Diagnosis of Attention Deficit Hyperactivity Disorder
Diagnostic Test list for Attention Deficit Hyperactivity Disorder:
The list of medical tests
mentioned in various sources as
used in the diagnosis of Attention Deficit Hyperactivity Disorder
includes:
- Parent consultant
- Teacher consultation
- Psychological assessment
- Dietary changes - may possibly rule out certain food reactions.
Attention Deficit Hyperactivity Disorder Diagnosis: Book Excerpts
Tests and diagnosis discussion for Attention Deficit Hyperactivity Disorder:
Attention Deficit Hyperactivity Disorder (ADHD): NWHIC (Excerpt)
A reliable diagnosis of ADHD can be made with well-tested diagnostic
interview methods. Diagnosis is based on history and visible behaviors in
the child's normal environment. A doctor making a diagnosis should ask for
input from the child, parents, teachers, and other health care providers.
The doctor will collect information on a thorough history about the
symptoms, and on the medical, developmental, school, psychosocial, and
family histories. He or she also will consider other causes for the
problem, and review other conditions that could be present. It is helpful
to find out what has prompted the request for evaluation and how the
problems had been approached in the past. At this time, there is no single
test for ADHD. This is not unique to ADHD, but applies to most psychiatric
disorders. (Source: excerpt from Attention Deficit Hyperactivity Disorder (ADHD): NWHIC)
Attention Deficit Hyperactivity Disorder (ADHD): NWHIC (Excerpt)
Diagnosing and treating ADHD in adults can help them put their problems
into perspective, better understand the reasons for many of their lifelong
symptoms, and improve their self-esteem, work performance and skills,
educational abilities and social skills. Also, adults with ADHD are
protected under the Americans with Disabilities Act of 1990, which does
not allow discrimination in public accommodations, like education, and
employment. (Source: excerpt from Attention Deficit Hyperactivity Disorder (ADHD): NWHIC)
Attention Deficit Hyperactivity Disorder (ADHD): NWHIC (Excerpt)
The diagnosis of ADHD in the preschool child is possible, but can be
difficult and should be made cautiously by experts well trained in
childhood neurobehavioral disorders. Developmental problems, especially
language delays, and adjustment problems can sometimes look like ADHD.
Treatment should focus on placing the child in a structured preschool with
parent training and support. Stimulants can reduce difficult behavior and
improve mother-child interactions, but they usually are saved for severe
cases, or when a child is unresponsive to environmental or behavioral
interventions. (Source: excerpt from Attention Deficit Hyperactivity Disorder (ADHD): NWHIC)
Attention Deficit Hyperactivity Disorder: NIMH (Excerpt)
According to the diagnostic manual, there are three patterns of
behavior that indicate ADHD. People with ADHD may show several signs of
being consistently inattentive. They may have a pattern of being
hyperactive and impulsive. Or they may show all three types of behavior.
Because everyone shows some of these behaviors at times, the DSM
contains very specific guidelines for determining when they indicate ADHD.
The behaviors must appear early in life, before age 7, and continue for at
least 6 months. In children, they must be more frequent or severe than in
others the same age. Above all, the behaviors must create a real handicap
in at least two areas of a person's life, such as school, home, work, or
social settings. So someone whose work or friendships are not impaired by
these behaviors would not be diagnosed with ADHD. Nor would a child who
seems overly active at school but functions well elsewhere. (Source: excerpt from Attention Deficit Hyperactivity Disorder: NIMH)
Attention Deficit Hyperactivity Disorder: NIMH (Excerpt)
Next the specialist gathers information on the child's ongoing behavior
in order to compare these behaviors to the symptoms and diagnostic
criteria listed in the DSM (Diagnostic and Statistical Manual of Mental
Disorders). This involves talking with the child and if possible,
observing the child in class and in other settings.
