The initial symptoms to look out for
How ADHD is diagnosed
Current ADHD treatment options
How to know if those treatments are making a difference
In this module, you will learn:
The initial symptoms to look out for
How ADHD is diagnosed
Current ADHD treatment options
How to tell if the treatment is making a difference
The Diagnosis of ADHD and First Treatments – 5m24s
3.1 The Initial Symptoms to Look Out For
We can now move on to something that is of the utmost importance - the diagnosis of
ADHD.
Getting a diagnosis is the first step towards improving the life of the person with ADHD. In this
module, we will explain when it’s appropriate to seek an ADHD diagnosis, how to go about it and
what the process involves.
We also introduce treatment options and how they might initially be approached. While ADHD is a
chronic condition, there are effective treatments out there that can help, and we will explore them in
detail throughout the entire course.
Exploring this information regarding ADHD symptoms does not mean that you are able to make a
diagnosis. Instead, this is merely to provide you with guidance on identifying possible symptoms,
before seeking professional advice and support from a qualified medical practitioner.
There are several symptoms that you should be looking out for if you suspect ADHD. We have
already touched on those symptoms, but it is worth briefly reviewing them.
Symptoms will vary depending on the subtype of ADHD, but some of the main symptoms
experienced by people with the condition are as follows:
They often fidget and are restless
They often act impulsively
They often lose things
They often don't appear to be listening
They are very easily distracted
They are often unable to finish tasks
Children with ADHD may forget things, leave tasks incomplete, rush through things, and play
roughhouse when they should be sitting still. Although they don't mean to, they often disrupt other
children as well as teachers and parents.
They may often do things without permission, rush, jump, pull or grab without control. Many of them
often display intense emotions that may seem disproportionate to the situation at hand. Children
with ADHD may also display oppositional or defiant behaviours.
Please keep in mind that young children are often naturally curious, restless, impatient and fidgety,
and this doesn't mean all of them have ADHD.
However, if the behaviour is having a significant negative impact on their life, it is worth getting
them assessed. Start taking notes on their behaviour, as they will be vital in the diagnosis process.
This is also a good time to start discussing your concerns with the child’s teachers if they are at
school.
A child can be diagnosed as having ADHD if they display six or more symptoms of hyperactivity,
impulsivity or inattention, for at least six months before their assessment. In addition, these
symptoms must have appeared before the age of 12. The symptoms need to be present in more than
one setting, so for most children, this will generally mean at home and at school.
For adults to be diagnosed with ADHD they must meet the same general criteria, but they only need
to exhibit 5 symptoms. For them, the different settings could be home, work and social life, and their
symptoms must have a negative impact on their life - for example, they lost a job because of their
inattention symptoms, or they consistently forget to complete important tasks such as paying bills.
The symptoms must not be attributable to any other mental health conditions.
We must stress one very important point - there is no set or single test that has been designed that
can help with the diagnosis of ADHD. It has to be done as an accumulation of symptoms and patterns
of behaviour over a minimum of six months, so there is no intelligence test, blood test, or anything
else that can be done to reach this particular conclusion.
FACT
ADHD symptoms tend to appear at an early age, and they often become more noticeable when
circumstances change, such as when a child begins going to school.
Source: National Health Service
3.2 How ADHD is Diagnosed
If the symptoms that were listed above resonate with you, it does mean that getting
yourself or your child assessed for ADHD is something to give some serious consideration
to.
However, a number of people are unsure as to how they go about this. Do they go to their GP? Do
they go to a specialist?
In most instances, a GP is unable to make a formal diagnosis of ADHD. However, an appointment
with them to discuss the issues that you are facing would be an important first step.
Your GP will ask questions about the symptoms and may refer you to a specialist for assessment if
they think it necessary. In some cases, they may instead ask you to monitor the situation for a few
months to see if there’s any improvement, and then refer you if there is no change.
The actual assessment would be made by a child psychiatrist or paediatrician in the case of a child,
or a psychiatrist in the case of an adult. In either case, the assessment could also be made by any
medical professional who has ADHD expertise.
A diagnosis of ADHD will be made following a comprehensive clinical evaluation, which can
include, but is not limited to:
Physical examination
Clinical interviews
Parent/teacher/self-reports, by use of validated rating scales - such as SNAP Questionnaire
Objective ADHD assessments such as QbTest/QbCheck
Assessment examples: Qb Test. SNAP Questionnaire.
It’s crucial that a full examination is performed by a doctor to rule out any other possible underlying
causes of the symptoms. The kind of things they will be looking for are sleeping problems, anxiety,
depression or thyroid problems. These different issues could significantly affect the way that
someone behaves - and that is why they have to be ruled out at the earliest opportunity.
Another important part of the process for getting a child diagnosed is inviting parents and teachers
to fill out detailed checklists regarding the child's behaviour, activities and responses. These reports
are an invaluable resource for health professionals when trying to make a diagnosis, which is why
it’s important to start making notes of any symptoms and issues as soon as they are noticed.
Based on the information gathered during the evaluation, a diagnosis is made when the child or
adult's ADHD symptoms meet the criteria as set out in a medical classification system such as the
DSM-5 (Diagnostic and Statistical Manual of Mental Disorders – 5th edition).
According to the DSM, the following has to apply to an individual for a diagnosis of ADHD
to be reached:
A child must have displayed six or more symptoms of inattentiveness or hyperactivity-
impulsivity continuously for at least six months. An adult must have presented with 5 or more
symptoms over the same time period.
The symptoms must have been observed before the age of 12. This can be problematic in
ADHD diagnosis for adults simply because of the amount of time which has passed.
