What is the diagnosis process for ADHD?

A physician or mental health professional performs a series of extensive evaluations to diagnose attention deficit hyperactivity disorder (ADHD). Often, a doctor will start with a physical exam to rule out any medical conditions that may be causing ADHD symptoms.

Then, different aspects of the person's life will be evaluated. The practitioner will review the person's behaviors, emotions, moods, and performance at school or at work. Significant people in the patient's life will be interviewed about the person's personality and life experiences. This helps the doctor or treating specialist gain insight into how others view the person and how pervasive the person's symptoms are.

The doctor may request that the person complete achievement and intelligence tests, and the person may be observed in a variety of settings.

Diagnosing children with ADHD
Children from minority groups tend to be underdiagnosed and undertreated for attention deficit hyperactivity disorder (ADHD). Children from different ethnic groups, including white, black, and Latino, are diagnosed with ADHD at similar rates. 

Here is the breakdown of children diagnosed with ADHD, according to a 2007 study by the Centers for Disease Control and Prevention:

• 7.6% of white children
• 7.4% of black/African American children
• 5.1% of Hispanic/Latino children

According to the National Resource Center on ADHD, these numbers may show the percentage of children diagnosed with ADHD, but they do not reflect the actual numbers of children who need treatment for ADHD. Currently, African American children tend to be referred for ADHD diagnosis and treatment three times less often than white children. Children from ethnic minority backgrounds are also less likely to receive medications for ADHD than whites. 

Cultural differences may affect these statistics, including the fact that some minority groups are less likely to seek mental health treatment for any reason, including ADHD.

Attention deficit hyperactivity disorder (ADHD) is often diagnosed by a doctor using established guidelines after consideration of long-term symptoms of inattention, hyperactivity, and impulsiveness. Be prepared to answer questions about such symptoms. A medical examination probably will be required to eliminate other possible causes of symptoms.

Learn how to identify ADHD in this video from Discovery Health.

Most cases are diagnosed by a pediatrician, but there’s no single test for the disorder. The diagnosis is made after a complete physical exam, an extensive medical history, and a long talk with your doctor about what you’ve been noticing at home. And that’s not all. Next, your doctor will talk to your child’s teachers (and a school psychologist, if there is one) and ask them to make observations and fill out questionnaires and rating scales. (Many teachers are achingly familiar with this drill.) That information gathering will help evaluate possible coexisting concerns, such as a learning disability, depression, or an anxiety disorder.

From The Smart Parent's Guide: Getting Your Kids Through Checkups, Illnesses, and Accidents by Jennifer Trachtenberg.

Although attention deficit/hyperactivity disorder (ADHD) is difficult to convincingly and precisely diagnose in the preschool years, evaluation and associated intervention can dramatically improve the prognosis of the behaviors of concern. You should start with an evaluation by your primary care health provider. There needs to be a diagnostic formulation, and this may require further evaluation by a subspecialist such as a developmental-behavioral pediatrician, pediatric neurologist, pediatric psychologist, or child psychiatrist. (Notice the word pediatric or child is in the title of each of these because not all specialists have experience with children in this age group.)

ADHD more frequently than not coexists with other disorders such as anxiety disorder, disruptive behavior disorders, and learning disorders.

To make sure your child has gotten a thorough evaluation at the minimum, both you and your child should be interviewed to rule out other possible alternative diagnoses. In my practice, I tell parents I will not give a diagnosis before three full sessions of evaluation. Additionally, both parents and teachers should fill out forms that help to quantify the severity of symptoms to make sure they are severe enough to indicate an impairment in functioning. Most kids have some of the symptoms some of the time, but a diagnosis requires that a child’s functioning be impaired in two different settings—usually both home and school. While that is the minimum standard for making a diagnosis, ideally your child could additionally get a more thorough neuropsychological evaluation that would directly measure attention and other relevant processes.

However, if you are concerned about the accuracy of a diagnosis, I recommend that the child or the family receive 12 sessions of standard therapy BEFORE an evaluation. The reason for this, is that if there are stressors and conflicts in the family, you have a chance to solve these problems and build your child’s emotional intelligence which will reduce disruptive behavior and attention deficits.

