ADHD Testing

What is ADHD?

I hear it all the time, “My kid has her nose in a book most of the day, she can’t have ADD!” Sometimes it’s, “He can build Legos all afternoon” or “He can sit in front of video games for hours, there’s no way he’s got ADHD!” But let me be clear: ADHD has nothing to do with paying attention to activities that kids or adults enjoy. Because, if we’re honest, we can all dive into things we love, and we can keep going for a long time—sometimes even hours. And for many people with ADHD, their motivation and interests can fuel them even more, oftentimes during enjoyable activities they have more stamina than peers. But, ADHD has everything to do with paying attention to activities people DON’T enjoy. That aren’t naturally rewarding. Cleaning up their room, completing a math worksheet, or studying for a big test instead of talking with a friend.

But what about the brain and ADHD? In a nutshell, ADHD is when the frontal lobes of the brain develop slower than usual. And why is this important? Because, above all, the frontal lobes are responsible for purposeful, planned behavior (the fancy term for this is executive functioning). It’s a fancy term, but here is what Executive Functioning is: knowing what to do, when to do it, and actually doing it. For instance, think paying attention to a classroom lecture even though you really want to check Instagram or chat with your friend about last night’s game. Or, think about waiting your turn during a conversation rather than cutting off your friend. Now, a keyword here is SLOWER. Students with ADHD have frontal lobes that mature slower than others. So, kids, teens, and adults with ADHD aren’t destined to struggle for the rest of their lives; rather, the goal of any treatment plan is to support the development of the frontal lobes.

What’s the difference between ADD and ADHD?

First, I hate to break it to you, but there’s no such thing as “ADD.” Well, there is, but it’s technically called something different, ADHD Inattentive type. But so many people still use the term “ADD” that it gets confusing. Here’s the point, when we talk about ADHD, it could be one of three types: 1) primarily restless, impulsive, and hyperactive, 2) primarily spacey, inattentive, and disorganized, or 3) a combination of both. So, don’t fear if I talk about ADHD but you or your child are struggling with only symptoms of inattention. Part of the testing process is understanding which symptoms are most intense.

What are signs of ADHD?

Let’s be honest, no one’s attention skills are perfect. Throughout the day there are plenty examples of when our attention slips or fades. When we’ve got a book open at night and realize that we have absolutely no idea what we had just read, when we forget an item on our grocery list, when we’re driving along the same route and miss a turn, or socially when we speak without thinking. Like telling an adoptive mother that her son looks just like her—yeah, I’ve done that.

But for students with ADD/ADHD, these struggles are much more intense and much more pervasive. Sustaining attention in class can be arduous, like most of us in a lecture about chemical engineering (sorry, engineers). Talking with friends, doodling, or just daydreaming are so much more engaging. And outside of class, the struggles continue. Homework isn’t written down, papers are scattered, assignments are missing or late, and studying is rushed or doesn’t happen at all. And ultimately, grades plummet, and it’s hard to play catch up. Socially, students with ADD/ADHD may burn bridges because of their impulsivity or difficulty picking up on nonverbal cues and subtleties.

And when do these struggles first appear? Sure, there are times when ADD/ADHD symptoms are obvious when a student enters kindergarten or even before, but for many others, it’s not as obvious. The times that I frequently see attention problems become unmanageable are at important transitions, like starting middle school and managing the demands of multiple teachers, completing the longer and more complex assignments in high school, or starting college and having to prioritize work amidst a host of fun-filled alternatives.

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Testing for ADHD

Making an ADHD diagnosis is tricky, and here is why: attention problems can be a symptom of a wide range of difficulties: from learning disabilities to anxiety, limited motivation to concussions. And, there is not one test or procedure that can definitively diagnose ADD/ADHD. These are just two reasons my evaluations are so comprehensive. Testing sessions usually last around three hours, I elicit feedback from parents and teachers, and I take my time to consider all the factors that might be impacting attention, follow-through, organization, etc. In the end, I have a detailed picture of a student, their particular struggles, and our plan moving forward is not a one-size-fits-all arrangement.

Who diagnoses ADHD?

There’s a lot of professionals who can diagnose ADHD: medical doctors like pediatricians or psychiatrists, nurse practitioners, psychologists, and counselors. And there are pros and cons of each (check out a brief comparison here). Medical professionals can do a few things I can’t—like conclusively rule out thyroid problems. But medical professionals typically don’t set aside the time that I can. I mean, what doctor is going to spend two to three hours on an evaluation? As a school psychologist, I have two decades of experience working in schools, observing students in class, and collaborating with teachers and parents to help students thrive. Most clinical psychologists have never set foot in a school.

And, while we’re on the subject, there’s another important reason that I’m different than many psychologists. Lots of psychologists think that an evaluation for ADHD has to rule out a learning disability. This means more testing—a lot more testing. This means more money, too. And yes, it’s true that about 45% of students with ADHD have a learning disability (check out this study). So, there are times when we should do a comprehensive assessment. But, when students have breezed through elementary school—when most learning disabilities first surface—then there typically isn’t much reason to complete loads of testing. Of course I look to rule this out, but that shouldn’t take four extra hours of testing.