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Areas › Focus, starting, and ADHD › Getting assessed and diagnosed
Go back over a handful of old cases rather than only reading about it. Where a child made less progress than you expected, ask what you never assessed. This is not an exercise in guilt. Training routes separate psychiatric from developmental and learning conditions, then send people out to see children who arrive with both.
'Lord, increase me in knowledge' (Quran 20:114). The prayer is put in the mouth of the Prophet himself, so no one is above asking it.
طه
فَتَعَٰلَى ٱللَّهُ ٱلۡمَلِكُ ٱلۡحَقُّۗ وَلَا تَعۡجَلۡ بِٱلۡقُرۡءَانِ مِن قَبۡلِ أَن يُقۡضَىٰٓ إِلَيۡكَ وَحۡيُهُۥۖ وَقُل رَّبِّ زِدۡنِي عِلۡمࣰ ا
exalted be God, the one who is truly in control. [Prophet], do not rush to recite before the revelation is fully complete but say, ‘Lord, increase me in knowledge!’
Qur’an 20:114read it in the library
Translation: M.A.S. Abdel Haleem, The Qur'an, Oxford University Press, 2004.
Missing what you were not trained to see is a documented pattern. A review of adults arriving at services with other psychiatric problems found unrecognised ADHD underneath fairly often, partly through overlapping symptoms and partly through limited insight. It is a narrative review about adult ADHD rather than about training gaps, and it describes the same shape: what nobody is looking for stays unfound.
Barkley RA, Brown TE. (2008). Unrecognized attention-deficit/hyperactivity disorder in adults presenting with other psychiatric disorders.. CNS spectrums doi
Strength of evidence: one line of research. A single study, or a theoretical account.
You cannot notice a category you were never taught to look for.
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.
When someone says their heart races on their medication, ask whether it ever did before they started. It is the cheapest question you have and it usually sorts the answer out.
Carry the rough proportions into every ADHD assessment. Executive function difficulty in the great majority, coordination difficulty in around half, dyslexia in something like a quarter to two fifths. A workup that never asks about handwriting, sport or reading is not finished.