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How to diagnose ADHD / ADD?

How to diagnose ADHD / ADD?

An unequivocal and one hundred percent assured diagnosis is still difficult to achieve today and, as we will see, is also quite laborious. Therefore, even a quick or, as some parents or sufferers sometimes imagine, a "quick diagnosis" is impossible to carry out. In this country, ADHD diagnostics can only be performed by a child psychiatrist familiar with the subject matter or child and adolescent psychologists, in the case of adult patients by a practicing clinical psychologist or a neurologist / psychiatrist familiar with the subject matter. It must also differential diagnoses and any concomitant diseases (comorbidities), such. As a disorder of social behavior, anxiety disorders, borderline personality disorder (in adolescence and adulthood), be respected. However, it has often proved difficult for those affected to find a competent specialist in ADHD in their area. This can be particularly cumbersome because it is not enough to make a single brief visit: answering and discussing the standardized questionnaires and tests takes several hours in each case (on average 3 - 6). The fact is that either the relatively thin distribution of "ADHD specialists" or the difficulty of diagnosing them means that many people are diagnosed only at a relatively advanced age. 


Adhd Diagnostic criteria

Serious diagnosis requires / should consider multiple levels, which of course complicates the process. A common diagnostic system called DISYPS-II is based on three evaluation levels: At the clinical level (diagnostic checklists, DCL) The level of foreign judgments by parents, teachers or kindergarten teachers / educators (third-party assessment forms, FBB) The level of self-determination of the child, but usually only from the age of eleven (self-assessment sheets, SBB)            

It is important that the individual symptoms observed as "disturbing" are not only present at a level which is in any case adequate for the stage of development of the child, but go beyond this level. The medically correct wording in most diagnostic manuals is "abnormally increased" or "significantly increased" behavioral originality, better formulated as "significantly increased suffering". Because this is what matters. Whatever may be "abnormally exalted" in a person's life; as long as this person does not actually suffer from it, one should by no means "tinker" an illness out of it.

X-ray image & Co

One of the most frequently asked questions to experts regarding the diagnosis and "reliability" of statements is something like this:"Is not there a technical procedure that clearly proves or rules out ADHD?"Unfortunately, this does not exist yet! At least not for the "serial diagnostics"!For more precise medical diagnostics, there are currently hardly any technical developments available, as there is still no standardized picture presentation for the vast majority of "disorders" in the human brain, if one ignores the scientifically and quite promising experiments with the extremely expensive PET. Scan and, more recently, the so-called QEEG. The two methods can make the features of the ADHD-specific brain activity in the affected regions visible in different ways. The latter method could soon, in fact, be applied more broadly due to the relatively low cost. So, as there are no real alternatives, it's clear that the history of whether ADHD is present or not is important. The doctor has various diagnostic procedures available. In the first place is already routinely almost always the history. When it comes to ADHD and other behavioral deficits, the family situation is first observed, mental illnesses and alcohol and drug abuse are observed and analyzed. Anamnesis also includes criteria such as pregnancy and childbirth as well as previous illnesses. To obtain this information, parents, teachers, and other caregivers are interviewed, as KONZENTRUM will show you in the next section. Diagnosis also includes comprehensive behavioral observation and, in some cases, video recording in order to demonstrate the results to the parents using reactions, gestures and facial expressions, and later to present a comparison to demonstrate a successful treatment.


In order to come closer to a reasonable suspicion of ADHD or even its exclusion, as already mentioned, even the best diagnosticians must do one thing above all else: ask questions! But for a multifactorial disorder such as ADHD, the importance of this diagnostic method is particularly high. Doctors, whose consultation with a serious approach to parents probably no way around, now use rather complex but standardized survey methodologies: With many questionnaires and tests that are standardized according to international criteria (for example, DSM IV manual), bordering, for example. Pediatricians, child and adolescent psychiatrists or child psychologists, the causes of the symptoms. Ideally, this is done in three phases: 1) Questioning the child, parents and caregivers about the specific symptoms (anamnesis) 2) Intelligence and performance diagnostics. The background is that intellectual challenges often cause school problems 3) Clarification of the relationship within the nuclear family of the child (the already indicated psychosocial factors). In modern terms: the "systemic approach" in nuclear family and environment. Here are important starting points for a later therapy.

For the psychosocial components mentioned in this appearance, however, should also be considered as a compassionate family or education counselor or child psychologist. For the foreign judgments (teachers, parents) a number of questionnaire procedures are available. These include, for example, the screening sheet for attention-deficit / hyperactivity disorders (ADHD arc), with the aid of which indications of ADHD or ADD and their concomitant symptoms are to be recorded. Here, the two areas of life family and kindergarten or school are considered separately on a four-level answer scale.

It has been shown that it is extremely helpful for a later diagnostic procedure and also abbreviates it, if you first create a small "collection" of direct observations of the child at school and at home. It is certainly easy to understand why this watch list can be helpful in the event of a later detailed in-patient medical history.

Adhd Testing

         A psychological test should take at least two to three hours to ensure a thorough behavioural observation in the test situation. Pure concentration tests such as the d2 test  or the concentration test alone are not enough to make a statement about a child's ability to concentrate in everyday life. In addition, a number of other tests should be used. B. the thinking skills are performed. Also an intelligence diagnostics should be carried out.


