ADHD

Evaluation and Diagnosis of ADD/ADHD

ADHD Diagnosis

The presence of attention-deficit/hyperactivity disorder (ADHD) cannot be identified by a physical test, like a blood test or an X-ray. Instead, a health professional uses an evaluation process to diagnose ADHD. During the evaluation, the clinician gathers information about you or your child to determine if the criteria for ADHD are met. The criteria come from the Diagnostic and Statistical Manual of Mental Disorders (DSM), which is the official diagnostic guide used in the United States.

What Happens During an ADHD Evaluation?

The evaluation process is detailed and can take even an experienced clinician a number of hours. This time is often spread over several appointments. This helps you to be mentally fresh for each appointment.

A large part of the evaluation is an in-depth interview with the patient. Here, the clinician will find out what problems you are currently facing. The clinician will also ask about your medical history, including physical and mental aspects.

Family medical history is also relevant, as is information about your birth and any issues your mother might have had during pregnancy. Developmental history, such as the age when you started to walk and talk and learn to read, will also be documented. If a child is being evaluated, a parent can usually answer these questions. As an adult, you might be able to get this information from your parents or records.

Some screening might be needed to rule out physical disorders like a thyroid disorder, kidney or liver disorder, or epilepsy. Eyesight and hearing tests might be requested, particularly if there are problems with reading.

Further screening for conditions you/your child might have in addition to the ADHD may be necessary. Examples of other conditions are learning disabilities, anxiety, depression, mood disorders, and autistic spectrum disorder.

Interviews with parents or a partner are often part of the evaluation, as they can provide supplementary information and insights. Questionnaires or interviews with other significant people, such as the teachers of a child or siblings of an adult, can also be helpful.

Intellectual screenings, measures of sustained attention and distractibility, and memory testing can all be part of the evaluation as well.

What Are the Criteria to Diagnose ADHD?

The DSM-5, published in May 2013, outlines the following criteria for professionals to use when assessing for ADHD. This diagnostic standard is valuable, as it means everyone is assessed in the same way no matter where they live or who is doing the evaluation.

1) Presentation of Symptoms
The DSM lists nine symptoms for inattentive ADHD, and nine symptoms for hyperactive/impulsive presentation (below, we include adaptations of each).

child needs to experience six or more symptoms from one of the below lists for six months or longer. 

person who is 17 years or older needs to experience five or more symptoms from one of the below lists for six months or longer.

Inattentive ADHD 

  • Frequently makes careless mistakes in schoolwork or work; paying attention to detail is difficult
  • Has problems keeping attention on tasks or fun activities
  • Does not appear to be listening when someone is speaking directly to them
  • Following through on instructions is difficult. Completing a task, homework, or chores from start to finish is rare because of loss of focus or getting distracted.
  • Has difficulty organizing tasks and activities
  • Tries to avoid tasks that require mental effort for extended periods, such as schoolwork or work projects
  • Loses belongings frequently
  • Very easily distracted
  • Forgetful in day-to day-activities

Hyperactive/Impulsive ADHD

  • Sitting still is very hard; usually fidgets and squirms in the seat or taps hands and feet
  • Frequently stands up and moves around rather than remaining seated, even when being seating is socially expected
  • Runs or climbs at inappropriate times; adolescents or adults might be less physical but feel internally restless.
  • Quietly participating in play or leisure activities is almost impossible. 
  • Often described as always ‘on the go’ or ‘driven by a motor’
  • Talks excessively
  • Will answer a question before the speaker has finished asking it
  • Has problems waiting for their turn
  • Frequently interrupts people who are speaking or engaged in an activity

2) The Symptoms of ADHD Have Been Present Since Childhood
There needs to be evidence that there were problems with attention and self-control before the age of 12 years. If you are an adult being tested for the first time, the clinician will be able to get this information from your old school records, your own memories, and information from interviews with your parents or siblings.  

3) The Symptoms Are Present in More Than One Setting
Are there significant problems with inattentive and/or hyperactivity impulsive symptoms in two or more important settings? This could be at home, in the classroom, on the playground, at school, at work, in the community, and in social settings.

