At What Age Should a Full ADHD Evaluation be Done?
by Ernest J. Bordini, Ph.D.,
A recent inquiry was received on our website, essentially asking at what age is testing appropriate.
“Your website is incredible and so informative. Thank you so much for your effort in educating regular parents like us. I do have a question. In all the sites I've seen, I've not seen an age at which the full ADHD evaluations are routinely done. I took my son to a neurologist today and they told me that he is severely ADHD (which we already knew). I said I wanted to do a full evaluation on him, but they said we really should wait another year. Can you tell us why we might need to wait a year? Thank you in advance for your time.” (details deleted to protect confidentiality)
Thanks for the compliments on the website. Lots of hard work went into it and it is nice to hear it is appreciated.
Great question! The reason many people tend to put off full evaluations until a child reaches kindergarten or first grade is that there are a wider variety of tests at later ages. Often, if the child is clearly so hyperactive that any testing is likely to be a gross underestimate of skills, it can be appropriate to wait till the child is on medication to test. The younger the child the fewer skills generally that can be assessed. At the youngest ages of many tests, children need to get fewer items correct to obtain a adequate score. Since the number of items is related to statistical reliability, testing very young children, especially those whose performance may also be impaired by inattention or hyperactivity (even with medication ) means such tests must often be considered cautiously. However, that does not mean that there are not good tests at young ages, or there are not very good reasons for doing them (such as concerns about general level of intelligence, sensory-motor integration difficulties, or language and communication disorders).
What different providers mean by a "full assessment" of attention-deficit hyperactivity disorder likely varies a great deal by settings. Unfortunately, financial resources , insurance plan limits, and managed care often restrict what can be done. There often is a mentality of only testing for what you are looking for.
Good assessment of ADHD not only means figuring out the child is hyperactive and has difficulty staying on task more than other children their age. The issues of whether attention problems are primarily auditory or visual may have some implications for teaching styles. Due to concerns about co-existing disorders, ruling out fine motor difficulties and learning difficulties can be very important, because if these exist, early remediation can be critical. Making sure there isn't an underlying language disorder can also be important. So, aside from risks for misdiagnosis, early assessment can help identify areas to target for intervention. Since ADHD children find school work more frustrating than other children, an ounce of prevention or early intervention is much better than attempting remediation when they fall behind and subsequently develop even more resistance to working in areas of weakness.
For a general discussion on the assessment of ADHD try this page.
For more on the assessment of ADHD see our ADHDASSESSMENT.COM website
For more on therapy for ADHD try our ADHD-THERAPY.COM websit
Hope that helps,
Ernest J. Bordini, Ph.D.