Before considering that your child has a brain disorder you may want to rule out all other possible and more likely explanations including sleep, diet, skill level, and family stress or conflict. It is possible that a course of therapy that increases your child’s emotional intelligence would improve his behavior and attention so that by the end of treatment you wouldn’t even need an evaluation. And the “side effects” of increased emotional intelligence include improved social and emotional functioning for the rest of his life!

Diagnosis of ADHD by DSM-IV criteria require that symptoms criteria must be present in at least two settings (home and school), and present before age 7. Diagnosis of attention deficit requires at least 6 of the 9 possible symptoms. Diagnosis of the hyperactivity-impulsivity type requires at least 6 of the 9 symptoms.

Specific symptoms of inattention are:

• Dose not pay attention to detail
• Has difficulty sustaining attention at school
• Dose not seem to listen when spoken to
• Does not follow through on instructions or finish task
• Has difficulty organizing task
• Avoids, dislikes, or is reluctant to engage in tasks that requires sustained mental effort
• Often losses things
• Is easily distracted
• Is forgetful

Specific symptoms of hyperactivities are:

• Often fidgets with hands or feet or squirms
• Often leaves seat in class room or elsewhere
• Often runs about or climbs excessively
• Has difficulty playing quietly
• Often on the g, acting as if driven by motor
• Often talks excessively

Specific symptoms of Impulsivity:

• Often blurts out answers before question are completed
• Often has difficulty awaiting turn
• Often interrupts and intrudes on others

ADHD is diagnosed using diagnostic testing, like Vanderbilt scoring scales. Symptoms must be present by a certain age, exist in more than one setting, and affect quality of life. For instance, a child who fits criteria for ADHD at home, but not at school will not likely be diagnosed with ADHD. In addition, your pediatrician will want to rule out other medical reasons. Something as simple as poor sleep hygiene or poor sleep quality may masquerade as ADHD.

There's no blood test or brain scan to find out if you have attention deficit hyperactivity disorder (ADHD). Doctors diagnose ADHD the same way they diagnose a lot of other conditions: by gathering different kinds of information and comparing it to an accepted medical definition. The tools they use are described below:

Questionnaires. There are several standard questionnaires (forms) used to check for ADHD and other mental health problems. The questionnaires ask about symptoms in different settings. They also ask about stress levels and coping styles. For a school-aged child, questionnaires will also be used to gather information about the child's classroom behavior and academic performance.

Medical history. The doctor asks about past and present illnesses, personality and development, and family history.

Physical exam. A thorough exam helps a doctor know if symptoms come from a condition other than ADHD. (Some conditions can also make ADHD worse.)

Guidelines for diagnosis. Using information from the sources described above, a doctor diagnoses ADHD if the following are true:

• The behaviors are not age appropriate.
• The symptoms generally were recognized by age 7.
• The symptoms interfere with performance in two or more settings—for example, at school, home, work, or in personal relationships.
• The symptoms have lasted 6 months or longer.

Attention deficit hyperactivity disorder (ADHD) can be difficult to diagnose, so it's important to pay attention to behaviors in your child, such as difficulty with focusing. Some of the symptoms of ADHD include distractibility, forgetfulness and disorganization. A child with ADHD is also likely to be impatient and loud. For an ADHD diagnosis, your child must show symptoms in at least two different settings, such as at home and school.

Part of the reason that it's difficult to diagnose ADHD is because the symptoms may overlap with other conditions. Since there's no one way of testing for it, a diagnosis is often made based on observations from teachers and parents. Typically the child with ADHD will have trouble in school, both in terms of behavior and school performance. If your child's teacher has expressed concerns, or if you have your own concerns, discuss them with your child's pediatrician.

Your child’s pediatrician may ask that you and your child's teacher complete a questionnaire specifically designed to detect ADHD symptoms. Based on the questionnaire, your child's pediatrician may recommend an evaluation by a pediatric therapist or psychiatrist. Getting a proper diagnosis is one of the first steps you can take to help your child succeed if he has ADHD.