ebook_ADHD2019

The World Federation of ADHD Guide 57 sense, auditive and visual assessment should be initial steps of any assessment for ADHD. In addition, the sleep pattern should also be investigated. Although sleep problems and disorders are frequent associated features or comorbid conditions in ADHD, sometimes an inadequate sleep quality might itself generate pronounced inattentive symptoms during the day. Other medical conditions like hyperthyroi- dism should also be excluded. Baseline measures for growth (height, weight) and cardiovascular parameters should be taken, especially when medication treatment is being considered. Referral for genetic examination is recommended if there is a clear developmental delay and/or in case a suggestive phenotype is identified (e.g., fragile X syndrome). As mentioned above, almost all mental disorders that can co-occur with ADHD need also to be considered in the differential diagnosis, since they can also result in inattentive and/or hyperactive/ impulsive symptoms. In the process of conducting a careful differential diagnosis, some clinical tips might be relevant: a Consider the age of onset of every disorder – ADHD starts in childhood or adolescence, while most other disorders start later. Exceptions might be ODD and sleep problems. b Assess the trajectory of symptoms – although ADHD symptoms might su- ffer the impact of the demands of environment not being always flat along development, the disorder has a more chronic trait-like course. Thus, strong swings of symptoms might suggest other disorders like bipolar disorder whe- re, besides the core manic symptoms, hyperactivity, impulsivity and irritabili- ty are episodic. The same applies for ADHD symptoms only associated with depressive symptoms during a major depressive episode. c Disentangle if the ADHD symptoms are not only intrinsically related to symptoms of another mental disorder (e.g., inattention only as a consequen- ce of dysfunctional thoughts/rumination related to performance as in GAD, or mental rituals of counting as in OCD; inattention and executive deficits following abuse or dependence of marijuana without any previous history of ADHD symptoms). SUMMARIZING THE FLOW OF THE ASSESSMENT PROCEDURES In essence, as ADHD is a clinical diagnosis, the assessment will rely in a careful standard clinical interview including all its elements (e.g., chief complaint, current and past symptoms, daily-life, medical history, family history, comprehensive psy- chopathological review of symptoms, individual strengths). As mentioned above, the final diagnosis will rely on an integrated clinical judgment based on the sum of the information received from different sources from which history was collec- ted (e.g., patient, parents, teachers, significant others) after any disagreements