The child's teachers, past and present, are asked to rate their
observations of the child's behavior on standardized evaluation forms to
compare the childžs behaviors to those of other children the same age. Of
course, rating scales are subjective--they only capture the teacher's
personal perception of the child. Even so, because teachers get to know so
many children, their judgment of how a child compares to others is usually
accurate.
The specialist interviews the child's teachers, parents, and other
people who know the child well, such as school staff and baby-sitters.
Parents are asked to describe their child's behavior in a variety of
situations. They may also fill out a rating scale to indicate how severe
and frequent the behaviors seem to be.
In some cases, the child may be checked for social adjustment and
mental health. Tests of intelligence and learning achievement may be given
to see if the child has a learning disability and whether the disabilities
are in all or only certain parts of the school curriculum.
In looking at the data, the specialist pays special attention to the
child's behavior during noisy or unstructured situations, like parties, or
during tasks that require sustained attention, like reading, working math
problems, or playing a board game. Behavior during free play or while
getting individual attention is given less importance in the evaluation.
In such situations, most children with ADHD are able to control their
behavior and perform well.
The specialist then pieces together a profile of the child's behavior.
Which ADHD-like behaviors listed in the DSM does the child show? How
often? In what situations? How long has the child been doing them? How old
was the child when the problem started? Are the behaviors seriously
interfering with the child's friendships, school activities, or home life?
Does the child have any other related problems? The answers to these
questions help identify whether the child's hyperactivity, impulsivity,
and inattention are significant and long-standing. If so, the child may be
diagnosed with ADHD.
Adults are diagnosed for ADHD based on their performance at home and at
work. When possible, their parents are asked to rate the person's behavior
as a child. A spouse or roommate can help rate and evaluate current
behaviors. But for the most part, adults are asked to describe their own
experiences. One symptom is a sense of frustration. Since people with ADHD
are often bright and creative, they often report feeling frustrated that
they're not living up to their potential. Many also feel restless and are
easily bored. Some say they need to seek novelty and excitement to help
channel the whirlwind in their minds. Although it may be impossible to
document when these behaviors first started, most adults with ADHD can
give examples of being inattentive, impulsive, overly active, impatient,
and disorganized most of their lives. (Source: excerpt from Attention Deficit Hyperactivity Disorder: NIMH)
Diagnosis of Attention Deficit Hyperactivity Disorder: medical news summaries:
The following medical news items
are relevant to diagnosis and misdiagnosis issues for Attention Deficit Hyperactivity Disorder:
Diagnostic Tests for Attention Deficit Hyperactivity Disorder: Online Medical Books
16 MEDICAL BOOKS ONLINE!
Review excerpts from medical books online, free, without registration,
for more information about diagnostis of Attention Deficit Hyperactivity Disorder.
HYPERACTIVE REFLEXES:
Ask the Following Questions:
(Algorithmic Diagnosis of Symptoms and Signs)
- Are they intermittent or persistent? If the hyperactive reflexes are intermittent, one should consider multiple sclerosis and cerebral vascular insufficiency.
- Are they focal? If the hyperactive reflexes are focal, and especially if they are unilateral, one should consider vascular diseases, space-occupying lesions, or multiple sclerosis. Certain degenerative diseases such as amyotrophic lateral sclerosis may also present with focal hyperactive reflexes.
- If the hyperactive reflexes are focal, are they unilateral? Unilateral hyperactive reflexes are characteristic of hemiplegia. Hemiplegia is usually associated with a cerebral vascular disease or space-occupying lesion of the brain, especially if there are cranial nerve signs. However, early spinal cord tumors may present with unilateral hyperactive reflexes.
- Are there cranial nerve signs? The presence of cranial nerve signs suggests that the lesion is above the foramen magnum, and a cerebral or brain stem tumor is the first thing to be considered. A cerebral vascular lesion or multiple sclerosis must also be considered.
- Is there dementia? The presence of dementia along with the hyperactive reflexes, especially if they are diffuse, suggests Alzheimer's disease, Pick's disease, general paresis, and Korsakoff's syndrome. There are many other causes of dementia to consider.
