In family practice, attention-deficit/hyperactivity disorder (ADHD) is a condition that is diagnosed and treated on a regular basis.  Often people express their opinion that it is overdiagnosed and overtreated.  On the other hand, medical literature indicates that it is more likely underdiagnosed and undertreated.    The disorder is a common one that affects about 8% of children.  For many, ADHD will persist into adulthood. 

In my office, each of our exam rooms has a mirror that is visible to patients when they are sitting on the exam table. The mirrors measure about 36 inches tall and are mounted on the wall.  While most children generally enjoy mirrors, I have noticed that some children will look into the mirror for much of the visit, often while making a variety of facial contortions.  Over time I began to realize that children with ADHD were significantly more likely to make faces in the mirror for much of the visit.

I now jokingly describe this as having a positive “mirror test.”  Over the past 2 decades, I have noticed that a child’s reaction to the mirror seems to be consistently correlated with having a formal diagnosis of ADHD with hyperactivity and impulsivity (made through clinical evaluation and neuropsychological testing).

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While the “mirror test” is not necessarily scientific evidence of the disorder, it has consistently demonstrated that children who playfully look in the mirror for long periods of time during their office visits are likely to have ADHD.  While my informal screening tool cannot be utilized diagnostically, it probably is a manifestation of the impaired executive functioning and impulse regulation (due to underlying neurobiological brain differences) that is so well documented in medical studies of the condition.

Neuropsychological evaluation involves extensive testing that, along with clinical evaluation, is considered the gold standard for diagnosing ADHD. It helps to identify areas of cognitive strengths and weaknesses and is a valuable tool for confirming the diagnosis.  The evaluation is also helpful in identifying comorbidities such as mood, anxiety, tic, or behavioral disorders, as well as learning disabilities.  Neuropsychological testing is often invaluable to obtain academic support and accommodations that children may need in the educational setting.

However, before beginning the process of formal evaluation, if you are looking for an informal screening tool based on anecdotal evidence, consider placing a mirror in a safe, accessible space in your exam room.  It may prove to be useful for identifying youth in need of initial screening with brief rating scales for ADHD in your practice.