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To make an accurate differential diagnosis of ADHD and its associated conditions in adolescence, a clinician must thoroughly understand the DSM-IV Criteria for these disorders as well as the limitations of the DSM-IV diagnostic model, develop familiarity with the different presentations of ADHD and common ADHD look-alikes in adolescents, collect information from multiple informants, and become familiar with a wide variety of assessment methods. Above all else, clinicians must take the time needed to collect, sift through, analyze, and interpret the assessment data. Because clinicians in any one discipline may be expert at some but not all of the assessment issues and methods, they often need to involve multiple disciplines on a consultative basis (Robin, 1998, p.77). In order to maximize the chances of an accepted and accurate diagnosis, clinicians must enlist the cooperation of the adolescent, his or her teachers, various other faculty and staff members of the school [who come in contact with the student on a daily basis], as well as the student’s family. The diagnostic process can sometimes be unnerving to all participants, especially the student. Clinicians serve their clients well when they work closely with them and provide necessary supports throughout the evaluation process. When assessing adolescent ADHD, according to Robin (1998), clinicians look to six primary areas: (a) medical status [Is the student in good health? Is the student seeing and hearing well?], (b) inclusionary criteria for ADHD [Is the clinician looking at the core symptoms, chronicity, pervasiveness, and impairments?], (c) co morbidity [Is there an LD factor or other coexisting condition?], (d) differential diagnosis [Is the adolescent underachieving in school?], (e) cognitive functioning [What is the student’s intellectual ability and impairments?] and (f) family functioning [How is the family getting along? Are there conflicts within the home?] Accordingly, Robin (1998) states “there is no one single test for ADHD” (p. 79). The information collected comes from many places starting with the student, the school, his or her parent(s)/guardian(s), and any other individuals closely intertwined in the student’s life. The author continues making the point that “we must rely on physical examinations and laboratory tests, educational tests, behavioral observations, and the review of archival records such as report cards and schoolwork samples, as methods to tap the six primary areas of assessment” (p.79). Barkley (1998) states that “the behavioral problems of children with ADHD are by no means limited to the school setting. Another place in which there is great potential for encountering ADHD difficulties is in the home” (p. 373). Since ADHD can be traced back to childhood, it is imperative to acquire reliable history of past behavioral difficulties as well as present concerns. Parental recall of the child’s early life events, particularly in families with several siblings and ADHD parents, may not be accurate . . . Unlike younger children, adolescents can provide valuable information concerning their ADHD symptoms as well as their perceptions of peers, family, and school difficulties, and the clinicians should routinely seek their input (p. 79). Throughout this segment clinicians have been referred to as taking the lead in the diagnosis of adolescent ADHD. This is an important factor. Administrators must be mindful as should their faculty, that teachers cannot officially diagnose ADHD and nor should they tell a parent that they think their child has ADHD. While it is true, Dendy (2000) reminds us that, classroom teachers are the individuals most closely associated with the student on a daily basis and are most likely to be the first ones to suspect that a student may have ADHD. However, if an adolescent is suspected of having ADHD teachers should share their suspicions with their administrator(s), school guidance counselor, school social worker, and school psychologist well before sharing any diagnostic information with the parent.
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Evaluations
and Diagnoses