- Are there other long tract signs? The presence of hyperactive reflexes with sensory changes should suggest pernicious anemia, syringomyelia, and Friedreich's ataxia. It may also indicate multiple sclerosis, a spinal cord tumor, a brain stem tumor, or basilar artery insufficiency.
DIAGNOSTIC WORKUP
Hyperactive reflexes, especially if they are unilateral, are a clear indication for an imaging study. It is wise to consult a neurologist or neurosurgeon before determining which imaging study to order. If there are cranial nerve findings and dementia, a CT scan or MRI of the brain should be ordered.
If there are hyperactive reflexes of all four extremities without dementia or cranial nerve signs, MRI of the cervical spine would probably be the most appropriate procedure. It may, however, be necessary to get a CT scan or MRI of the brain anyway.
If only the lower extremities are involved, MRI of the thoracic cord would probably be most appropriate, but then MRI of the cervical spine should be done if the thoracic MRI is negative. Spinal fluid analysis will help diagnose multiple sclerosis, central nervous system syphilis, cerebral hemorrhages, or abscess. A CBC, serum B
12
and folic acid, and Schilling test will help diagnose pernicious anemia. Plain films of the appropriate level of the spine are necessary in trauma cases. An EEG and psychometric testing should be done in cases of dementia. SSEP, VEP, and BSEP studies are helpful in diagnosing multiple sclerosis. Carotid duplex scans and four-vessel angiography may be necessary for diagnosing cerebral vascular disease.
» READ BOOK EXCERPT ONLINE »
Source: Algorithmic Diagnosis of Symptoms and Signs, 2003
ANKLE CLONUS AND HYPERACTIVE AND PATHOLOGIC REFLEXES:
Approach to the Diagnosis
(Differential Diagnosis in Primary Care)
A neurologist should be consulted at the outset. The neurologist will be able to determine whether a CT scan or magnetic MRI should be ordered and whether it should be of the brain, brainstem, or spinal cord. If there are obvious cranial nerve signs, the imaging study will include the brain and brainstem. Spinal cord lesions usually require x-ray of the spine and possibly myelography and spinal fluid analysis. In suspected intracranial pathology, a spinal tap should not be done until a CT scan or MRI has ruled out a space-occupying lesion.
» READ BOOK EXCERPT ONLINE »
Source: Differential Diagnosis in Primary Care, 2007
Agitation:
History and physical examination
(Handbook of Signs & Symptoms (Third Edition))
Determine the severity of the patient’s agitation by examining the number and quality of agitation-induced behaviors, such as emotional lability, confusion, memory loss, hyperactivity, and hostility. Obtain a history from the patient or a family member, including diet, known allergies, and use of herbal medicine.
