A teacher's and SENDCos guide to ADHD tests and assessments.
What is an ADHD test?
Attention Deficit Hyperactivity Disorder or ADHD is one of the mental disorders that affect both children and adults. Persons with ADHD have differences in brain activity and brain developmental disorders that affect self-control, attention and the ability to remain still. ADHD can affect a person at home, at school, at work and in friendships. Symptoms of attention deficit hypersensitivity disorder may vary from person to person and may change with age, and not every person with ADHD possesses all these symptoms.
Scientific research suggests that diagnosis of ADHD isn’t that easy. Many people feel restless, unfocused and scattered at times, but not everyone has ADHD. Even chronic distractibility or hyperactivity doesn’t necessarily equal ADHD.
To find out if a child or adult has ADHD, a medical professional has to be involved. Healthcare practitioners may use several tools: a questionnaire, medical history of past and present problems, medical assessment or checklist of symptoms, to rule out other reasons for the symptoms.
Getting a formal diagnosis and assessment is important because it is easy to confuse ADHD symptoms (such as concentration problems and hyperactivity) with other medical problems and psychiatric disorders such as emotional issues and learning disabilities. These are treated differently.
What to do if you think your child may have ADHD
The first step is to discuss the matter with a GP. Those who are worried about their child may speak to the child's teachers, before talking to a GP, and ask if teachers have any doubts about the child's behaviour.
A GP may ask questions about:
- When did the symptoms start?
- Where did the symptoms occur, for instance, in school or at home?
- How did the symptoms affect a person or his child's everyday life?
- Are these symptoms making socialising difficult?
- Does the person have a family history of ADHD?
- Did the person face any recent significant incidents in life, such as a death or divorce in the family?
The GP may ask about any other symptoms or medical conditions the affected person may have.
If the GP feels that a person may have ADHD, they usually first recommend a "watchful waiting" period, which lasts about 10 weeks. In this period, it is observed whether or not the medical issues and symptoms improve, become worse or stay the same.
The GP may also suggest attending a group-based parent training or ADHD-focused parents education programme. Being offered an education programme or parent training does not indicate poor parenting or that someone has been a bad parent – it intends to teach people how to help themselves and their children.
If there is no improvement in the behaviour, and both family and the GP feel it's affecting their every day life, the GP refers to a Specialist or Mental Health Professional for the formal assessment.
For adults with the symptoms of ADHD, the GP may suggest an assessment if:
- The person was not diagnosed with ADHD in childhood, but the symptoms appeared during childhood and have been affecting his daily life since then;
- The symptoms cannot be elucidated by mental health conditions;
- The symptoms considerably affect every day life – for instance, if the affected person finds intimate relationships difficult and has been underachieving at work;
- An adult may also be referred to a health care professional if he/ she had ADHD in childhood and its symptoms are now resulting in some degree of functional impairment.
What are the different types of assessment tools used for ADHD?
Behaviour assessments are not the same as screening tests or diagnoses that determine learning differences. There is no fixed right or wrong answer to the behaviour assessment. These are used to assess areas of strength and weakness and how children interact with their surrounding world. These assessments can specify behaviour patterns and causes for the behaviour. Mostly families, teachers and others observe the children and respond to questions about them. Behaviour assessments usually include input from parents as well as teachers. Some behaviour assessment tools may be used to monitor the impact of medications and other effective treatment therapies for those already diagnosed with ADHD.
Following are some of the most common psychological tests used for the behaviour assessment.
- Conners Parent and Teacher Rating Scale: This may help medical professionals diagnose behavior disorder. Teachers and parents fill out a short multiple-choice questionnaire about a child's behaviour. Older children may also be asked to fill out the questionnaire. This type of behaviour assessment explores the presence and severity of different areas of mental health disorders such as social life skills disorders, sleep disorders, seizure disorder, learning problems and symptoms of inattention and hyperactivity. It may also help in monitoring the effectiveness of stimulant medication and other therapies for children who are already diagnosed. Its outcomes out where further assessment may be needed.
- Vanderbilt Assessment Scales: This is used to assess the presence and severity of neuro-developmental condition such as ADHD symptoms. Health care team can also use this to determine other common behavioural concerns and how these might be affecting a child's education and behaviour. This test is used after a general assessment that shows a child displays signs of ADHD. Teachers and parents are asked how frequently they notice symptoms for attention deficit disorders and other behavioural difficulties. Some of the questions are about hyperactivity and focus issues. The provided options include “very often, ” often,” “occasionally,” and “never.” If most of the answers are “often” and “very often,” it may point to ADHD.
- Achenbach Child Behavior Checklist: This is an ADHD test, which is used to measure social, behavioural and emotional abilities and development. This test involves a list of 100 statements about children's behaviour. Then the teachers and parents are asked to rate how “untrue” or “true” each statement is for the kid being assessed. It includes a checklist for child behaviour for both preschoolers and older children. The outcomes of this test may indicate a variety of emotional and behavioural issues, mainly including ADHD, conduct disorders, oppositional defiant disorder (ODD), depression, and phobias.
- Barkley Home and School Situations Questionnaires: These questionnaires are used as a diagnostic tool to measure a child's behaviour, both at school and at home. In these questionnaires, parents have to rate the behaviour of a child in 16 different home situations; whereas, teachers have to rate the behaviour in 12 different school situations. For officially diagnosing a child with ADHD, the child’ behaviour must be problematic in these two areas of life. Barkley Home and School Situations Questionnaires provide an effective way to show that.
