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When your child is experiencing difficulties that suggest that he or she may have AD/HD, you as a parent can take one of two basic paths to evaluation. You can seek the services of an outside professional or clinic, or you can request that your local school district conduct an evaluation.

In pursuing a private evaluation or in selecting a professional to perform an assessment for AD/HD, you should consider the clinician's training and experience with the disorder, as well as his or her availability to coordinate the various treatment approaches. Most AD/HD parent support groups know clinicians trained to evaluate and treat children with AD/HD. You may also ask your child's pediatrician, a community mental health center, a university mental health clinic, or a hospital child evaluation unit.

It is important for you to realize, however, that the schools have an affirmative obligation to evaluate a child (aged 3 through 21) if school personnel suspect that the child might have AD/HD or any other disability that is adversely affecting educational performance. (That means the child must be having difficulties in school. Those difficulties include social, emotional, and behavioral problems, not just academic troubles.) (See below if your child is under three years old.) This evaluation is provided free of charge to families and must, by law, involve more than one standardized test or procedure.

Thus, if you suspect that your child has an attentional or hyperactivity problem, or know for certain that your child has AD/HD, and his or her educational performance appears to be adversely affected, you should first request that the school system evaluate your child. Be sure to put your request in writing. Your letter should include the date, your name, your child's name, and the reason(s) you are requesting an evaluation. The letter should state the type of educational difficulties your child is experiencing. Keep a copy of the letter in your file.

But My Child is a Toddler . . .

If your child is under three years old, and you suspect that AD/HD may be affecting his or her development, you may want to investigate what early intervention services are available in your state through the Part C program of the Individuals with Disabilities Education Act (IDEA).

Since AD/HD is a developmental disorder, diagnosing young children requires some special consideration. For instance, toddlers don't pay attention for long periods of time, so a clinician wouldn't necessarily find inattention in a toddler a symptom of AD/HD. Also, toddlers are more easily frustrated and do shift activities a lot. It's important that the person doing the diagnosis be very familiar with normal child development in order to determine what behaviors would be inappropriate for that age.

You can find out about the availability of early intervention services in your state by contacting the state agency responsible for administering early intervention services, by asking your pediatrician, or by contacting the nursery or child care department in your local hospital.

Preschoolers (children aged 3 through 5) may be eligible for services under Part B of the Individuals with Disabilities Education Act (IDEA). If your child is a preschooler, you may wish to contact the State Department of Education or local school district, ask your pediatrician, or talk with local day care providers about how to have your child assessed through your school district's special education department.

Also, under Head Start regulations, AD/HD is considered a chronic or acute health impairment entitling the child to special education services when the child's inattention, hyperactivity, and impulsivity are developmentally inappropriate, chronic, and displayed in multiple settings, and when the AD/HD severely affects performance in normal developmental tasks (for example, in planning and completing activities or following simple directions).

If your child is school-aged (six or older), and you suspect that AD/HD may be adversely affecting his or her educational performance, you can ask your local school district to conduct an evaluation. With the exception of the physical examination, the assessment can be conducted by school personnel as long as a member of the evaluation group is knowledgeable about assessing AD/HD. If not, the district may need to use an outside professional consultant trained in AD/HD assessment. This person must know what to look for during child observation, be competent to conduct structured interviews with parents, teacher(s), and child, and know how to administer and interpret behavior rating scales.

Identifying where to go and whom to contact in order to request an evaluation is just the first step. Unfortunately, many parents experience difficulty in the next step-getting the school system to agree to evaluate their child. In the past, some schools have not understood their obligations to serve children who, because of their AD/HD, are in need of special education and related services. In 1999, AD/HD was specifically listed in the federal regulations of IDEA under the disability category of "other health impairment." The inclusion of AD/HD in this disability category should help to clarify the school's obligation to evaluate children who are suspected of having AD/HD that is adversely affecting educational performance.

However, if the school district does not believe that your child's educational performance is being adversely affected, it may refuse to evaluate your child. In this case, there are a number of actions you can take, including pursuing a private evaluation. It is also important to persist with the school, enlisting the assistance of an advocate, if necessary. You can generally find this type of assistance by contacting the Parent Training and Information (PTI) center for your state, the Protection and Advocacy (P&A) agency, or a local parent group. A school district's refusal to evaluate a child suspected of having AD/HD involves issues that must be addressed on an individual basis. Your state's PTI, P&A, or a local parent group will typically be able to provide information on a parent's legal rights, give specific suggestions on how to proceed, and in many cases offer direct assistance. You may also use a special education attorney.

For children who are evaluated by the school system, eligibility for special education and related services will be based upon evaluation results and the specific policies of the state. Many parents have found this to be a problematic area as well. Therefore, eligibility for special education services-and the services themselves-will be discussed in greater detail in Section III of this Briefing Paper.

For the moment, however, let us look at what we know about managing AD/HD and the specific difficulties associated with the disorder.