Ask if the patient is being treated for any illnesses. Has he had any recent infections, trauma, stress, or changes in sleep patterns? Ask the patient about prescribed or over-the-counter drug use, including supplements and herbal medicines. Check for signs of drug abuse, such as needle tracks and dilated pupils. Ask about alcohol intake. Obtain the patient’s baseline vital signs and neurologic status for future comparison.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Signs & Symptoms (Third Edition), 2006
Deep tendon reflexes, hyperactive:
History and physical examination
(Handbook of Signs & Symptoms (Third Edition))
After eliciting hyperactive DTRs, take the patient's history. Ask about spinal cord injury or other trauma and about prolonged exposure to cold, wind, or water. Could the patient be pregnant? A positive response to any of these questions requires prompt evaluation to rule out life-threatening autonomic hyperreflexia, tetanus, preeclampsia, or hypothermia. Ask about the onset and progression of associated signs and symptoms. Next, perform a neurologic examination. Evaluate the patient's level of consciousness, and test motor and sensory function in the limbs. Ask about paresthesia. Check for ataxia or tremors and for speech and visual deficits. Test for Chvostek's (an abnormal spasm of the facial muscles elicited by light taps on the facial nerve in a patient who has hypocalcemia) and Trousseau's (a carpal spasm induced by inflating a sphygmomanometer cuff on the upper arm to a pressure exceeding systolic blood pressure for 3 minutes in a patient who has hypocalcemia or hypomagnesemia) signs and for carpopedal spasm. Ask about vomiting or altered bladder habits. Make sure to take the patient's vital signs.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Signs & Symptoms (Third Edition), 2006
Attention deficit hyperactivity disorder:
Diagnosis
(Professional Guide to Diseases (Eighth Edition))
The child is usually referred for evaluation by the school. (See Diagnosing attention deficit hyperactivity disorder.) Diagnosis of ADHD usually begins by obtaining data from several sources, including the parents, teachers, and the child himself. Complete psychological, medical, and neurologic evaluations rule out other problems. Then the child undergoes tests that measure impulsiveness, attention, and the ability to sustain a task. The combined findings portray a clear picture of the disorder and of the areas of support the child will need.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Agitation:
History and physical examination
(Professional Guide to Signs & Symptoms (Fifth Edition))
Determine the severity of the patient’s agitation by examining the number and quality of agitation-induced behaviors, such as emotional lability, confusion, memory loss, hyperactivity, and hostility. Obtain a history from the patient or a family member, including diet, known allergies, and use of prescribed or over-the-counter drugs, including supplements and herbal medicines.
Ask if the patient is being treated for any illnesses. Has he had any recent infections, trauma, stress, or changes in sleep patterns? Check for signs of drug abuse, such as needle tracks and dilated pupils, and ask about alcohol intake. Obtain baseline vital signs and neurologic status for future comparison.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Deep tendon reflexes, hyperactive:
History and physical examination
(Professional Guide to Signs & Symptoms (Fifth Edition))
After eliciting hyperactive DTRs, take the patient’s history. Ask about spinal cord injury or other trauma and about prolonged exposure to cold, wind, or water. Could the patient be pregnant? A positive response to any of these questions requires prompt evaluation to rule out life-threatening autonomic hyperreflexia, tetanus, preeclampsia, or hypothermia. Ask about the onset and progression of associated signs and symptoms. Next, perform a neurologic examination. Evaluate level of consciousness, and test motor and sensory function in the limbs. Ask about paresthesia. Check for ataxia or tremors and for speech and visual deficits. Test for Chvostek’s sign (an abnormal spasm of the facial muscles elicited by light taps on the facial nerve in patients who have hypocalcemia) and Trousseau’s sign (a carpal spasm induced by inflating a sphygmomanometer cuff on the upper arm to a pressure exceeding systolic blood pressure for 3 minutes in patients who have hypocalcemia or hypomagnesemia) and for carpopedal spasm. Ask about vomiting or altered urination habits. Be sure to take vital signs.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Attention deficit hyperactivity disorder:
Diagnosis
(Handbook of Diseases)
Commonly, the child with ADHD is referred for evaluation by the school. Diagnosis of this disorder usually begins by obtaining data from several sources, including the parents, teachers, and the child himself. Complete psychological, medical, and neurologic evaluations rule out other problems. Then the child undergoes tests that measure impulsiveness, attention, and the ability to sustain a task. The combined findings portray a clear picture of the disorder and of the areas of support the child will need.
For characteristic findings in patients with this condition, see Diagnosing attention deficit hyperactivity disorder.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
Agitation:
History
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Determine the severity of the patient’s agitation by examining the number and quality of agitation-induced behaviors, such as emotional lability, confusion, memory loss, hyperactivity, and hostility. Obtain a history from the patient or a family member, including diet and known allergies.
