Diagnosing ADHD

Adhd impacts people of all ages and from a variety of ethnic and socio-economic backgrounds. When ADHD clients come into a clinician's office, they oftren present a variety of recognizable symptoms. These often appear in what's referred to as "clusters." For the clinician with limited experience, working with ADHD and its multiple co-morbid clinical symptoms, it is important to note these clusters of symptoms as they appear across the developmental range of children, adolescentss, and adults. Some ADHD patients may present symptoms that cannot be easily recognizable by the therapist, given the patient's age and relative developmental level. These same patients may also have comorbid psychiatric symptoms, such as depression or oppositional defiant disorderwihich often over-shadow the more subtle ADHD symptoms. Therapists who work with couples and families may also be surprised to detect ADHD symptoms in parents and other family members across several generations. Family therapy with adolescents allows clinicians and families to take a closer look at which symptoms have had a cyclical affect in families. The presence of ADHD will also shape the interactional pattern and roles among family members for several generations, though this is difficult to predict. ADHD symptoms create patterns of low self-esteem and poor soical and academic skill in children when left unsupported. This in turn can evoke frustrated parental responses that may take the form of scapegoating the ADHD child. Perceived parental failures may then lead to marital problems. Whether one works primarily with children, adolescents, or adults, it is important for the clinician to be aware of the subtleties of the ADHD diagnostic criteria as well as the ongoing literature and research regarding the disorder's neurobiological etiology and behavioral manifestations that infrom both assessment and treatment. Since the ADHD field is relatively new and ever changing, the literature often contains contradictory and even controversial theories. While there are numerous symptoms to ADHD, the primary criteria has to do with inattention, hyperactivity and impulsivity across multiple sub-criteria. Differentiating among the criteria is fairly easy to make especially among hyperactive children. However, the therapist will need to learn to look carefully for the more subtle patterns of inattention that may exist in very bright children who do not display the symptoms of hyperactivity. Many of these children may never be diagnosed with ADHD. The combined subtyped is designed to include the child whodisplays a broader range of ADHD symptoms that span all three areas: inattention, hyperactivity, and impulsivity. This subtype tends to be used more frequently with younger children simply because it can be more difficult to differentiate the various symptoms in this age group. It may also be used with ADHD adults who display milder forms of both hyperactivity and inattentions. For the therapist who works predominately with adolescents or adults, the criteria will need to be skillfully interpreted and translated regarding the behavioral variations for older adolescents, young adults and older adults.

This excerpt was taken from Family Therapy for ADHD by Craig A. Everett and Sandra
Southbury, CT 06488




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