Developing a History of Behavior
Your physician will probably begin his analysis with a diagnostic review during which he will gather information about your developmental history, health history, school history, employment history, social history, childhood and present behavior patterns, alcohol and drug history, and psychiatric history. He will also conduct a complete medical interview to rule out other medical conditions to which ADHD may be secondary or whose symptoms may mask or mimic adult ADHD.
Since adult ADHD often includes neuropsychological problems, he may also administer or prescribe tests that measure attention, memory, intellectual functioning, and academic achievement. Test scores, as well as your response to taking tests, can help determine if your symptoms demonstrate ADHD.
Your physician will also conduct clinical interviews with you, your parents, teachers, and friends who knew you as a child to find out more about your behavior then. As you might imagine, trying to remember specific details of your behavior more than 20, 30, or even 40 years ago can be daunting.
In addition, studies have cast doubt on the validity of using personal memories to establish a backward diagnosis of adult ADHD, claiming many childhood memories are too inaccurate or subjective to be clinically relevant.
In fact, a growing number of adult ADHD experts are pushing for the creation and adoption of new adult criteria that would advance the onset of ADHD from age seven to between the ages of 16 to 18. New criteria would also place much less importance on childhood memories in establishing a diagnosis. But until ADHD diagnostic criteria are reviewed and possibly revised in 2012, patients and experts alike are hampered by the current guidelines.
A medical expert needs to be a great detective to assemble a valuable history of behavior. She must know enough about childhood and adult ADHD to ask relevant questions, gather and interpret a wide range of data, and weigh recollections against objective facts.
Parents and Teacher Interviews
Although teachers are often the first to suggest that a child has ADHD, parents are usually the first to suspect a child has a problem.
Unfortunately, studies show that recollections from parents and teachers regarding the childhood behavior of an adult are usually much less accurate than memories provided by patients.
Because ADHD has a strong genetic component, a history of ADHD in the immediate or extended family may be useful in determining the childhood status of an adult patient.
As an adopted child, Ruth always suspected something was wrong, but she had no family medical history to reference. After tracking down and meeting her biological family, the 47-year-old learned that her biological parents and her three biological siblings had ADHD. In fact, all three siblings had suffered experiences similar to hers in college, and had “fallen apart and dropped out.”
Parents of children with ADHD are 24 times as likely to suffer from the disorder themselves as are parents of children without the disorder, according to a study in the Journal of the American Academy of Child & Adolescent Psychiatry.
Parents whose children had both ADHD and oppositional defiant disorder or conduct disorder were found more likely to have mood, anxiety, and substance abuse issues than other parents. Living with kids who have ADHD can also exacerbate a parent's own problems, and vice versa.