ADHD: Who Can Make the Diagnosis?

By Eve Kessler, Esq.

AT A GLANCE

Because ADHD involves a range of issues and may include multiple co-existing conditions, diagnosing it is challenging • Families turn to a variety of professionals to diagnose ADHD with varying results • Understanding the pros and cons of each can help you determine which professional is best-suited to your child’s needs and your family’s situation


You’re concerned about your child. The warning signs are there, but you don’t know what they mean. You just know something isn’t right.

Your child is four or seven or twelve. She’s in her own world; can’t get going in the morning; doesn’t complete assignments because she’s “daydreaming.” At school, he’s not able to sit still and stay on task, and only focuses on work that interests him. She blurts out answers or thoughts; he throws blocks, or runs around at circle time. Maybe she holds it together at school, but crashes when she gets home, seeking alone time with toys or texting friends. Your in-laws say your husband was “just like that” growing up, struggling in school and having trouble making friends.

Is it a learning issue? Behavioral challenge? Mental health problem? ADHDYou worry and wonder who you can turn to for a reliable diagnosis. To help you sort through your options, use this list of pros and cons about the various professionals commonly called upon to diagnose and treat the condition.

Pediatrician or Primary-Care Physician

Pros: You probably have established a positive relationship with your family doctor or your child’s pediatrician. They are already familiar with your family’s medical history and they can prescribe medications, if appropriate. It is usually easy to make appointments and office visits are likely covered by insurance or considerably less expensive than appointments with specialists.

Cons: Unless the doctor is a Developmental and Behavioral Pediatrician, specially trained in the characteristics and idiosyncrasies of neurological disorders, she may have a limited knowledge of ADHD (and co-existing conditions) and limited experience diagnosing and treating it. Routine physicals and short office visits will not give her enough time or information to make a meaningful and thorough diagnosis, in which she is able to distinguish the cause of your child’s condition from other conditions with similar clinical features. While she may be able to “treat” ADHD by writing a prescription, without more extensive knowledge, she will not be able to manage the medications expertly over time. Nor will her office be able to offer other valuable options, such as cognitive behavioral therapy (CBT) or family counseling.

Clinical Psychologist

Pros: Clinical psychologists are trained to diagnose and treat mental, emotional and behavioral disorders, such as ADHD/co-existing conditions. They perform psychological assessments and are expert in providing psychotherapy, including CBT and family therapy. Office visits are less expensive than appointments with psychiatrists or neuropsychologists.

Cons: While clinical psychologists may understand how the brain works, they are not medical doctors and, therefore, cannot prescribe medications. Because medications are often an important part of treating ADHD/co-existing conditions, if medications become part of your child’s treatment plan, a referral network to psychiatrists or other medical doctors will need to be in place.

Psychiatrist

Pros: Psychiatrists are medical doctors qualified to diagnose and assess mental health disorders, including ADHD/co-existing disorders, and to treat the conditions with medication, which may need to be prescribed and managed over time.

Cons: Thoughtful medication management is tricky and time consuming and visits to psychiatrists are expensive. Because it is likely that counseling will be necessary after the initial diagnosis, especially in the areas of executive function and life skills, therapy providers or coaches may be crucial additions to a treatment team.

Neurologist

Pros: Neurologists are medical doctors specializing in diagnosing and treating disorders of the central nervous system. They may play a role in the diagnosis and treatment of co-existing conditions, such as a seizure disorder, for which an EEG is necessary.

Cons: While there may be an overlap between some of the conditions that neurologists and psychologists treat, neurologists do not generally diagnose mental health and psychiatric disorders, such as ADHD. As with psychiatrists, neurologists are expensive and do not provide therapy or counseling.

Neuropsychologist

Pros: Neuropsychologists are clinical psychologists with advanced training in neuropsychology, the specialization of how disorders of the brain and nervous system affect cognitive function and behavior. They are specifically trained in the diagnosis, interpretation, assessment, and treatment of brain-based disorders. Through clinical interviews, a neuropsychological evaluation (“neuropsych”), and the possible use of brain scans, they are able to identify the underlying causes of symptoms; evaluate the severity of impairments and level of functioning; develop overall treatment plans; and make educational recommendations based on the behavior and learning styles of children with ADHD, cognitive and learning disabilities, and co-existing medical, neurodevelopmental and psychiatric conditions. Neuropsychologists may also work with other medical professionals to determine a detailed and accurate diagnosis and treatment plan.

As part of a thorough neuropsych, a neuropsychologist will analyze data; review records; and write a report—which explains the reasons for the testing, describes the child’s history, details the test results (including specific strengths and needs), and makes explicit recommendations and referrals for future treatment. When complete, she will review the report/recommendations with the child and/or parents, and oftentimes she will attend school-based meetings to advocate for her recommendations to become part of the child’s educational plan.

Cons: There is a dearth of skilled neuropsychologists and, consequently, often long waiting times for appointments. A comprehensive neuropsych is expensive and not generally covered by insurance plans. In addition, as described above, a neuropsych is time-consuming to interpret and the report may take weeks to complete after the initial interviews and testing.

Keep in Mind

As you evaluate your options it’s important to keep in mind the following:

  • ADHD is a complex, nuanced disorder, which impacts many aspects of your child’s life, and is often complicated by co-existing conditions (e.g., mood and anxiety disorders, depression, learning disabilities, etc.). A precise diagnosis can be made only after a thorough evaluation of symptoms by a qualified professional who has training and experience diagnosing and treating neurological and psychiatric disorders.
  • There is a difference between a clinical diagnosis of ADHD and an ADHD evaluation to determine if your child is eligible for special education and related services. While the US Department of Education does not require a medical or clinical diagnosis of ADHD for eligibility purposes, such a diagnosis is required for prescription medication and proper medication management.
  • A diagnosis of ADHD does not guarantee eligibility for special education services. Under the IDEA category Other Health Impaired (OHI), your child’s ADHD must adversely affect educational performance in order to qualify for special education services.
Helping Professionals
School psychologists, with a Masters degree or a PhD, can administer educational, cognitive, and emotional assessments, serve as members of your child’s school-based team, provide guidance, and offer referrals to practitioners with expertise in ADHD and co-existing conditions. Some—but not all—schools allow properly trained, experienced, and licensed school psychologists to diagnose ADHD. Those who are also in private practice may have more diagnostic experience and access to a wider network for referrals. School psychologists cannot, however, prescribe or manage medication. Educational psychologists, with either a Masters degree or a PhD, provide educational testing. They may be trained to administer cognitive assessments of intellectual functioning, but they are not generally trained to assess emotional functioning. While not able to diagnose ADHD themselves, they may provide guidance to your child’s school team and offer referrals to practitioners specializing in ADHD and co-existing conditions. As with other psychologists, they cannot prescribe or manage medication.

Eve Kessler, Esq., a criminal appellate attorney with The Legal Aid Society, NYC, is co-founder of SPED*NET, Special Education Network of Wilton (CT), and a Contributing Editor of Smart Kids.

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