How ADHD Is Diagnosed

The Full Library of ADHD Assessments and Tests

Diagnosing ADHD is a nuanced and time-intensive process, if done right. It takes patience and many different tools, including these 6 types of assessments administered by practitioners ranging from psychologists to occupational therapists to pediatricians.

A doctor filling out a questionnaire for a patient
Doctor consulting parent and child

There’s no quick test for ADHD. Unlike diabetes or anemia, ADHD can’t be detected with a blood test or scan. “Like other psychiatric diagnoses, the boundaries of ADHD are fuzzy, so clinician judgment plays a big role,” says Joel Nigg, Ph.D., a professor of psychiatry, pediatrics, and behavioral neuroscience at Oregon Health & Science University.

Any good ADHD evaluation will begin by critically analyze many aspects of the patient’s daily life, such as learning, memory, cognitive functioning, executive functioning, reasoning, social functioning, verbal and non-verbal communication. If the patient is a school-aged child or adolescent, the testing should include an intelligence test (IQ), and may also gauge math, reading, and writing skills.

When performed thoroughly and effectively, a formal assessment should offer therapy, treatment, and educational strategies to address the specific needs it reveals or confirms. Below is a rundown of 6 types of evaluations commonly performed on children who exhibit signs of ADHD and related conditions, including learning disabilities. We will cover ADHD diagnosis, and beyond.

[Free Download: What Every Thorough ADHD Diagnosis Should Include]

1. Neuropsychological Evaluation

The gold standard of assessments is the neuropsychological evaluation, and it’s also the most comprehensive. This assessment analyzes how an individual’s brain functions, and is used to identify brain-based disorders like ADHD, autism, and learning disabilities. This type of evaluation involves an interview, input from other sources (i.e. parents, teachers, and family members) through questionnaires and rating scales, plus pencil-and-paper tests. It may also include the review of a student’s work and grades, when applicable.

The Tests

A neuropsychological evaluation comprises standardized tests that are administered the same for everyone and scored based on a predefined scale. This allows the evaluator to compare each individual’s results to a baseline — in this case, a neurotypical (“normal”) individual of the same age — and compare brain functioning to a norm for that age and gender.

The evaluation analyzes some or all of the following areas, depending on the patient’s symptoms and complaints:

  • intelligence
  • executive functioning
  • processing
  • attention
  • memory
  • visual-spatial functioning
  • communication/language skills
  • emotion and mood
  • personality
  • sensory integration/processing
  • motor skills
  • academics

Specific tests often used in neuropsychological evaluations for ADHD include:

  • Vanderbilt Assessment Scales
  • Conner’s Parent and Teacher Rating Scales
  • Vineland Adaptive Behavior Scales
  • Behavior Assessment System for Children (BASC)
  • Barkley Home and School Situations Questionnaires
  • Wechsler Intelligence Scale for Children (WISC-V)
  • Woodcock Johnson III Tests of Cognitive Abilities
  • Wechsler Individual Achievement Test (WIAT-III)
  • Additional language tests include GORT, Boston Naming, HRB-Aphasia

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The Time Required

A neuropsychological evaluation is typically performed by a psychologist with specialized training and experience in the field of neuropsychology. The assessment could take anywhere from 2 to 8 hours — sometimes stretched over several visits — depending on the practitioner and the depth of the testing required.

The Outcome

When the assessment is complete, the psychologist will score the tests and questionnaires, analyze the data, and write a report. The report should include:

  • A diagnosis of a learning or developmental disorder, if warranted
  • Information about the patient’s specific strengths and weaknesses, including his or her learning type
  • Recommendations for accommodations and strategies to help at home, work, or school
  • Answers to the questions and concerns you posed to the evaluator

Most practitioners meet patients in person to review the evaluation results. A patient and/or parent should have a better understanding of herself or her child in the end.

If more in-depth exploration is needed in particular areas, the evaluator may recommend further testing with different professionals.

2. Occupational Therapy Evaluation

Many people don’t realize that occupational therapy evaluations can and should be used for most individuals with ADHD. This evaluation takes an in-depth look at aspects of functioning such as sensory processing, motor coordination, balance, emotional awareness, self-regulation, planning and organization, handwriting, and daily life skills (like tying shoes). An occupational therapy evaluation can provide a great deal of insight into struggles and weaknesses in these areas, as well as treatment of identified difficulties.

The Tests

An occupational therapy evaluation begins with an inventory of the patient’s history including his or her background and developmental information, a caregiver interview, and clinical assessments and observations.

[Free Guide: How to Prepare for Your ADHD Evaluation]

The Time Required

Plan on devoting at least 2 hours to the occupational therapy evaluation. The actual time required for this assessment will depend on the practitioner and the number of areas he or she needs to evaluate.

