Tests and Physical Assessments to Rule Out Causes of ADHD

1.In diagnosing attention deficit-hyperactivity disorder (ADHD) a physical is a necessary component to ruling out physical causes of the observed behavior (p. 551). What tests and physical assessments are done to specifically rule out other causes of possible ADHD behavior or diagnosis? What are the criteria to be classified as having ADHD? Is there more than one type of ADHD? How are these children distinguished from others with SLD (p. 550-551)?
ADHD is defined as a persistent pattern of either inattention and/or hyperactivity/impulsivity that interferes with development or functioning (Foley, 2019). Symptoms must persist for 6 months and be present before age 12 and be seen in more than one setting and interfere with functioning. There are three types of ADHD; combined ADHD (ADHD-C), predominantly inattentive ADHD (ADHD-I) or hyperactive/impulsive ADHD (ADHD-HI) (Foley, 2019). Signs of inattentiveness include making careless mistakes, being easily distracted, forgetting or losing things, being unable to complete tasks, difficulty listening and carrying out instructions, and being disorganized. Hyperactivity includes fidgeting, not sitting in a seat, talking excessively, interrupting frequently, and needing frequent movement breaks.
In order to have an accurate diagnosis there should be different environments and different perspectives. Oftentimes parents and teachers are requested to fill out behavior rating scales. It is nice to have the perspective of large group and small group settings. A complete history including a prenatal history, parent history, developmental history and physical can help rule out physical causes of behaviors. However there are overlapping conditions that can make ADHD more difficult to diagnose. Some symptoms of ADHD include sleep disturbances, mood dysregulation, emotional lability, low self esteem, low frustration tolerance and irritability making it difficult to diagnose because of the overlap of mood disorders and personality disorders (Marangoni, 2018). Differential diagnoses also exist including Tourette’s, SLD, ODD, ASD, bipolar, anxiety, and depression to name a few (Foley, 2019). In order to distinguish ADHD from SLD the provider must take into account the DSM5 diagnostic criteria for ADHD and base it on a thorough review of history, physical, rating scale and interviews to determine if ADHD is present. The most common comorbidity experienced by students with ADHD are SLDs (12-60%) (Foley, 2019).
The Neuropsychiatric Electroencephalograph (EEG)-Based Assessment Aid (NEBA) for ADHD has recently been created to bring objectivity to the diagnosis of ADHD and to serve as a potential biomarker. The NEBA may serve as a guidance tool, coupled with clinical impressions to determine a diagnosis of ADHD (Fairman et al., 2020). The NEBA uses a patient’s EEG to compare the ratio of theta to beta brain waves; higher theta–beta ratios are associated with a diagnosis of ADHD. Even though the NEBA could advance the degree of objectivity in an ADHD diagnosis, it is currently not recommended to use routinely (Fairman et al., 2020). Therefore, the diagnosis of ADHD may continue to remain subjective.
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