Loading practices
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Areas › Focus, starting, and ADHD › Getting assessed and diagnosed
Plenty of families never went near a clinic. Help was not trusted, or the answer at home was to stop complaining and get on with it, so the difficulty stayed and the diagnosis never happened. When you ask the wondering question, leave room for people to be tentative about it. 'My mother could never finish anything' is information, even with no letter behind it.
'We know what his soul whispers to him' (Quran 50:16). A relative who was never assessed was never unseen either; it was only the record that did not exist.
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وَلَقَدۡ خَلَقۡنَا ٱلۡإِنسَٰنَ وَنَعۡلَمُ مَا تُوَسۡوِسُ بِهِۦ نَفۡسُهُۥۖ وَنَحۡنُ أَقۡرَبُ إِلَيۡهِ مِنۡ حَبۡلِ ٱلۡوَرِيدِ
We created man––We know what his soul whispers to him: We are closer to him than his jugular vein––
Qur’an 50:16read it in the library
Translation: M.A.S. Abdel Haleem, The Qur'an, Oxford University Press, 2004.
Two lines of evidence say much the same thing. A review of systematic reviews put community prevalence of ADHD in children at roughly two to seven per cent, with a further five per cent sitting just under the diagnostic threshold, well above what services actually record. A research review on girls and women with ADHD describes systematic underdiagnosis, with referral habits and diagnostic conventions among the reasons they were passed over. So the undiagnosed relatives are not a rounding error.
Sayal K, Prasad V, Daley D, Ford T, Coghill D. (2018). ADHD in children and young people: prevalence, care pathways, and service provision.. The lancet. Psychiatry doi
Hinshaw SP, Nguyen PT, O'Grady SM, Rosenthal EA. (2022). Annual Research Review: Attention-deficit/hyperactivity disorder in girls and women: underrepresentation, longitudinal processes, and key directions.. Journal of child psychology and psychiatry, and allied disciplines doi
Strength of evidence: one line of research. A single study, or a theoretical account.
Counting only the diagnosed relatives counts only the ones who reached a service.
Before you decide a strategy has failed, check whether the medication underneath it is doing its job. If someone is sitting in front of you still struggling, the honest first answer is usually that it is not, quite.
While you are taking the family history, ask about seizure disorders and psychosis too, not only about attention. A family carrying other neurological or psychiatric conditions is worth knowing about whatever you end up concluding.
Hyperactivity and impulsiveness almost never turn up alone. When restlessness appears with no attention difficulty beside it, that is a reason to ask what else might be going on.