ADHD Evaluation: What Your Child's Pediatrician Does

Maybe a teacher has mentioned that your child can't stay in their seat. Maybe homework takes three hours because your child drifts off after every problem. Or maybe you just have a feeling that something is harder for your child than it is for other kids. If you are wondering about ADHD (attention-deficit/hyperactivity disorder), your child's pediatrician is a good place to start. This article walks through what an ADHD evaluation looks like, what you can bring to make it more useful, and what happens if your child is diagnosed.

Who usually notices the signs?

Parents and teachers are often the first to notice. A preschool teacher may see a child who can't sit through circle time. A second grade teacher may notice a student who rushes through work, loses papers, or calls out answers. At home, you may see a child who can't finish a simple task without five reminders, or who acts before thinking in ways that put them in danger.

Every young child is active and forgetful sometimes. What matters is whether the behavior is much stronger than in other children the same age, whether it shows up in more than one place, and whether it gets in the way of learning, friendships, or family life.

Book a visit just for this concern

An ADHD evaluation takes time. It usually works best as its own visit, not squeezed into the end of a sports physical or a sick visit. When you request the appointment, mention that you want to talk about attention or behavior, so the office can plan enough time and may send you forms ahead of the visit.

What to bring

The more information your pediatrician has, the clearer the picture. Helpful things to bring:

• Your notes. Write down the behaviors that worry you, when they started, and a few specific examples.
• School records. Report cards, teacher comments, test results, and samples of schoolwork.
• Any past evaluations. Speech, learning, or psychology testing, or school special education reports.
• Family history. ADHD, learning problems, anxiety, depression, or other mental health conditions in parents, siblings, or close relatives. ADHD often runs in families.
• A sleep picture. When your child goes to bed, when they wake up, and whether they snore or wake often at night.

Rating scales from parents and teachers

There is no blood test, brain scan, or single quiz that can diagnose ADHD. Instead, the pediatrician gathers reports from the adults who see your child every day. You will likely be asked to fill out a standard rating scale. This is a checklist of behaviors, such as "has trouble waiting their turn" or "is easily distracted," where you mark how often each one happens.

Your child's teacher (or more than one teacher, for older kids) fills out a similar form. Coaches, child care providers, or other caregivers may be asked too. Comparing home and school reports helps show whether the symptoms happen across settings or only in one place. If the forms come back very different, that is useful information too, and your pediatrician will talk with you about why.

Ruling out other causes

Many things can look like ADHD. A big part of the evaluation is checking for these, because some need a very different kind of help. Your pediatrician will take a full medical history and do a physical exam, and may look into:

• Sleep problems. A child who is short on sleep, or who has sleep apnea from large tonsils, can be cranky, restless, and unfocused during the day.
• Hearing and vision. A child who can't hear the teacher clearly or see the board may tune out or act up.
• Learning differences. Dyslexia or other learning disabilities can make a child avoid or rush through work. A child can also have both ADHD and a learning disability.
• Anxiety and depression. Worry or sadness can make it very hard to concentrate.
• Stress or big changes. A move, a new sibling, divorce, a loss, or trouble at school can all show up as behavior changes.
• Other developmental or medical conditions, such as speech and language delays, autism, or seizures.

If something else seems to be going on, your pediatrician may refer your child to a specialist, such as a child psychologist, developmental pediatrician, or child psychiatrist, for more testing.

How ADHD is diagnosed, in plain words

Pediatricians use a standard set of criteria. Put simply, a child may be diagnosed with ADHD when:

• They show several signs of inattention (trouble focusing, following through, staying organized), hyperactivity and impulsivity (fidgeting, talking out of turn, acting without thinking), or both.
• The signs are clearly stronger than in other children the same age.
• They started before age 12.
• They have lasted at least six months.
• They show up in two or more settings, such as home and school.
• They cause real problems with schoolwork, friendships, or daily life.
• Another condition does not explain them better.

There are three main types: mostly inattentive, mostly hyperactive and impulsive, and combined. A quiet daydreamer who never disrupts class can still have ADHD. The American Academy of Pediatrics (AAP) guidelines apply to children ages 4 through 18. Diagnosing younger children is harder because behavior changes so quickly at that age.

The process may take more than one visit. It is normal for your pediatrician to wait for forms to come back before making a decision.

If your child is diagnosed: a short look at treatment

ADHD is treated as a long-term condition, like asthma. The plan depends a lot on your child's age. Following AAP guidance:

Preschoolers (ages 4 to 5)

The first step is usually behavior therapy, with parents learning specific ways to manage behavior at home. Changes in the preschool or child care setting can help too. Medication may be considered only if behavior therapy does not help enough and problems are still serious.

School-age children (ages 6 to 11)

The AAP recommends medication approved for ADHD along with behavior therapy for parents and support in the classroom. Many children do best with both. Your pediatrician will explain the choices, possible side effects, and how the right dose is found over time.

Teens (ages 12 to 18)

Medication is also recommended, with your teen's agreement, along with behavior support. Teens should be part of the conversation about their own care. Driving, schoolwork load, and planning for adulthood all come into play at this age.

School supports

The school is part of the team. Many children with ADHD qualify for a 504 plan, which gives them accommodations such as extra time on tests, a seat near the teacher, or breaks. Children who also need special teaching may qualify for an IEP (Individualized Education Program). You can ask your child's school in writing to evaluate your child. Your pediatrician's notes can help with that request.

Follow-up visits

An ADHD diagnosis is the start of a plan, not the end of a visit. Expect regular follow-up appointments, especially in the first months of treatment, to check how things are going at home and school, adjust medicine if your child takes it, and watch for side effects like a poor appetite or trouble sleeping. Rating scales are often repeated to see whether things are improving. It also helps to agree on a few clear goals with your pediatrician, such as finishing homework without a fight or getting along better with classmates, so you can tell what is working.

For more detail, see the AAP's pages on how ADHD is diagnosed in children and treatment goals for children with ADHD.

When to call us

Call your A thru Z Pediatrics office if:

• A teacher or caregiver has raised concerns about attention, activity, or impulse control.
• Your child is falling behind in school, losing friends, or often in trouble, and you are not sure why.
• Your child takes ADHD medicine and has side effects, such as poor appetite, weight loss, trouble sleeping, or mood changes.
• Your child seems very sad, anxious, or withdrawn.

Call 911 or go to the nearest emergency room if your child talks about hurting themselves or others, or if your child may have taken too much of any medicine. For a possible overdose without serious symptoms, you can also call Poison Control at 1-800-222-1222.

Ready to talk about your child's attention or behavior? Request a visit.