Diagnosing ADHD

ADHD Assessment

Confused about the different ADHD assessments available?

Young Boy Being Tutored by His Teacher Looking to have an ADHD assessment conducted but not sure what type of health professional to see and what the differences are? Neuropsychologists have a very different way of diagnosing ADHD compared to the typical paediatrician due to their different type of expertise. Paediatricians will typically diagnose based on opinions of parents and possibly teachers through questionnaires and meeting with the family. This type of assessment is brief and does not include formal testing of attention skills or other cognitive abilities. A neuropsychologist will typically have a 1 hour interview with the parent/s and then take 3-4 hours to formally assess the child. They will also typically obtain standardised measures of attention, impulsivity and hyperactivity using parent and teacher ratings. Formal and objective testing of attention skills is conducted in order to get an unbiased measure of what attention problems the child is experiencing. Part of the diagnostic criteria of ADHD is that a child is affected academically or socially, and this will also be assessed formally through testing . A neuropsychologist is also formally trained in looking at psychological and behavioural issues that often can present as attention problems, and make sure other underlying factors such as other processing/cognitive issues are ruled out. Many children with visual processing and auditory processing deficits are misdiagnosed as having ADHD, which then can lead to years of inappropriate therapy which has no benefit. At the SCDC we are committed to finding out the exact nature of your child’s cognitive issues so that we can tailor therapy uniquely to your child’s needs. Paediatricians and neuropsychologists often work together due to their different areas of expertise as neuropsychologist cannot medicate children.

ADHD assessment at the Sydney Cognitive Development Centre

STEP 1: Initial phone interview with our intake officer

Prior to booking an appointment all of our patients go through a screening process by our intake officer. They will go through all your areas of concern as well as ask you about your child’s general skills in other areas. At this stage you may be asked to forward us reports from other assessments you may have done so that we can determine the extent of testing still required. An initial consultation with the parents will be booked as well as the assessment date for us to formally assess your child.

STEP 2: Completion of standardised rating scales by parents & teachers

After your appointment has been booked we will then send you links to online standardised rating scales. These include (1) a developmental history questionnaire, (2) a comprehensive development screening questionnaire looking at diagnostic criteria for 13 different disorders including all three subtypes of ADHD, (3) a questionnaire looking at executive skills (eg. planning and organisation). These questionnaires not only look at symptoms of ADHD and attention issues, but also look at social, emotional and behavioural issues both at home and at school that may be resulting in behaviours that may be misdiagnosed as ADHD.

STEP 3: Initial consultation with parents

This involves a 1 hour interview with the parents to look holistically at how the child is functioning and to help further guide the assessment process. This consultation goes through the developmental history and other possible issues that may underlie attention problems either at school or at home (eg. visual and hearing issues, head injury, sleep problems, sleep apnoea, etc) to help make a differential diagnosis.

STEP 4: Formal neuropsychological assessment

The child then undergoes a neuropsychological assessment looking at the key features of ADHD. These include academic underperformance (comparison of IQ vs academic level), executive planning/organisation issues, and full attention testing (see below). Often families are referred to paediatricians for ADHD assessment, however often these paediatricians will need to refer out for formal testing to obtain the vital information for diagnosis . Even a psychologist cannot conduct these neuropsychological tests, as they should only be conducted by someone with formal neuropsychological training. Make sure that any person you choose to do your assessment can formally assess all the required attention and executive skills commonly seen in children with ADHD.
  • Visual attention span
  • Auditory attention span
  • Visual selective attention
  • visual sustained attention
  • Auditory sustained attention
  • Switching attention
  • Divided attention (auditory vs visual)
  • Divided attention (auditory vs auditory)
  • Impulsivity to auditory information
  • Impulsivity to visual information
  • Planning
  • Organisation
  • Abstract concept formation
  • Cognitive Flexibility
  • Utilisation of feedback
  • Time management
It is felt that many people misunderstand what attention is. Attention is an umbrella term for many different skills and without formally assessing each aspect of attention, and truly understand what aspect of attention is affected, recommendations for remediation will unhelpful and often inappropriate. Attention testing is also the only objective way of assessing a child’s attention skills rather than just getting the opinion of a parent or teacher. Attention testing will show a parent how their child falls out compared to other children their age on a range of tests and allows for the parent to understand the severity of the problem rather than given a “yes” they have ADHD diagnosis based solely upon the diagnostic criteria. Many times we find that attention skills are all age appropriate which leads us to then examine other processing reasons for the child struggling to maintain their attention.

STEP 5: Feedback session

Once the results are available and have been analysed the parent/s will be given verbal feedback. At this stage a diagnosis will be discussed along with possibilities for therapy. A careful therapy plan will be formulated.

STEP 6: Report

Within 2-3 weeks the family will receive a detailed neuropsychological report which will outline all tests conducted, results, diagnosis, summary of strengths and weaknesses, follow-up required as well as individualised recommendations according to all the areas of weakness noted. We prepare both a parent report, which has specific recommendations for use in the home, as well as a separate teacher report, which has only school related recommendations. Our reports are very detailed and usually are between 20-30 pages each.

STEP 7: Follow-up treatment & therapy

See our 7-step ADHD program for more details on our complete therapy program.

STEP 8: Review

Following intervention we usually like to briefly review children to make sure that all areas of skill have improved . At this stage we may make some additional recommendations to further improve areas of weakness. We find that as children develop there are usually several periods where we usually need to reassess their needs and engage in more skill training. This usually occurs when they reach grade 4 as the executive requirements in the classroom increase, year 7 when large amounts of structure are removed and children need to be more autonomous in their skills, and prior to HSC.