         A diagnosis should be based on information from different sources, as a single test may not cover the complete differential diagnosis (see next paragraph). Therefore, in addition to questioning the affected child, the parent / educator and teachers, basic diagnostics also include thorough psychological test diagnostics, neurological examination and behavioural observation
         ADHD can only show up in adolescents in puberty. In any case, the symptoms must bring significant disruption to the daily life of the person involved. For example, in many drug compendiums and study materials, a medical indication is only in the foreground if, as already mentioned in the introduction to diagnostics, phrases such as "abnormally increased symptoms" or "significant suffering" are correct.

Differential diagnosis (exclusion)

Exclusion of possible other disorders that would better explain the hyperkinetic symptoms is essential at every level of diagnosis. For example, there should be no profound developmental disorder, schizophrenia, or other psychological disorder. In order to differentiate ADHD from other clinical pictures, a clinical examination is indispensable, just as other psychological examinations aim to separate ADHD from, for example, reduced intelligence. For reasons of cost, an MRI is rarely produced in clinics or medical practices. An EEG is performed to provide information about other illnesses. Especially in the case of medication should be ruled out in this way that, for example, an epilepsy exists.


         Finally, of course, it must be mentioned that no ADHD image really resembles the other one. As is the case with all other human diseases. This even goes so far as to start from three fundamentally different symptoms and then determine the severity of ADHD:

ADD, combined type with all three guiding symptoms

ADD, predominantly hyperactive-impulsive

ADD, mostly inattentive

What does ADHD mean for affected children?

Case studies: Mathew and Sammy

         The case studies of elementary school children Mathew and Sammy are selected to show typical features of ADHD. On the other hand, they describe different Perspectives (child, parents, and teachers) and make finally, at the same time attentive to school-relevant formulations, as they are also in find verbalized testimonies.

         We hereby invite you explicitly to get involved in the different perspectives and on your different perceptions to pay attention. Change of perspective can be useful be to the situation of the affected children and their families to understand even better. This approach is already expressed by an old Native American proverb:
"To really understand someone, you have to have at least a thousand miles in it be gone.”

Case 1: Mathew (2nd year)           

The 8-year-old Mathew attends the second primary school class and wonders why the whole thing Life is so "stupid" and if it is not much better would have been never born. Everything was just "stupid". The younger brother would be loved more and everything, he was allowed nothing. Mom does not love him anyway, and he does Dad never has time for him. He would like to go not even to school, because there are only againstBe him. He is unfairly rejected by the Teachers always accused of blaming everything to be. And constantly he is so provoked by other children that he is only wildly around strike. He did not know what was going on with him. The teachers see Mathew as a class Kasper who constantly play in the foreground got to. He was hardly to be slowed down on Mondays, especially when he was disturbed by interruptions and running around. Because of his low frustration limit the boy was constantly involved in quarrels and brawls. His services are fluctuating and dependent on the form of the day. His typeface should be Mathew urgently needed to improve and he had to keep more order. Amazingly, the boy was in the two-person situation as transformed and very accessible. The teachers think that that the parents do not properly educate their son. Mathew just had to learn to be more motivated and ambitious. Especially the mother is desperate. She has that Feeling that the older son is slipping away from her, and because of the numerous complaints from the school she fears a massive school failure. From The school Mathew has a very bad opinion, all teachers are "stupid", "stupid" and unjust. No understand him. Often he has to do penalties that his hatred for the School still reinforced. In addition, Mathew constantly attacks his younger brother. His restlessness and distraction have He is barely under control, and he feels already in principle by the slightest criticism asked a question. His eating habits were very high Wish, and there is always something up the ground. Her husband does not feel Mathew’s mother very understood and supported. He represents the Conception that Mathew is a wild boy who "the horns still repel".           
Approach and further development As the situation becomes more acute, the parents are looking for a specialist. The psychological testing shows that Mathew over a good intelligence, but only for a short time can concentrate. Every sound and every Movement distract him. After the subsequent medical examination, the Doctor diagnosed with ADHD more pronounced Hyperactivity and impulsivity. He recommends that First, treat the child psychotherapeutically and, if necessary, medically. He advises the Parents, parallel to a parent training participate. You agree with this approach Mathew learns in behavioral individual training to deal with his impulsivity and Ignore provocations, so that theLocation at school and a bit relaxed at home. His self-esteem rises by being Focus is directed to what he manages and what he is good at. The parents also benefit from her training. They learn about the unrest of theirChild to respond more calmly and clearer Structures and rules in everyday family life too bring. In addition, Mathew 'parents inform his Teacher and arrange that the boy gets time off. In addition, the teachers tie his urge to move into helpful actions such as “clean the panel” positive. The fixed seat at relieved a table with calmer children Mathew the constructive cooperation in the classroom. Because of his good academic achievementsMathew receives the recommendation in the middle of the 4th grade to change to high school.Case study 2: Sammy (4th grade) Sammy is ten years old and attends the fourth Primary school. She knows that the marks of the first semester will decide which secondary school she is allowed to attend. Although she studies diligently, she knows most of them. Class work only a little. Somehow feel Look at that as if everything had blown away. Sammy feels like being "stupid" and not to get along as well as the others. There she was so strict. During the lesson, she sits very still and then notices suddenly, that she was in a completely different world. The clouds in the sky or the singing bird on the tree in front of the window their class would know so interesting to tell stories. In the evening she falls that falling asleep more and more difficult. Sometimes she could not remember a lot of stomachache and headache. Also mom is never happy with her. The "stupid" orders, such as getting drinks or sorting laundry, could be but nobody noticed. It's all too much for her.

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