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Diagnosis of Attention Deficit Hyperactivity Disorder (ADHD)
Although many attempts have been made to identify ADHD using standardized psychological testing, there is no standard test or set of tests to diagnose ADHD. The diagnosis is a matter of degree and must be made by a mental health professional with experience in this area who has thoroughly assessed your child’s behavior in a variety of situations.
Family and teachers or employers (in the case of teens or adults) must be involved in this process. All the elements of the evaluation are matters of opinion, expectation, and comparison. Furthermore, all the behaviors associated with ADHD are normal, to some degree, in all children at certain stages of development.
It is important to identify other possible causes for the inappropriate behavior. This may include:
- Physical conditions, such as epilepsy
- Environmental challenges, such as family problems
- Psychiatric disorders
- Learning disabilities
Children with ADHD often have other problems, such as:
- Anxiety or depression
- Oppositional defiant disorder
- Conduct disorder
- Learning and language disorders
- Physical conditions such as sleep apnea
Comprehensive testing and evaluation is key to properly assessing your child.
The most detailed diagnostic criteria are found in the Diagnostic and Statistical Manual of Mental Disorders. Because most cases of ADHD are diagnosed in childhood, diagnostic criteria are geared toward children.
The American Academy of Pediatrics recommends that the following guidelines be used for diagnosis in children 4-18 years old:
Evaluation should be initiated if a child shows signs of:
- Poor school performance
- Behavior problems
During diagnosis, the following information should be gathered directly from parents, caregivers, teachers, or other school professionals:
- Assessment of symptoms of ADHD in different settings (home and school)
- Age at which symptoms started
- The degree to which the behavior affects the child's ability to function
The healthcare professional should examine the child for other conditions that might be causing or aggravating symptoms, such as:
- Anemia, thyroid dysfunction, lead poisoning, or other conditions
- Learning or language disorders
- Disruptive behavior
- Depression or anxiety
- Tourette syndrome
For a diagnosis of ADHD to be made, symptoms must:
- Be present in 2 or more of the child's settings (home, school, activities)
- Have started by the time the child is 7 years of age
- Make it hard to function at school, at home, and/or in social situations
- Interfere with the child's ability to function for at least 6 months
Connors Continuous Performance Testing (CPT), a computerized attention test, is often used to help confirm the diagnosis of ADHD. Examples of standardized behavior checklists that also assist in diagnosing ADHD include:
- Achenbach Behavioral Checklist
- ADD-II Comprehensive Teacher Rating Scale (ACTeRS)
- Child Behavior Rating Scale
- Copeland Symptom Checklist for Attention Deficit Disorder
- Conners Rating Scales
- Vanderbilt Rating Scale
Attention-deficit hyperactivity disorder (ADHD). Family Doctor—American Academy of Family Physicians website. Available at: https://familydoctor.org/condition/attention-deficit-hyperactivity-disorder-adhd. Updated June 2017. Accessed October 4, 2017.
Attention-deficit hyperactivity disorder (ADHD) in adults. EBSCO DynaMed website. Available at: http://www.dynamed.com/topics/dmp~AN~T231898/Attention-deficit-hyperactivity-disorder-ADHD-in-adults. Updated December 27, 2016. Accessed October 4, 2017.
Attention-deficit hyperactivity disorder (ADHD) in children and adolescents. EBSCO DynaMed website. Available at: http://www.dynamed.com/topics/dmp~AN~T113926/Attention-deficit-hyperactivity-disorder-ADHD-in-children-and-adolescents. Updated May 23, 2017. Accessed October 4, 2017.
Attention deficit hyperactivity disorder (ADHD). National Institute of Mental Health website. Available at: http://www.nimh.nih.gov/health/publications/attention-deficit-hyperactivity-disorder/index.shtml. Accessed August 14, 2012.
Attention deficit hyperactivity disorder (ADHD). National Institute of Mental Health website. Available at: https://www.nimh.nih.gov/health/publications/attention-deficit-hyperactivity-disorder-adhd-the-basics/index.shtml. Updated 2016. Accessed October 4, 2017.
Diagnostic and Statistical Manual of Mental Disorders (DSM-5). American Psychiatric Association; 2013.
Stern T, Rosenbaum J, et al. Massachusetts General Hospital Comprehensive Clinical Psychiatry. Philadelphia, PA: Mosby Elsevier; 2008.
Understanding ADHD: Information for parents. Healthy Children—American Academy of Pediatrics website. Available at: https://www.healthychildren.org/English/health-issues/conditions/adhd/Pages/Understanding-ADHD.aspx. Updated January 9, 2017. Accessed October 4, 2017.
10/28/2011 DynaMed Systematic Literature Surveillance. http://www.dynamed.com/topics/dmp~AN~T113926/Attention-deficit-hyperactivity-disorder-ADHD-in-children-and-adolescents: Subcommittee on Attention-deficit/hyperactivity Disorder, Steering Committee on Quality Improvement and Management. ADHD: clinical practice guideline for the diagnosis, evaluation, and treatment of attention-deficit/hyperactivity disorder in children and adolescents. Pediatrics. 2011;128(5):1007-1022.
- Reviewer: EBSCO Medical Review Board Adrian Preda, MD
- Review Date: 09/2018
- Update Date: 12/11/2020