ATTENTION DEFICIT DISORDER (ADD or ADHD)
Some Notes About Making the Diagnosis – Our Policy
Requests to consider the diagnosis of ADD or ADHD (there is actually no difference between these two terms – they are two names for the same disorder) are the most commonkind of developmental consultation request we receive. Typically this issue has been raised by teachers in a parent meeting, or the parents have read something about ADD ~ ADHD and recognized some traits in common with their child (who may be underachieving in school).
ADD ~ ADHD is currently a very over-diagnosed and over-treated condition in this country (see our detailed article on ADD ~ ADHD). We feel this is a very bad trend, and we want to avoid it in our practice. Because of this, our policies about how we handle requests to consider ADD ~ ADHD often differ from teacher and parent expectations.
First, we never use “questionnaires” or “symptom checklists” to diagnose ADD ~ ADHD. We simply don’t believe in it. These kinds of instruments have become quite popular in the last 15 years, but they have also been shown conclusively to be very inaccurate, and are one of the main reasons for the epidemic of over-diagnosis in this field.
Second, we always require formal individualized testing of one sort or another in order to make this diagnosis, and especially prior to prescribing any medications to treat it. There are just two kinds of individualized testing which we consider adequate to diagnose ADD ~ ADHD – neurodevelopmental (ND) and neuropsychological (NP).
- ND testing can be obtained as part of a multidisciplinary team evaluation at Children’s Hospital in Boston. The advantage of doing it this way is that in addition to the ND exam, you also get academic achievement testing and a psychological evaluation as part of the bargain. Thus, such a team evaluation is a good way to address learning and emotional issues (both of which can mimic ADD) at the same time. The multidisciplinary evaluation may or may not be covered by your insurance. The main disadvantage is there may be a wait of several months to get an appointment.
- NP testing is obtained through referral to a private neuropsychologist or neuropsychological clinic. Neuropsychologists and neuropsychological clinics vary in quality, and so we hope that you consult us for a referral to one that we know and trust. NP evaluation is more thorough, extensive, and expensive ($2000-$3000) than other options. It can usually be obtained quickly (if there are no payment/insurance delays). Like the multidisciplinary evaluation, it may or may not be covered by insurance depending on your policy. It also addresses learning and emotional issues in addition to ADD, but in more depth than the multidisciplinary team. If problems in these areas are found, the NP testing will yield a deeper understanding of their nature and details.
So, if you are contacting us to request we consider a diagnosis of ADD ~ ADHD, and your child has already had ND or NP testing, schedule a RECORD REVIEW, INTERPRETATION, & ADVICE appointment as described above should be made. If you are requesting we consider ADD ~ ADHD and your child has NOT had ND or NP testing already, your should either schedule a NEURODEVELOPMENTAL EVALUATION or you should contact us (either through call-in, email, or our front desk) for a referral to a neuropsychologist or multidisciplinary team first, and then come in for a RECORD REVIEW, INTERPRETATION, & ADVICE appointment once the report of that evaluation is available.