Once reasonable and extensive interventions have been attempted for a child with learning concerns, it may ultimately be necessary for parents to pursue a private ADHD evaluation. As earlier described, a family pediatrician may be the best source to inquire about an ADHD evaluation. On occasion, the family pediatrician may refer the evaluation out to a community mental health professional. Perhaps less frequently, pediatric practices establish a working relationship with a community mental health professional to complete ADHD evaluations in house. As a child psychologist, I have enjoyed a fifteen year relationship with a large pediatric practice in my community. Once the treating pediatrician has completed the medical screen, I will complete the remainder of the ADHD evaluation for the referred child. I will gather all relevant information about a referred ADHD child prior to the first contact. My information gathering includes a background family history data form completed by the parents, rating scales and child behavior checklists completed by parents and classroom teacher, a physical screen completed by the pediatrician evaluating for medical concerns, and an individual phone contact with the classroom teacher to discuss the identified students classroom performance. This data will be progressively assembled on an evaluative form and reviewed in detail prior to the first contact with the referred child. An appointment will then be arranged for the parents to bring in the child for the first evaluative meeting. My first introduction with the family and referred child occur in the waiting room. Here I will draw critical first impressions of the referred child in regards to behavior, activity level, social comfort, and compliance with parent directives. The evaluation begins once the parents and referred child have been escorted to the inner office observation room. In the small confines of this room, it is critical to observe the childs behavior, activity level, play interests, engagement with adults, conversation, and contribution to the information gathering process. Child behavior in this situation can range between over-active self absorbed play to self-controlled seated behavior. Generally, children who are disinterested in the adult conversation and information gathering will appear and feel quite uncomfortable during this 30-40 minute period of time. Children struggling with excess activity level and stimulation seeking behavior will begin to complain to parents about boredom, hunger, or fatigue by no later than twenty minutes into the hour. Informal observations of the childs behavior will continue as I interview parents on pregnancy and birth history, developmental course, medical history, and family genetic history. A notable portion of time will also be spent discussing home behavior as well as school functioning and academic performance. Both parents have equal opportunity to present and discuss their personal perspectives on the main concerns described for the child. This evaluative interview will routinely extend two thirds into the hour at which point the parents are excused to the waiting room to allow the individual child interview to begin. Reassurances are immediately offered to the referred child as soon as the parents have left the observation room. A brief description of the individual interview structure tends to allow the child some comfort. Children generally will turn more relaxed as soon as I begin with my structured interview questions. This structured interview is comprised of basic questions regarding friendships, classroom performance and behavior, time spent with each parent, fantasy wish questions, and sentence completion items. The content of the interview questions tends to change rapidly enough to maintain the childs interest over the 20 minute individual evaluation. Children often appreciate this individual interview due to the personal attention and interest they receive. The individual child interview also reveals critical insight into the childs ability to listen, sustain attention, respond to questions, organize and sequence ideas, use efficient language to describe their thoughts, demonstrate reciprocal conversation skills, and demonstrate controlled activity level. The rapid pace of questions and changing content is easily managed even by the most hyperactive of children. Despite the ease of the interview, most children appear relieved when finally told they have completed the interview successfully. The ADHD evaluative session is completed once the child has been returned to the waiting room. The parents are encouraged to immediately re-schedule a return visit in order to hear the results of the ADHD evaluation. Parents are discouraged from returning with the identified child for this final meeting to review diagnostic impressions and recommendations. However, I will normally invite the referred child to return with the parents to hear the evaluative outcome if the are twelve years or older. It is my wish to make pre-teens feel included in the final outcome of the ADHD evaluation. A written ADHD evaluative report is constructed within hours of the childs departure. I find my clinical judgment and insight to be optimal immediately following the evaluative contact with child and parents. Additional copies of the evaluative report are made available to the parents when they return for the interpretation of the ADHD evaluation. |