The Outcome

When the evaluation is complete, the occupational therapist will score the assessments, analyze the information gathered, and write a report. The report should include:

  • A summary of the information gathered about the patient
  • Clinical impressions regarding level of functioning and areas of weakness
  • Proposed treatment goals and treatment plan

3. Speech-Language Evaluation

Many children with ADHD also have speech-language delays and/or disorders. If your child isn’t developing language and communication skills as developmental milestones dictate, a speech-language evaluation may be necessary. Your child’s school may offer this, or you may have to pursue this evaluation privately. You may be referred for an evaluation by your child’s doctor or therapist, or you may request it yourself.

The Tests

A speech-language evaluation is performed by a speech-language pathologist, or SLP, who has a master’s level education in the field. The evaluation will begin by gathering patient background and developmental information, conducting a caregiver interview, and performing clinical assessments and observations. The full evaluation typically takes 2 to 4 hours, depending on the clinician and the number of areas being assessed.

Potential areas of evaluation include:

  • Oral motor assessment, including feeding and swallowing
  • Articulation
  • Expressive language
  • Receptive language
  • Speech production and fluency
  • Auditory skills
  • Understanding of grammar and syntax
  • Word retrieval
  • Understanding instructions, especially as they increase in length and difficulty
  • Social language

The Outcome

When the evaluation is complete, the SLP will score the assessments, analyze the information gathered, and write a report. The report should include:

  • A summary of the information gathered about the child’s background and development
  • Clinical impressions of oral motor, communication, and processing functioning
  • Proposed treatment goals and a treatment plan to develop skills for more effective communication and language skills

4. Educational Evaluations

Up to 60 percent of children with ADHD also have one or more learning disabilities. It’s important to have your child evaluated in any academic areas where he or she is struggling or performing below grade level. A clinical psychologist, educational psychologist, or special education professional may perform the educational assessment, either through the school or via private evaluation.

The Tests

Educational evaluations vary widely for each student, depending on how many areas require assessment. This type of evaluation includes mostly written tests with some clinical observations.

Tests used to evaluate educational functioning and the potential for learning disabilities include:

*Note: An IQ test may or may not be part of educational testing. It isn’t always required.

The Time Required

It can take 1 to 4 hours or more, depending on the clinician and breadth of assessments. If multiple areas are being tested, the clinician will often break up testing into several separate sessions.

The Outcome

When testing is complete, the evaluator will score the assessments, analyze the information gathered, and write a report. The report should include:

  • A summary of parent and/or teacher concerns
  • The results for each test administered, including the subsection scoring (where applicable)
  • Diagnoses, if any
  • Specific teaching approaches, skill development, special services, and accommodations that will help the student achieve academic success

5. Neuropsycho-educational Evaluation

A neuropsycho-educational evaluation encompasses both the neuropsychological assessments and the educational assessments outlined above. This evaluation is considered to evaluate all aspects of potential neurological, psychological, and learning problems. It is typically conducted by a neuropsychologist or psychologist.

6. Autism Spectrum Disorder (ASD) Evaluations

The latest Diagnostic and Statistical Manual of Mental Disorders (DSM-V) allows that an individual may be diagnosed with both ADHD and autism spectrum disorder (ASD), which was not previously true. Studies show that 30 to 50 percent of individuals with autism show symptoms of ADHD, and that up to 60 percent of individuals with ADHD have symptoms of autism. That is a significant overlap, to say the least. A developmental pediatrician, neurologist, psychiatrist, or psychologist can perform an evaluation for autism. Whomever you choose, be sure that the clinician has experience specifically with autism.

The Tests

The evaluation for ASD begins by detailing a patient’s history and developmental information, conducting a caregiver interview, and conducting clinical assessments and observations.

Possible assessment tests include:

The Time Required

The time required to conduct an ASD evaluation may vary significantly. If symptoms are overt, a diagnosis could result from an hour-long meeting with the clinician, or a very comprehensive evaluation could take multiple meetings — each one lasting several hours..

The Outcome

Once the evaluation is complete, the clinician who performed the assessment will deliver a report containing the information gathered on the patient’s history and development, assessment results and scores, the clinician’s findings (a diagnosis of ASD or not), and recommendations for support.

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    1. Agree about the Children’s Memory Scale. Also consider the CHAMP (Child and Adolescent Memory Profile), although recognition memory only – not recall. Also consider using the TEA-Ch 2 (Test of Everyday Attention for Children – 2nd Edition), which examines the differences between sustained and selective attention, switching attention and dual task attention. This generates useful information for teachers and parents and children themselves on where their vulnerabilities are and is useful for recommendations for support.

      Amanda Owen, Developmental Neuropsychologist

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