Diagnosing ADHD in Children
Over the summer, I worked with quite a few elementary school kids who exhibited symptoms of ADHD. Two of these kids, in particular, were only six years old. While they have completely different profiles, both were referred for evaluation due to concerns with their attention, activity level, and academic progress. Their parents and teachers were concerned they had ADHD.
When I work with kids this young, I am always reminded of an important question:
What is an appropriate age to diagnose ADHD?
Before considering the answer, let’s examine what ADHD is.
ADHD Defined
According to the Diagnostic and Statistical Manual of Mental Disorder (DSM-V),
The essential feature of ADHD is a persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development.
Some of the other key features of ADHD include:
Symptoms have persisted for at least 6 months
Negatively impacts social and academic activities
Symptoms are present prior to age 12
Symptoms are not due to a separate underlying factor (medical, environmental, etc.)
Symptoms must be present in more than one setting (home, school, social settings, work, etc.)
The biggest take away here is that these symptoms must INTERFERE with the child’s functioning. That one word “interfere” is what distinguishes typical six-year-old behavior from actual ADHD.
Other Diagnoses
As mentioned above, a diagnosis of ADHD means that there is no other underlying condition causing the symptoms. Other conditions that may look like ADHD but are actually something entirely different are:
Auditory Processing Disorder
Oppositional Defiant Disorder
Specific Learning Disorder
Autism Spectrum Disorder
Anxiety Disorders
A huge part of an ADHD evaluation is ruling other conditions out. The clinician will typically do this by obtaining the child’s medical history, as well as the family’s medical history. It is essential when diagnosing a young child that the clinician consider all possible reasons for the child’s symptoms. I have seen numerous kids diagnosed with ADHD who actually struggle with something completely different. And this can present huge problems in the treatment plan going forward.
How is ADHD diagnosed in Children?
According to the DSM-V, only about 5% of children experience actual ADHD. Simply put, it’s not a common condition. To complicate matters, diagnosing ADHD is not an exact science; there is no test that definitively determines if ADHD is the cause. I like to think of an ADHD diagnosis as a puzzle. We find all the necessary pieces and start putting them together to make the picture.
In young children, a thorough evaluation by a trained clinician is essential to determining if ADHD is indeed the underlying condition.
A thorough evaluation will typically include these puzzle pieces:
Review of medical records
Review of previous evaluation if applicable
Consultation with the child’s parent(s)
Teacher input
Academic assessment
Observations during the evaluation
There can be other pieces to the evaluation, but these are the main components.
An alternative path for diagnosis is through the child’s pediatrician. However, these evaluations do not tend to be thorough and can very easily mis-diagnose the child.
What Age Can a Child be Diagnosed?
So now we get to the big question of today’s post. How young can a child be diagnosed with ADHD?
I have conducted hundreds of ADHD evaluations for students over the years, and I have worked with students as young as six. For me, that’s the youngest I would work with and even consider a diagnosis. And even at six years old, it is really difficult to diagnose a child accurately.
Most six year olds are still adjusting to their new found social and emotional skills, and this can often cause problematic behaviors that mimic ADHD symptoms. Furthermore, kids this age often have a difficult time articulating exactly what it is they feel inside, so self-report measures at this age are not very reliable.
Perhaps most significantly, many of the assessments and measures I use to diagnose ADHD do not start until a child is six years old. There are some that are designed for children younger than six, but I do not find them to be the most reliable.
Despite these concerns, I have seen plenty of six year olds who are clearly experiencing ADHD. These tend to be boys who exhibit significant inattention or hyperactivity and often struggle simply to finish the evaluation. In these cases, a diagnosis is pretty straight forward.
On the other hand, I have evaluated teenagers who exhibit mild symptoms of ADHD that do not necessarily present until they are in middle school. For these kids, it would be nearly impossible to identify the source of their challenges in early elementary school, as they simply were not significant enough.
The age at which a child can be diagnosed properly really depends upon the severity of the ADHD. According to the DSM-V, the severity of ADHD is broken down into three levels, each according to the number of symptoms and individual experiences:
1. Mild
2. Moderate
3. Severe
Based on these levels we can begin to approximate when a child will exhibit symptoms significant and clear enough to warrant a valid diagnosis. Please note that these are my approximations based on my experience evaluating students.
Mild ADHD – age 12
Moderate ADHD – age 9
Severe ADHD – age 6
As you can see, there is quite a range of ages when detecting ADHD. The more severe the ADHD and its symptoms, the earlier one can identify and diagnose it accurately. Furthermore, treatment options can vary significantly from age six to age twelve. While behavior therapy is the primary method of treatment I recommend, medication can have tremendous benefits for ADHD. And medication type and dosage is highly dependent upon the age of the individual. For these reasons, it is critical that ADHD be diagnosed properly and timely.
If you suspect your elementary school child experiences symptoms of ADHD, make sure you consult a trained clinician to help you determine the root of these symptoms.