4) The Symptoms Affect Performance
There is evidence that symptoms reduce your ability to perform to your full capability. Examples of where this can occur are in school, at work, and socially.

Making the Diagnosis: ADHD Presentations and Severity

Before a diagnosis of ADHD can be reached, it is important that a doctor checks for other possible causes of the ADHD-like symptoms. Examples are sleep disorders, bipolar disorder, and autism. If those are ruled out and all the points of the DSM criteria are met, then an ADHD diagnosis can be made. 

Depending on the symptoms present, you or your child will be diagnosed with one of the three ADHD presentations:

  • Predominantly Inattentive Presentation: Enough symptoms of inattention are present and have been for the past six months or longer.
     
  • Predominantly Hyperactive-impulsive Presentation: Enough symptoms of hyperactivity-impulsivity are present and have been for the past six months or longer.
     
  • Combined Presentation: Enough symptoms of both inattention and hyperactivity-impulsivity are present and have been for the past six months or longer.

The clinician will also indicate the severity level of the ADHD:

  • Mild: There are enough symptoms to meet the ADHD diagnosis criteria and you/your child experience minor impairment in functioning.
     
  • Moderate: Symptom severity falls in between the ‘mild’ and ‘severe’ categories.
     
  • Severe: There are many more symptoms present than the minimum requirement for diagnosis, some of the symptoms are particularly severe, or there is a considerable impairment as a result of the symptoms.

Who Is Qualified to Diagnose ADHD?

Children can be diagnosed by a child and adolescent psychiatrist, a pediatrician, or a psychologist. A neurologist or family doctor who is knowledgeable about ADHD can also diagnose ADHD.

A psychiatrist, psychologist, neurologist, and some family doctors can diagnose ADHD in adults. Before booking an appointment, ask specifically if the care provider has experience diagnosing adult ADHD.

When trying to find a qualified professional in your area, speaking with your family doctor is a good starting point. While your doctor might not carry out the detailed evaluation, he or she will usually be able to give you a referral to a professional who can.  

Other people may also know of clinicians who are qualified to diagnose ADHD. These other sources could be a teacher at your child’s school, another parent, friends, support group members, or perhaps another professional you are seeing, such as a therapist. Note that who is licensed and qualified to make an ADHD diagnosis depends on which state you live in.

What Triggers People to Get Tested for ADHD?

Usually there is a specific event that prompts people to reach out for help. For a child, that might be failing a test. As a parent, you know your child is smart, but the academic results do not reflect your child’s intelligence or effort. Perhaps your child has gotten into trouble for disruptive behavior for the tenth time that semester, or a teacher mentions the possibility of ADHD at a parent teacher evening. 

In adults, the event might be the end of a relationship that was important, losing a job, or getting a poor performance review. Or maybe you were going through the process of getting your child diagnosed and you realized that you have all the symptoms of ADHD too.

Alternatively, there might not be one particular event, but rather an accumulation of frustrations and disappointments.

Is it Important to Get an ADHD Diagnosis?

There are many advantages to getting an official ADHD diagnosis. When you know exactly what is causing your or your child's problems, you are able to treat it and get or provide relief from the symptoms that are causing distress. There is also an emotional benefit. ADHD results in a lot of guilt and shame about underachieving. A diagnosis helps to release those negative emotions. 

It might seem tempting to diagnose yourself or your child with ADHD using information you find online. However, there are downsides and potential dangers to that. For example, the most common way to treat ADHD is with medication. However, because stimulants are a controlled drug, most doctors need evidence of an official diagnosis before they prescribe ADHD medication. In addition, accommodation at school or in the workplace can only be granted when you show written evidence of a diagnosis.

Also, if you self-diagnose, you might do so incorrectly. This could mean that a health condition that has ADHD-like systems could go undetected and untreated. 

A Word From Verywell

After ADHD has been diagnosed, treatment can begin. You or your child can start addressing the ADHD symptoms that have been affecting quality of life. 

Remember, ADHD treatment is diverse and much broader than prescription medication. Finding the right treatment can feel overwhelming at first. Take it step by step. Learn about the different options. Work closely with your or your child's doctor until you find the right combination of treatments that are effective.

Source:

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC.

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