How Experts Make an ADHD Diagnosis
“The DSM-IV remains the basis of the diagnosis, but most clinicians go beyond that in their assessments,” says Hallowell. In addition to reviewing these criteria, doctors will conduct a thorough clinical interview using one standardized ADHD rating scale. A screening test is also often administered to rule out coexisting conditions that are common in people who have ADHD -- learning disorders, anxiety, and mood disorders.
The symptoms listed in the DSM-IV are reviewed periodically. According to the latest DSM-IV guidelines, in order to be diagnosed with ADHD, a patient has to have shown at least six of nine symptoms of inattention and/or hyperactivity/impulsivity prior to age seven. In addition, these symptoms must impair the person’s functioning in more than one setting -- home, school, or work.
Not all doctors subscribe to these criteria. Many professionals point out that some patients have ADHD symptoms that aren’t recognized until later in life, particularly children who are very bright or who have the inattentive form of ADD.
Diagnosing an adult is trickier than diagnosing a child. “The DSM-IV criteria are based only on research with children four to 17 years old,” says Thomas E. Brown, Ph.D., assistant clinical professor of psychiatry at Yale University School of Medicine and associate director of the Yale Clinic for Attention and Related Disorders. “As a result, most clinicians bend the criteria when it comes to the age of onset -- recent research has shown that, in some people, symptoms don’t appear until adolescence, when there are greater challenges in self-management -- and the number of symptoms. Clinicians often diagnose adults who have just four or five symptoms, not seven or eight, if they show significant impairment.”
While some doctors use computer programs, such as continuous performance tests (CPTs), to check for attention and impulsivity problems, or brain scans, such as single-photon emission computed tomography (SPECT), to look for abnormalities in the brain, the most reliable evidence for a positive diagnosis, according to most experts, is a patient’s history.
Where to Go for an ADHD Diagnosis
Next: ADHD Diagnosis Step 1: The Consultation
ADHD Diagnosis Step 2: Testing, Testing
ADHD Diagnosis Step 3: Learning How to Manage Symptoms
Five Common Diagnosis Mistakes