ADD: The Medical Evaluation

The medical examination consists of three major components: (1) the medical interview, (2) the physical examination, and (3) laboratory tests. The medical interview will allow the physician to see if there are other medical conditions that may seem like ADD and/or disorders that occur simultaneously (comorbid). Also, if medication is indicated, it is very important to determine if the child has any medical condition that would interfere with the specific medication.

The multidisciplinary evaluation is best done at a university-based medical facility or a teaching hospital. Many hospitals have established clinics that provide this kind of thorough evaluation. If this is not available to you or if you prefer to work with an individual practitioner, you should ask your physician the following questions:

• What does the evaluation include?
• How much experience do you have with children or adolescents with ADD?
• Will you consult with other professionals before a diagnosis is made?
• If medication is prescribed, how will you monitor the effectiveness?
• Will you consult with teachers to measure the effectiveness of the intervention?

Unless you are satisfied with the answers, you are better off finding another physician. You want to make sure that all members of the multidisciplinary evaluation team work for the benefit of you and your child. The medical evaluation is critical in the diagnosis of ADD. Your assertiveness before you begin the process will insure that it will be a thorough evaluation.

After a thorough medical interview, a physical exam is undertaken. Basic information such as height, weight, and head size are obtained and compared to groups of children at the same age. Hearing and vision screenings are done. If a hearing disorder is suspected, parents will be referred to an audiologist, a professional trained in the evaluation of hearing, and/or a physician who specializes in ear-nose-and-throat disorders, also referred to as an ENT or otolaryngologist. If visual problems are present, parents will be referred to an optometrist, a person who measures vision, or an ophthalmologist, an M.D. who specializes in the eyes. Blood tests will be performed and any problems will require additional evaluation.

The neurological exam will look at central nervous system functioning. If any problems are found, more extensive testing will be undertaken. During this exam the physician will also be evaluating the child's speech and language, thinking skills, and coordination, and other motor functioning (for example, catching a ball, hopping, jumping, skipping). Once again, any problems are followed up with more thorough evaluations.

The final part of the medical evaluation is the laboratory tests. There is no test now available that will diagnose ADD. Laboratory tests such as electroencephalograms (EEGs), magnetic resonance imaging (MRI), computerized axial tomograms (CT Scans), blood work, urinalysis, and chromosome studies are not routine parts of the evaluation. These should be used only if there is some indication of a specific, treatable medical disorder, such as a seizure disorder. If these are recommended, be sure to ask the physician why. If you are not pleased with her answer, seek a second opinion.

The medical evaluation is a critical part of the multidisciplinary evaluation. It can rule out the presence of other medical conditions and/or mental health disorders. And it will provide valuable information for other members of the team about the appropriateness of medication.