No physical findings are diagnostic of ADHD, and there are no laboratory studies or electroencephalography (EEG) findings that aid in the diagnosis. Neuropsychological testing, including computerized or manual performance tests of attention and impulsivity, may be helpful in assessing a patient’s cognitive strengths and weaknesses but cannot definitively rule in or out a diagnosis of ADHD. Diagnosis is made by taking a careful psychiatric history, using as much collateral information as is available, such as job evaluations, old report cards and, if possible, the input of partners and family members. Brain imaging studies (including the test known as a SPECT scan) are not recommended; they are expensive and provide no additional diagnostic benefit.
Many patients with ADHD have long suffered under the impression that they just have a “character problem,” ”just need to work harder” or are purposely “self-sabotaging,” when in fact they are working quite hard to try to manage a treatable biologic problem. There are patterns and life stories of inattention, distractibility, impulsivity and disorganization that only be coherently explained and addressed by the diagnosis of ADHD.
On the other hand, not all patients with difficulties in attention and distractibility have ADHD. The following are some of these other factors:
-Depression, anxiety, learning disabilities, substance abuse and sleep disorders can all cause similar difficulties and are not best treated with ADHD medications.
-In some cases there can be a mismatch between a person’s talents and their chosen career that can manifest as problems with focus and task completion.
-Some people attribute problems with excessive attention to detail (“hyperfocusing”) to ADHD, but there is very little research that supports this conceptualization. In these cases there is certainly a dysfunction of attention, but it is not usually best explained by a diagnosis of ADHD; the underlying biologic challenge of ADHD is usually a deficit, rather than surplus of attention. Hyperfocusing is more likely due variously to obsessive personality styles, anxiety, or to one of the many neurocognitive states that can cause difficulties for a person but that have not yet been scientifically categorized.
-There are many patients who likely have some, but not all, of the genetic makeup that it takes to have the full syndrome of ADHD. They experience attentional or organizational difficulty, but not enough whereby the can be diagnosed with the disorder. In this sense, ADHD is a “spectrum disorder,” whereby there are some people who definitively do have it, others that definitively do not, and many people who are somewhere on the diagnostic spectrum. In this last group, patients can struggle with certain attention-related areas of their life and even though they don’t formally have ADHD, neither is another problem or disorder a better explanation for the difficulties. It is essentially a partial case of ADHD. In these situations treatment with medications is generally not recommend as a first step in treatment; cognitive-behavioral therapy, organizational help, or finding ways to alter the working environment may be better treatment plans.
The following is a link to a recent podcast discussion regarding diagnosing ADHD:
http://dl.dropbox.com/u/27785958/IAPADHDNYTimesDiscussion.mp3