Ask if the patient is being treated for any illnesses. Has he had any recent infections, trauma, stress, or changes in sleep patterns? Ask the patient about prescribed or over-the-counter drug use, including supplements and herbal medicines. Ask about alcohol intake.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Deep tendon reflexes, hyperactive:
History
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
After eliciting hyperactive DTRs, take the patient’s history. Ask about spinal cord injury or other trauma and about prolonged exposure to cold, wind, or water. Also find out if the patient could be pregnant. A positive response to any of these questions requires prompt evaluation to rule out life-threatening autonomic hyperreflexia, tetanus, preeclampsia, and hypothermia. Ask about the onset and progression of associated signs and symptoms. Also ask about paresthesia, vomiting, and altered bladder habits.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Agitation:
History and physical examination
(Nursing: Interpreting Signs and Symptoms)
Determine the severity of the patient's agitation by examining the number and quality of agitation-induced behaviors, such as emotional lability, confusion, memory loss, hyperactivity, and hostility. Obtain a history from the patient or a family member, including diet, known allergies, and all medications, including the use of herbal medicine. Also ask the patient about substance abuse.
Ask if the patient is being treated for any illnesses. Has he had any recent infections, trauma, stress, or changes in sleep patterns? Observe the patient for signs of substance abuse, such as needle tracks, dilated pupils, jaundiced skin, or abdominal ascites. Ask him about alcohol intake. Obtain the patient's baseline vital signs and neurologic status for future comparison.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
Deep tendon reflexes, hyperactive:
History and physical examination
(Nursing: Interpreting Signs and Symptoms)
After eliciting hyperactive DTRs, take the patient's history. Ask about spinal cord injury or other trauma and about prolonged exposure to cold, wind, or water. Could the patient be pregnant? A positive response to any of these questions requires prompt evaluation to rule out life-threatening autonomic hyperreflexia, tetanus, preeclampsia, or hypothermia. Ask about the onset and progression of associated signs and symptoms. Next, perform a neurologic examination. Evaluate the patient's level of consciousness, and test motor and sensory function in the limbs. Ask about paresthesia. Check for ataxia or tremors and for speech and visual deficits. Test for Chvostek's (an abnormal spasm of the facial muscles elicited by light taps on the facial nerve in a patient who has hypocalcemia) and Trousseau's (a carpal spasm induced by inflating a sphygmomanometer cuff on the upper arm to a pressure exceeding systolic blood pressure for 3 minutes in a patient who has hypocalcemia or hypomagnesemia) signs and for carpopedal spasm. Ask about vomiting or altered bladder habits. Be sure to take the patient's vital signs.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
ANKLE CLONUS AND HYPERACTIVE AND PATHOLOGIC REFLEXES:
Approach to the Diagnosis
(Differential Diagnosis in Primary Care)
A neurologist should be consulted at the outset. The neurologist will
be able to determine whether a CT scan or MRI should be ordered and whether
it should be of the brain, brainstem, or spinal cord. If there are obvious
cranial nerve signs, the imaging study will include the brain and brainstem.
Spinal cord lesions usually require x-ray of the spine and possibly
myelography and spinal fluid analysis. In suspected intracranial pathology,
a spinal tap should not be done until a CT scan or MRI has ruled out a
space-occupying lesion.
» READ BOOK EXCERPT ONLINE »
Source: Differential Diagnosis in Primary Care, 2007
Attention Deficit/Hyperactivity Disorder (ADHD):
Attention Deficit/Hyperactivity Disorder - DIAGNOSIS
(The 5-Minute Pediatric Consult)
- Typically, patients are brought to medical attention during the early school years because their behavior falls out of normal range in their ability to pay attention in class, to avoid class disruption, and/or to control impulsive behavior.
- Patients with ADHD can be diagnosed and treated in the pediatrician’s office.
- A large percentage of patients with ADHD may have associated conditions and will need multidisciplinary pediatric teams of developmental pediatrics, psychologists, neurologists, and/or psychiatrists for assessment and treatment.
» READ BOOK EXCERPT ONLINE »
Source: The 5-Minute Pediatric Consult, 2008
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