner will ask questions like, "What's your favorite subject at school? What's your least favorite? Why?" Depending on your child's age, questionnaires or computer tests may be used to pinpoint his developmental level or difficulties. The practitioner will watch to see if your child is fidgety or restless or has trouble paying attention to the interviewer. The child's total evaluation will probably be broken up into two sessions, each about 60 minutes long.

Interview with the parents The practitioner will probably start the interview with your child present, to get a sense of how your family interacts, and then continue with just you and your partner. When you're alone with the practitioner, this will be your time to talk about your concerns and frustrations with your child's inattention, failure to follow through on homework or chores, non-stop activity, etc. The interviewer will want to know about your home life and parenting style, when your child does his homework and in what setting, how he gets along with neighborhood children, and so on. You might also be asked to fill out a questionnaire or ratings scale on your child's abilities and symptoms. The interview with your child present might last an hour. The second interview, without your child, might last 90 minutes.

Interview with the teacher If your child is in school, your practitioner will ask his teacher to fill out a ratings scale or behavior checklist and will interview her for about a half hour, asking about such things as whether your child has trouble waiting his turn, doesn't seem to listen when spoken to, or often leaves his seat in the classroom. If your child spends a lot of time in childcare or an after-school program, it might also make sense to get input from the professionals there.

Physical examination The practitioner will require that your pediatrician give your child a thorough physical exam, if she hasn't already, to rule out any health issues that could be causing ADHD-like symptoms, such as vision or hearing problems.

Follow-up Once the assessment is complete, the practitioner will probably want to meet with you again for about an hour to talk about treatment. If drug therapy seems warranted, the specialist will confer with your child's doctor, who may want to see you and your child again for a half hour or more before prescribing medication. If you're not happy with the results of the assessment or the recommended treatment, you may want to get a second opinion. In addition to medication, treatment options may include behavior therapy (changing your child's environment to help improve behavior), parent training (providing you with skills to deal with your child's behavior in positive ways), school accommodations (working with the school to make it easier for your child to function there), and various alternative treatments.

How much does an ADHD evaluation cost?

It's not inexpensive, and health insurance doesn't always cover more than a doctor's physical examination. While the cost may be more or less depending on where you live and whom you see, the average total is about $ 500. A child psychiatrist typically charges $ 200 or more an hour and by the time you add up all the hours, the total could approach $ 1,000. A psychologist might charge between $ 100 and $ 125 an hour. Licensed clinical social workers or school psychologists may require only $ 250 to $ 350 or less for the total evaluation. Keep in mind that if your practitioner isn't an M.D., you'll have additional charges for exams and consultations with your pediatrician. If the cost is prohibitive for your family, talk to your doctor or school officials. They may have information about special fees or services for low-income families.