Attention Deficit Hyperactivity Disorder (cont.)
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ADHD in Children Diagnosis
The evaluation of a child suspected of having ADHD is multidisciplinary, involving comprehensive medical, developmental, educational, and psychosocial evaluations. Interviewing parents and the patient along with contact with the patient's teacher(s) is crucial. Investigation regarding the family history for behavioral and/or social problems is helpful. While direct person-to-person contact is considered vital at the outset of an investigation, follow-up studies may be guided by comparing standardized questionnaires (from parents and teachers) completed prior to intervention and subsequent to medication, behavioral therapy, or other treatment approaches. While there is no unique finding on the physical exam in patients with ADHD, unusual physical features should prompt consideration of consultation with a geneticist due to the high association with ADHD behavioral patterns and well-recognized genetic syndromes (for example, fetal alcohol syndrome).
At this time, no lab test, X-ray, imaging study, or procedure is known to suggest or confirm the diagnosis of ADHD. Specific tests may be ordered if indicated by specific symptoms.
Physicians and parents should be aware that schools are federally mandated to perform an appropriate evaluation if a child is suspected of having a disability that impairs academic functioning. This policy was strengthened by regulations implementing the 1997 reauthorization of the Individuals With Disabilities Act (IDEA), which guarantees appropriate services and a free, appropriate public education to children with disabilities from ages 3 to 21. If the assessment performed by the school is inadequate or inappropriate, parents may request that an independent evaluation be conducted at the school's expense. Furthermore, some children with ADHD qualify for special-education services within the public schools, under the category of "Other Health Impaired," although not all children with an established diagnosis of ADHD will qualify for special services based upon school district testing. If a child is deemed in need of special services, the special-education teacher, school psychologist, school administrators, classroom teachers, along with parents, must assess the child's strengths and weaknesses and design an Individualized Education Program (IEP). These special-education services for some children with ADHD are available though IDEA.
Despite this "federal mandate," the reality is that many school districts, because of underfunding or understaffing, are unable to perform an "appropriate evaluation" for all children suspected of having ADHD. The districts have the latitude to define the degree of "impairment of academic functioning" necessary to approve "appropriate evaluation." This usually means the children who are failing or near-failing in their academic performance. A very large segment of the ADHD-affected children will be "getting by" (not failing) academically (at least in their early years of school), but they are usually achieving well below their potential and getting more and more behind each year on the academic prerequisite skills necessary for later school success. Thereafter, further educational testing may be requested from the school district. Unfortunately, some families will have to assume the financial burden of an independent educational evaluation. These evaluations are commonly done by an educational psychologist and may involve approximately eight to 10 hours of testing and observation spread out over several sessions. A primary goal of an educational evaluation is to exclude/include the possibility of learning disorders (for example, dyslexia, language disorders, etc.).
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