| According to the American Psychiatric Association's | | | | interfering conditions. On occasion, I will be fortunate to |
| DSM-IV, ADHD is a disorder that first presents in | | | | learn crucial information about the presenting child that I |
| childhood usually observed before the age of seven | | | | have come to recognize as "Rule Outs" of ADHD. |
| years in a child. It is characterized by developmentally | | | | While these Rule Out factors are not necessarily |
| inappropriate levels of inattention, distractibility, | | | | absolute in their distinguishing ability, they usually |
| impulsivity, and/or hyperactivity. Impairment is realized in | | | | increase my potential of accurately diagnosing ADHD. |
| one or more major life areas typically in the home, in | | | | Age of onset is one of these differential diagnostic |
| the classroom, in social interactions, in occupational | | | | factors. The presence of ADHD can be recognized at |
| settings, or other areas of adaptive functioning. The | | | | least by the age of seven in a child. Generally by this |
| symptom list goes on to describe a variety of | | | | age, a child has developed in multiple areas including |
| interferences that can be presented with ADHD that | | | | cognitive, social, emotional, behavioral, and physical so |
| can easily disrupt performance, learning, and behavior | | | | as to allow them to meet the majority of routine |
| in any child. Curiously, the symptom description fails to | | | | expectations held for that student in the classroom. |
| specify the amount or severity of symptoms with the | | | | The same cannot be said for five year old children |
| exception that the interference must exceed normal | | | | who may still be developing their ability to self regulate |
| developmental levels evident in children. As a result, | | | | attention and activity level so as to facilitate learning in |
| parents and professionals alike are left with the | | | | the kindergarten classroom. My comfort level in |
| challenge of distinguishing excessive ADHD symptoms | | | | attempting ADHD evaluations is substantially improved |
| from those that are normal for a child's specific level | | | | when the identified child is at least six years of age. By |
| of development. | | | | this chronological age, I can more accurately use my |
| Good practice demands that an ADHD evaluation | | | | clinical expertise and judgment to determine when |
| include the gathering of multiple types of information | | | | activity and inattention is observed beyond expected |
| from a variety of sources. A simultaneous effort must | | | | developmental levels. |
| be made to rule out as many alternative disorders that | | | | I use a related Rule Out factor whenever I evaluate |
| can present with similar attention and performance | | | | students who are somewhat older in age. Recently, I |
| difficulties. This could include but not be limited to the | | | | evaluated a fifth grade girl referred due to her lower |
| impairments observed in learning disabilities, | | | | academic achievement and difficulty attending |
| developmental delays in younger children, sensory | | | | specifically in the area of Math. Her absence of |
| regulation dysfunction, mood difficulties and depression, | | | | inattentive symptoms or concerns during earlier |
| anxiety, as well as basic low motivational effort. These | | | | elementary years cast serious doubt on a possible |
| alternative disruptions will easily and predictably | | | | ADHD diagnostic. Not only was there an absence of |
| interfere with a child's optimal performance and | | | | earlier ADHD concerns, but this student enjoyed |
| learning in the classroom. However, distinguishing these | | | | excellent academic achievement and performance in |
| interferences in the classroom remains a challenge for | | | | all prior elementary years. Unfortunately, her math |
| teachers and professionals especially when attention | | | | performance began to show degradation as she |
| deficits are characteristic of a variety of interfering | | | | progressed in curriculum involving higher abstraction in |
| disorders. | | | | concepts and problem solving. In my opinion, increased |
| As a child psychologist, I realize this professional | | | | academic challenge will predictably generate higher |
| challenge every time I begin a new ADHD evaluation | | | | levels of inattention and poor task engagement in |
| for a presented child. I will then lament the absence of | | | | students and cannot be recognized as the neurological |
| an accurate and objective evaluation for ADHD that | | | | impairment of ADHD. |
| can effectively distinguish inattention from alternative | | | | |