It is better to learn as much as one can about the clinical assessment of ADHD. Some tests are used to evaluate social and academic skills. These test results are used to prescribe stimulant medication and create treatment plans, and Individualized Education Programs (IEPs) for the person diagnosed with ADHD.
What about ADHD in adults?
ADHD assessment for adults is more difficult because of the disagreement about whether the same symptoms used to diagnose ADHD in kids also apply to adults.
Sometimes, an adult can be diagnosed with ADHD if he/ she demonstrates 5 or more symptoms of hyperactivity, or 5 or more common symptoms of life challenges, impulsiveness or inattentiveness, mentioned in diagnostic criteria for kids with ADHD
The mental health providers may need to see an adult's old educational records or speak to the teachers or parents, who knew the affected person very well in the affected person's childhood. An adult ADHD, also have moderate to the high effect of these symptoms on various areas of life, like:
- Relationship issues with the partner;
- Problems in making or keeping friendships;
- Intimacy-related issues and parenting issues;
- driving carelessly;
- Failure in education and career difficulties.
If an adult's difficulties are current and did not occur in the past, he/ she is not likely to be considered to have ADHD. It is because scientific research indicates that adverse effects of ADHD do not develop for the first time in adulthood.
Supporting children with ADHD in school
Allaa Gawish, working in Egypt British International School providing special education support offers us some words of wisdom.
Attention Deficit Hyperactivity Disorder (ADHD), a neurobiological condition that is a lifelong span that affects behaviour. ADHD may not be cured but the quality of life can be improved by medication and appropriate support. Although, treatment plan by medication is the most shared method in dealing with ADHD, also, therapy such as ‘Cognitive Behaviour Therapy (CBT)’ and lifestyle modifications are crucial strategies alongside medications (Verywell Mind, 2019).
- Inattentive: People usually refer to it as ‘Attention Deficit Disorder (ADD).’ The person has a symptom of inattention (easily distracted) but is not hyperactive.
- Hyperactive/ Impulsive: The person has hyperactivity and impulsivity symptoms but not inattention symptoms.
- Combined: The person has symptoms of hyperactivity, impulsivity, and inattention.
(Healthline, 2017) and (Verywell Mind, 2020)
From my experience, we often see a variety and mix of different symptoms in the classroom including:
● Easily distracted
● Short attention Span (Loses focus)
● Seems unable to listen
● Lack of organization (e.g: losing things)
● Difficulty in following instructions
● Excessive physical activity and talking
● Interrupting Conversations
● Careless mistakes (e,g: acting without thinking, forgetting items)
● Little sense of danger (Risk taker)
● Difficulty with social interaction (e.g: taking turns)
● Symptoms of both types
Guidance for helping children with ADHD
1. Be Consistent:
- Give information in short chunks.
- Give clear instructions.
- Rules should be posted and be updated when necessary.
- Allow the child to repeat the instructions to ensure that he/she understood the instructions; take into consideration that the child may hear the word but misunderstand the meaning.
- Create a daily routine to follow with his/her daily activities.
- Provide a schedule that would help during transitions (visual or written schedule).
- Provide a checklist for the child to tick off tasks that were achieved.
2. Limit Distractions:
- Make sure that the pupil is sitting in a place where you can have eye contact with the child.
- Place the child away from doors, windows, noise, any distracting objects and place them beside a good role.
3. Provide Frequent Feedback:
- Act quickly to negative behaviours and choose related consequences actions.
- Focus on positive reinforcement by rewarding good behaviours (e.g: use behaviour chart rewards).
- Use signals to attract the child’s attention rather than using their name, so it will not be embarrassing.
- Do not lose temper and remember that an ADHD child may not tend to misbehave but is struggling to control their actions.
4. Use Tools and Flexible Rules:
- Use different learning channels (Differentiation techniques in tasks, instructions, explanations, timings, and grouping).
- If the child is working in a group or in pairs make sure to clarify the role for each one in the group clearly.
- Increase the levels of activity, for example allowing the child to move during the lesson.
- Allow breaks.
- Always provide the child with extra time to finish the task or answer a question and always use a timescale to show an indicator for the time (e.g: sand timer, alarm).
5. Do Not Overload the child:
- Reduce the workload (e.g: breaking down the tasks and instructions into short activities).
- Regarding the homework, make sure to give the instructions clearly using verbal or written instructions.
- Try to reduce the amount of homework, and remember that an ADHD child is getting distracted by the environment; that means the homework that would take 5 minutes may take a longer time. Always give different homework styles (word search, a game related to the learning context).
6. Encourage Support:
- Allocate at least one person care, that the child can develop with them a positive relationship to act as a mentor and address their academic skills and social skills training.
- Allow the child to work with other peers to enhance their social skills and relationships with peers.
7. Parents Tips:
- Keep track of what your child eats if the child is getting hyperactive after certain types of food and provide your child with healthy foods.
- Make sure that your child is sleeping and waking up at the same time every day, ADHD children may have problems in sleeping as a result try to provide them with a sleep-friendly routine.
- Avoid using smartphones.
- Take a warm bath before going to bed.
- Doing relaxation exercises (such as listening to relaxation music).
- Writing a to-do list for the next day would help the child to organize their thoughts and clear their mind from distractions.
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