By Mohab Hanna, MD, Child and Adolescent Psychiatrist
ADHD is a common problem that is frequently encountered in early childhood especially if the child is manifesting obvious struggles in school in the form of behavioral problems, social problems or academic struggles. The prevalence rates of ADHD in the United States have remained at the same level for many years. Northern New Jersey and Bergen County are not unique for having many kids struggle with ADHD. Not all kids or teenagers who struggle with ADHD have the same symptoms. Sometimes, teachers and parents assume that kids have to be hyperactive and impulsive to have ADHD when in fact there are many kids who have ADHD who don’t have those symptoms at all.
Every day, in our Child and Adolescent psychiatry practice we see kids, teens, college students and even adults who come in wanting to know if they have ADHD; and if they do have ADHD then what should they do about it. As an experienced psychiatrist who specializes in the diagnosis and treatment of ADHD, I have become increasingly concerned about the process that is utilized to diagnose so many people with ADHD and to just “try medications”. For some patients, a thorough psychiatric evaluation with an experienced provider can be sufficient, but for most patients, it has become increasingly clear to me that we need more objective testing measures to help us come up with an accurate diagnosis or to even determine if there is in fact a problem in the first place.
The lack of objective measures in diagnosing ADHD can lead to misdiagnosis with potentially long-term consequences. We know that many younger children get diagnosed with ADHD when in fact they have anxiety. Treating a child with ADHD medication in that case can be harmful and cause unnecessary side effects for months or even years. Diagnostic accuracy for the presence or absence of ADHD is essential and is helpful for guiding treatment decisions whether for ADHD or for another psychiatric condition.
We have started incorporating ADHD testing as a routine part of our evaluation process to increase the accuracy of our evaluation and to help better guide treatment. In addition, if someone does go on medications for ADHD, we can repeat these standardized tests to objectively evaluate the effectiveness of the ADHD medications. All testing needs to be interpreted in the context of a clinical evaluation. This doesn’t diminish the role of a comprehensive psychiatric evaluation but enhances clinical decision-making and helps provide a more robust evaluation of ADHD.
For example, ADHD testing gives a more detailed understanding of the nature of ADHD which can potentially guide in the choice of which ADHD medication to use. For example, it can help guide whether a Ritalin based product like Concerta, or an Adderall based product like Vyvanse would be helpful or a non-stimulant medication like Atomoxetine (Strattera) or Guanfacine or Clonidine would be helpful.
The choice of ADHD medication is a significant one. Perhaps even more important, the ADHD testing provides an objective measure of the level of ADHD that is present to guide whether ADHD medications should even be used. Not all patients who have ADHD even need medications for treatment.
Data from testing is just numbers; the value is in the ability and skill of the psychiatry provider being able to interpret those numbers and make sense of them in the context of the big picture. Our goal at the ADHD Center of New Jersey is to provide the best evaluation possible for kids, teenagers, college students and adults as we utilize objective ADHD testing measures and clinical skill. It is very clear to me that this is essential to making good decisions and to preventing unnecessary harm and long-term problems for our patients.
