Your child fidgets, drifts off, never finishes what they start. The school has raised it. You're wondering whether to see someone, or you already have and you came home with a diagnosis: ADHD.
What does it mean? What does it cover? And above all, does it answer the question every parent asks: why isn't my child like the others?
Here is how it works.
A diagnosis based on a questionnaire
You'll be handed a questionnaire. Depending on the practitioner and where you live, it will be a Conners, a SNAP-IV or an ADHD-RS. You fill it in at home, alone or with the other parent, but never with the child. The teacher fills in one of their own, because the symptoms have to show up in at least two settings to count.
Over a series of questions, it asks whether your child can concentrate or not, and whether they are restless or not. Other questions may touch on defiance towards adults, rule-breaking, anxiety, mood. Note that only the first category counts towards the diagnosis.
For each question you answer never, sometimes, often, very often. When both parents sit down to it, they often disagree. That is the first flaw in the tool, and there are others. Your answers are also shaped by your mood that day and by how you feel about the questions themselves (guilt, denial, and so on). On the teacher's side, beyond their mood that day, the opinion they hold of your child colours their answers too.
What the doctor does with it
They add up your answers and the teacher's. They note what your child cannot do, based on what was ticked. If the score crosses a threshold and the difficulties genuinely weigh on the child's life, they make the diagnosis. Then they assess and decide on treatment.
So there is no blood test, no imaging, no biological marker. None exists.
In short
You ticked "my child often can't concentrate", and the doctor replies: indeed, they often can't, so they have ADHD.
Circularity
Circularity is simple: your answer is the answer.
Why does your child squirm on their chair? Because they have ADHD. And how do we know they have ADHD? Because they squirm on their chair. Repeated across fifteen or so questions.
This raises three problems.
Nothing establishes the cause. No question separates the child who sleeps badly from the one who doesn't hear well, or the one whose attachment system is on alert. Whatever the cause, the result is the same.
Nothing new in the predictions. You'll be told the score predicts school failure. But if you ticked that they don't listen, don't finish and don't follow instructions, you didn't need a questionnaire to know that.
And the word ADHD feels like an answer, as if there were nothing left to look for. Good, now we know what they've got!
What the word diagnosis means to most of us
When a doctor gives a diagnosis, you hear four things at once. We know what your child has. We know where it comes from. We know how to treat the cause. We know how it will develop.
That is what we understand, because to us, diagnosis means illness.
A question of aetiology
In medicine, a diagnosis unfolds in three stages.
First, here are the symptoms, here is what we observe: the syndromic, or clinical, diagnosis. Then we look for where it comes from: the aetiological diagnosis. Finally we measure the impact on the person's life: we assess severity.
For ADHD, we have the first and the third. Not the second, which is the one people expect.
When medicine doesn't understand, it has a word for that: idiopathic. So ADHD would belong among the idiopathic illnesses. Except that here the word isn't used, because ADHD is not an illness. It is a disorder. Attention deficit disorder, with or without hyperactivity. Hence the acronym.
In other words, medicine makes an observation based on your own observation, and attaches an acronym to it.
The differential diagnosis
Many things produce exactly the same clinical picture (syndromic, to be precise). Hearing loss. Sleep apnoea. Dyslexia. Anxiety, stress. Sensory processing difficulties. Iron deficiency. A bright child who is bored. Insecure attachment.
When the cause hasn't been established, you should proceed by elimination; that is called the differential diagnosis. Every other cause that could explain why your child can't concentrate or sits still should be measured and then ruled out. Except that this is the part that is often forgotten, or simply not done.
For instance, was an iron test done alongside your questionnaire answers? Did an occupational therapist draw up a sensory profile?
Your child has a diagnosis, but nobody has looked at what lies behind it?
Hearing, sleep, sensory profile, attention: a first appointment at the Activate Centre goes through what hasn't been measured yet.
The fever analogy
Let's try an analogy. Imagine we assessed fever with a questionnaire. Does your child feel hot? Do they seem more tired than usual? Are they complaining? And so on.
If you answer yes, the doctor can make an observation: yes indeed, they have a fever, and give it a diagnosis we might call HTS. High temperature syndrome. Then they'd write you a prescription for paracetamol. All without ever reaching for a thermometer.
The ADHD diagnosis is the same thing. An observation based on your observations, no measuring instrument, an acronym, a drug.
Which leaves, once again, the question of why. Why can't my child concentrate, why are they restless?
At the Activate Centre
At the Activate Centre, that is the question we try to answer. We don't know how to treat ADHD; nobody does, since nobody knows what it is. What we do know how to do is measure and work on attention, concentration, the sensory profile, emotional regulation and the relationship with others. That is what our children's ADHD programme is about.
And the result, to stay with the analogy: with us, the fever comes down, and stays down. Without medication.
That is what we see in around 80% of the children who have completed a course of rehabilitation, based on an assessment questionnaire filled in before and after.