Areas › Focus, starting, and ADHD › Getting assessed and diagnosed
Two referrals turn up again and again. A young child being asked to leave a school for behaviour, with no developmental or cognitive information anywhere in the file. And a parent saying something is wrong while the school says everything is fine. Both are describing adult frustration rather than a formulation.
In each case the first job is the same: get some data. Not another opinion, not another meeting, but something measured about how this child thinks and moves and reads. Disagreement between home and school is normal and it is information in itself, since a child can genuinely manage in one setting and be sunk in the other. Start there rather than deciding whose account to believe.
Qur’an and Sunnah
'Do not follow blindly what you do not know to be true: ears, eyes, and heart, you will be questioned about all these' (Quran 17:36). Acting on the loudest account without checking it is precisely the habit this warns against.
وَلَا تَقۡفُ مَا لَيۡسَ لَكَ بِهِۦ عِلۡمٌۚ إِنَّ ٱلسَّمۡعَ وَٱلۡبَصَرَ وَٱلۡفُؤَادَ كُلُّ أُوْلَٰٓئِكَ كَانَ عَنۡهُ مَسۡـُٔولࣰ ا
Do not follow blindly what you do not know to be true: ears, eyes, and heart, you will be questioned about all these
Qur’an 17:36read it in the library
Translation: M.A.S. Abdel Haleem, The Qur'an, Oxford University Press, 2004.
What the research says
Reports about the same child often diverge. The long follow up of the multimodal treatment study of ADHD found self report and informant report drifting apart as participants reached young adulthood, which is a reason to treat disagreement as ordinary rather than as somebody being wrong. Alongside that, a nationally representative United States survey found uneven public recognition of children's mental health problems and uneven ideas about where to get help, which is part of why families and schools arrive with such different pictures.
Swanson JM, Arnold LE, Molina BSG, Sibley MH, Hechtman LT, Hinshaw SP, Abikoff HB, Stehli A, Owens EB, Mitchell JT, Nichols Q, Howard A, Greenhill LL, Hoza B, Newcorn JH, Jensen PS, Vitiello B, Wigal T, Epstein JN, Tamm L, Lakes KD, Waxmonsky J, Lerner M, Etcovitch J, Murray DW, Muenke M, Acosta MT, Arcos-Burgos M, Pelham WE, Kraemer HC, MTA Cooperative Group. (2017). Young adult outcomes in the follow-up of the multimodal treatment study of attention-deficit/hyperactivity disorder: symptom persistence, source discrepancy, and height suppression.. Journal of child psychology and psychiatry, and allied disciplines doi
Pescosolido BA, Jensen PS, Martin JK, Perry BL, Olafsdottir S, Fettes D. (2008). Public knowledge and assessment of child mental health problems: findings from the National Stigma Study-Children.. Journal of the American Academy of Child and Adolescent Psychiatry doi
Strength of evidence: one line of research. A single study, or a theoretical account.
Why it works
When nobody has measured anything, the loudest description of the problem becomes the definition of the problem.
When not to
Where a child is at risk of exclusion, the practical steps that keep them in school cannot wait for the assessment to be finished.
This one is still a draft. It is waiting on a scholar and a clinician to read it before it is published.
Near this one
Ask for the old school reports every time. Some people arrive with a folder of every one they ever had, and you cannot tell in advance which people those are.
Run the assessment yourself and watch while they work. Under real effort you will see the small movements, the tics and the overflow that never appear in ordinary conversation, and none of it reaches you if a technician or an app does the testing.
Where a relative has taken ADHD medication, take the details: who they are to your patient, what they were given, what it did, and what was tried and dropped. Then put it in the referral letter.