It is unfortunate that the majority of recent publicity about AD/HD, in the UK, has focused almost entirely upon examples of bad practice: short and inadequate assessment procedures, the use of medication in the absence of other forms of support, the use of medication with very young children, the failure of private clinics to liaise with schools, etc. While I am not disparaging the importance of these issues, I was concerned at a recent training day to find a group of professionals so concerned with bad practice that they were unreceptive to talking about good practice.

Good practice regarding the treatment of AD/HD depends upon the initial diagnosis being correct, and for the following reasons AD/HD is not an easy disorder to identify. Firstly, a child can be inattentive, impulsive and hyperactive for many reasons other than AD/HD. Secondly, AD/HD is a continuum disorder, which is to say that we all suffer from the defining symptoms to some extent, and it is only when those symptoms persist over time and across situations in a severe form that an AD/HD diagnosis is appropriate. Thirdly, many children who suffer from AD/HD also suffer from other childhood disorders, all of which interact upon one another. Lastly, AD/HD itself can lead to secondary problems which are more damaging than the initial problems.

We cannot X-ray a child to find out if s/he is AD/HD, and even if we could this would only provide a starting point. The purpose of a psychological assessment is to establish what problems a child is experiencing and generating, and how these can be alleviated. A child's problems exist within the context of his/her home and school, and it is inevitable that some families and teachers will cope better than others with an AD/HD child. Furthermore, it is perhaps wrong of us to use the term "AD/HD child", as this describes only one part of the whole child. Some of the children I see have excellent social skills, while others have problems relating to adults or peers. Some are articulate, while others have problems with speech and/or language. Every human is an individual, and the term "AD/HD child" can be misleading in terms of differential diagnosis and treatment.

As a result, the assessment of childhood problems is often a complex, lengthy, multi-professional process, and one which should be properly explained to parents. Where parents understand the nature of an assessment, it will follow that they understand the diagnosis and the recommendations that follow. It is hoped that the following "good-practice guidelines" will help parents in this process.

The psychologist who assesses your child will not start from the premise that his or her problems are due to AD/HD. S/he will want to gather as much information as possible, and then "identify and define symptoms and problems which differentiate the target child from those in a similar population", i.e. from his/her peers (Goldstein, 1994). As Goldstein points out, this means that a specialist clinic will not differ, in principle, from a general clinic. The psychologist will want to learn as much as possible about the child's behaviour, and any preconceptions would only cloud his/her judgement. However convinced parents feel that their child is AD/HD, they should approach a psychologist with a careful and accurate description of the child's behaviours rather than a diagnosis.

As an Educational Psychologist I am committed to the principle of observing a child at home and at school. As noted above, problems do not exist in a vacuum, and it is important to see how "within child" factors interact with the environment. Questionnaires and rating scales can assist this process, and if it is difficult to observe the child directly the psychologist may depend upon this information. I use the Achenbach parent, teacher and child questionnaires. Results are computer analysed on 8 scales, and the 3 forms are compared to see how well they correlate. I also use the ACTeRS questionnaire, which differentiates between hyperactivity and attention problems. In addition, many psychologists use a comprehensive developmental history form (I have designed my own, as there was no British version available, and this is an up-dated version of the one I originally designed for my work at the Learning Assessment Centre in West Sussex). A developmental history form is an efficient way of gathering important information about the child and family prior to meeting. I often ask teachers to compare the referred child to his/her peers using a simple observation schedule such as the TOAD (an acronym for "Talking", "Out of Seat", "Attention" and "Disruption").

It is essential that the meeting between psychologist, parent and child should be non-judgmental. The aim is to identify and solve the child's problems, and all concerned will need to work in close co-operation if this process is to be successful. Part of the problem-solving is to see how parents and children relate to one another, remembering that the interaction between parents and child is complex and two-way: thus bad parenting can lead to childhood problems, and a difficult child can cause parents to lose their confidence and thus become less able in managing the child. This downward spiral of events can place tremendous stress upon a family, which is exacerbated by the fact that parents almost invariably blame themselves for their children's problems. Learning that the boot can be on the other foot can relieve guilt and anger, and set the scene to move forward. I frequently marvel at how well parents cope with immensely demanding children, and feel saddened that they have received criticism rather than support. The psychologist should be providing this support: educating parents and teachers regarding the management of AD/HD, offering on-going advice and acting as an advocate for the child and family.