ADHD Diagnosis

Medical providers rely on a specific list of criteria to diagnose attention-deficit/hyperactivity disorder. Most follow the criteria in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, known as DSM-5. The DSM-5 attempts to provide an inclusive set of guidelines to diagnose disorders across a wide range of demographics.

DSM-5 helps detect the minimum ADHD symptoms required for diagnosis. Physicians note the hallmark symptoms of ADHD, which are inattention and hyperactivity/impulsivity. They also give a comprehensive evaluation to rule out any mental disorders, such as anxiety or depression, that can cause issues similar to ADHD.

In addition to assessing behavioral symptoms of the patient, health care providers often interview people who interact with or care for someone who may have ADHD, including teachers, parents and other adults. These subjective observations can be an essential part of an ADHD diagnosis. Adults and children are evaluated based on different criteria.

Diagnosing ADHD in Children

In one study, the American Academy of Pediatricians observed that limited access to mental health services nationwide prevents many children from receiving an accurate ADHD diagnosis and proper treatment. It recommends a diagnostic procedure that involves practitioners spending enough time with the child, parents and stakeholders, such as teachers and other medical specialists. But it isn’t always easy to satisfy this requirement.

You must continuously monitor your child because ADHD is chronic, and symptoms often persist into adulthood.

Diagnosing ADHD in Adults

Making an accurate ADHD diagnosis for an adult can be challenging. ADHD is difficult to detect in adults with mild symptoms or those who compensate and excel in other areas. About 2.5% of adults are diagnosed with ADHD, but 60% of children diagnosed with the condition carry symptoms into adulthood.

Unfortunately, doctors don’t always detect the condition when someone is younger or may misdiagnose them with another issue with similar characteristics. Overdiagnosis, however, can occur in both adults and children. Men have higher rates of ADHD diagnosis. Gender differences in both prevalence and symptom profile are a continuing topic of research.

There are several ADHD diagnostic tests for adults. These include the adult ADHD self-rating scale, the Wender Utah Rating Scale (for diagnosing ADHD that could have been present in childhood) and the ADHD DSM-5 criteria.

As part of a typical ADHD test for adults, doctors interview family members for background on their loved one and their everyday life. They also gather as much information as possible about their condition in multiple settings — at work, at home and in social settings with friends and family.

The DSM criteria addresses inattentiveness, hyperactivity/impulsiveness or both. You must have experienced these symptoms for the previous six months or longer in at least two settings, such as school or work and church or with family, to receive a positive ADHD diagnosis.

At least five ADHD symptoms are necessary to satisfy the DSM diagnostic method for those ages 17 and older. Younger people must display at least six symptoms for diagnosis. Most would have experienced several attention/hyperactivity problems before age 12.

To avoid a misdiagnosis, your doctor must determine that no other disorder can better explain the emotional or behavioral issues.

Inattentive ADHD

To meet the criteria for inattentive ADHD, you (or your child) must not be able to maintain focus in some aspects of everyday life.

However, patients with inattentive ADHD don’t have predominantly hyperactive or impulsive tendencies.

Hyperactive-Impulsive ADHD

Hyperactive-impulsive ADHD causes uncontrollable restlessness that can inhibit your ability to learn, develop and succeed.

This type of ADHD diagnosis doesn’t include strong outward signs of inattentiveness.

Combined ADHD

No two people have the same severity and combination of ADHD symptoms. Under the DSM criteria, you will only receive a combined ADHD diagnosis if you show sufficient inattentiveness and hyperactivity/impulsivity characteristics.

For example, assume your behavior meets the criteria for inattentive ADHD but not a hyperactive/impulsive classification. Despite having mild impulsive tendencies, your doctor likely would categorize you as predominantly inattentive (rather than a combined ADHD patient). The reverse may also be true.

Symptoms of attention deficit, hyperactivity and impulsivity are treatable in patients across all age groups. If an ADHD assessment returns a positive diagnosis, your doctor may recommend a stimulant such as Adderall or methylphenidate (Ritalin).

Nonstimulants, including Strattera and guanfacine, may provide moderate symptom improvements and are excellent for children with ADHD and adults looking to minimize the risk of drug dependence. Besides ADHD medication, pediatricians may prescribe parent training in behavior management and other behavioral/mental health therapy for children.

Clinicians suggest that it’s important to consider whether behaviors actually cause distress or decrease desired performance levels. Forgetting appointments, misplacing pens or keys and finding your mind wandering in class or during Zoom meetings can happen to most people. When disorganization, fidgeting or other ADHD symptoms inhibit functioning or impede objectives, it can help to speak with a clinician.

An ADHD assessment with a clinician can help determine whether some behaviors are simply variants on the continuum or in fact are signs of ADHD.

If you do receive an ADHD diagnosis, discuss your best and safest ADHD treatment options with your doctor. Ask about resources available to help you or your child, including parent training, therapy and accommodations at school or work.

ADHD symptoms can be subjective, making it harder to diagnose accurately, especially when using ambiguous or incomplete diagnostic approaches. Unfortunately, these challenges may lead to ADHD overdiagnoses.

However, ADHD test results are becoming more reliable as more practitioners adopt current diagnostic guidelines. Additionally, doctors spend more time evaluating patients and increasingly involve parents, family members, teachers and peers in the evaluation process.

Greater use of the recommended ADHD screening tools and multimodal tests helps minimize the subjectivity of test results.

Start with your primary care provider or pediatrician when seeking an ADHD diagnosis. You can request a referral to a mental health specialist, such as a psychiatrist or psychologist, for comprehensive testing.

Getting your child proper evaluation and treatment for ADHD often entails finding a therapist certified in parent training. While you don’t need a neurologist to test for ADHD, you can see one to rule out other issues, such as seizures and sleep problems. A visit to an optometrist or ophthalmologist can rule out vision problems that can produce behaviors that mimic ADHD.