The symptoms must have been present in at least two different settings, to eliminate the
possibility that it is something in the environment that is leading to the emergent symptoms.
For children, this is normally home and school, and for adults, it could be home, work and/or
social life.
Evidence shows that these symptoms actually impair the way in which the individual is
functioning, whether it be in their social life, academic life, or family life.
The symptoms that are identified are not linked to any other form of mental disorder.
ADHD may be indicated in the case of a child if it's clear that the observed symptoms of impulsivity-
hyperactivity and/or inattentiveness go above and beyond what's normal for their age, and meet the
requirements above.
For adults, diagnosis can be more difficult, because under current guidelines it’s not enough to be
experiencing the symptoms in adulthood – they must have been present since childhood. It can be
helpful to get supporting information about any childhood symptoms from past teachers or
friends/family members.
It’s worth noting that if you’re not happy with the initial diagnosis, then do not give up. It can often
be the case that insufficient information has been provided for the evaluation, or a doctor has just
not realised the importance of what they are being told. It’s perfectly reasonable to ask for a second
opinion if you’re not satisfied with the outcome.
Next, we turn our attention to what happens after the diagnosis has been made, and this means
taking a look at some of the treatments that may be offered.
3.3 Current ADHD Treatment Options
We will look at the range of treatments in more detail in later modules, but at this stage,
we introduce some of the treatments and how they can be used in the first stages after
diagnosis.
The main recognised treatments for ADHD are medication and therapy. They can be very effective,
especially if used in combination with each other.
However, there is no guarantee that initial treatments are going to be an immediate success, as
there is a certain amount of trial and error involved. ADHD medications in particular are unlikely to
work perfectly on the first try, and a certain amount of adjustments to the dosage or even the type of
medication is to be expected in the early stages.
Like all medications, ADHD treatments come with potential side effects, such as sleep problems.
These may also make it necessary to modify the treatment plan.
Likewise, it could be the case that further underlying issues come to light during these early days,
for example, learning disabilities or mood disorders. Any ADHD medication will not treat these
conditions, so they also need to be addressed before significant improvements can be observed.
The most common types of treatment are as follows:
Medication
Medication is widely used for the treatment of ADHD and it has been shown to be effective in
treating both adults and children. There are several different types of medication out there that
could be used and are usually either stimulants, selective noradrenaline reuptake inhibitors (SNRIs)
or alpha agonist drugs.
Treatment plans may be different depending on the individual or the type of medication taken. For
example, some medications can be taken only on school days, while others should be taken every
day.
A typical approach is to start with small doses of any medication, and then make adjustments based
on efficacy and any side effects. It will be necessary to have multiple check-ups with your doctor
during this process.
We will look at medication in much more detail in a later module.
Therapy
Therapy plays a key role in helping a child to not only better understand their behaviour and the
feelings that they have but also allow them to gain better control over them. In addition, tailored
education programmes for parents can be very beneficial, as they help parents to support their
children with ADHD more effectively.
Types of therapy offered include Cognitive Behavioural Therapy (CBT) and social skills training. We
will look at these and other therapies in more detail in a later module.
Support from others
This is not a treatment as such, but it is crucial. Anyone with ADHD will benefit from having
supportive people around them who understand their condition. If you are a parent of a child with
ADHD, this is where your own education is going to be invaluable, as you play such a significant role
in helping them manage their condition.
3.4 How to Tell if Treatment is Making a Difference
So what happens once this initial treatment has commenced? How can you tell if it’s
working?
If an ADHD treatment is working, the patient should expect to have improved focus, better memory
and less impulsivity. They should be sleeping well, and have a better mood overall.
If the ADHD treatment is not working well, the patient might find that the improvements are not
strong enough or sustained, or alternatively, they could be experiencing severe side effects.
In the case of severe side effects, it’s most likely that the type of medication is not a good fit, and it
would be beneficial to try a different type. If there are no significant side effects but the
improvements are not enough, it could be that the dose needs to be changed.
Whether the medication appears to be working or needs some alterations, it can be helpful to track
progress in an organised, scientific way. The symptoms of ADHD are varied, and it can be hard to
tell if the treatment is working for all of them. For this exercise, it is best to focus on a core set of
symptoms.
Your ADHD specialist may ask you to come up with a list of up to 5 symptoms. Here are some
examples:
Impulsivity, acting or speaking without thinking
Emotional overreactions
Restlessness, fidgeting
Difficulty sticking with boring activities
Losing things
Procrastination
Distractibility
It is important that the symptoms chosen are only the ones that medication is known to help with. All
of the symptoms above fit into this category.
Other symptoms, such as having poor organisation and/or no sense of time, are not known to be
improved significantly by medication, and as such would be poor choices to use as markers of the
effectiveness of the treatment. Your doctor will be able to guide you in making choices for the list of
symptoms.
Once treatment has commenced, the symptoms can be tracked and logged to see if there are any
improvements. This is especially useful if the dose needs to be altered because, using this method,
you can see at which point further changes in medication stop having any effect.
It can take time to get an individual’s ADHD treatment right. Careful observation and continued
monitoring are key to this, both in the early stages and going forward.
SUMMARY
In this module, we have looked at the criteria that medical professionals use to diagnose ADHD and
some of the methods used to assess people for the condition.
We touched on the differences between diagnoses made in childhood and adulthood. While subtle,
they are significant and can make it harder to get an ADHD diagnosis as an adult.
Getting that all-important first diagnosis is a huge step for anyone affected by ADHD. The next step
is considering a treatment plan. For most people, this will mean medication, therapy, or a
combination of both.
In the next three modules, we explore how ADHD affects the individual in more detail, starting with
its impact in childhood.
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