How ADHD Is Diagnosed

The Full Library of ADHD Tests and Assessments for Related Conditions

What medical ADHD tests help doctors diagnose symptoms of attention deficit hyperactivity disorder? Diagnosing ADHD is a nuanced and time-intensive process, when done right. It takes patience and many different tools, including these 5 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

Medically Reviewed by William Dodson, M.D., a member of ADDitude’s ADHD Medical Review Panel

ADHD Tests: Symptom Assessments for Diagnosis

Unlike diabetes or anemia, attention deficit hyperactivity disorder (ADHD or ADD) can’t be detected with a blood test or scan. “Like other psychiatric diagnoses, the boundaries of ADHD are unclear, 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.

Many children and adults begin by taking an online test of common ADHD symptoms and then taking the results to an ADHD specialist for review and evaluation. ADDitude offers the following ADHD tests for children and adults:

ADHD Symptom Tests for Children

ADHD Symptom Tests for Adults

A proper ADHD evaluation begins with a critical analysis not just the results of these ADHD tests, but also other aspects of the patient’s daily life, such as learning, memory, cognitive functioning, executive functioning, reasoning, social functioning, verbal and non-verbal communication.

ADHD comorbidity must be taken into account. There are many non-ADHD conditions that frequently co-exist with ADHD — for example, learning disabilities, sensory processing disorder, speech/language delays, and autism spectrum disorder. The initial evaluation usually includes screening for these comorbid conditions. Then, if there is a high index of suspicion that other conditions are co-existent, one or more of the assessments listed below can be used to explore that co-existing condition further.

Below is a description of 5 types of evaluations for children who exhibit signs of ADHD and related conditions, including learning disabilities.

1. Evaluation for ADHD in Children

The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) lists the key symptoms of ADHD and explains criteria for a diagnosis. Your child’s physician uses the following assessments to determine if a child meets these criteria.

  • Clinical interview: The provider completes an extensive discussion with both the child and parents or guardians about family and developmental history and current symptoms or concerns. During the interview, parents might be asked about specific symptoms, when they first noticed them, and whether they occur in more than one setting, such as at home and at school. They might also be asked to describe steps they have taken to correct symptoms and behaviors and how those strategies worked. A good clinical interview takes two to three hours.
  • Normed rating scales: Patients and caregivers including parents, teachers, and family members fill out questionnaires to evaluate symptoms in different settings. Common rating scales include the Conners Comprehensive Behavior Rating Scales as well as Barkley Home and School Situations questionnaires.
  • Physical exam: Sometimes ADHD-like symptoms are caused by a medical problem, such as a thyroid condition. A thorough physical exam, which can include laboratory tests, is used to rule out these conditions and evaluate whether a person can safely take ADHD medication. During the physical exam, the provider notes temperament, mental status and behaviors. Your doctor might ask to observe your child in a play session to observe potential concerning behaviors.
  • Emotional assessment: Some emotional disorders, such as depression, generalized anxiety disorder, obsessive compulsive disorder (OCD), or oppositional defiant disorder (ODD), often accompany ADHD. When a child shows signs of one of these conditions, an emotional assessment, completed by a mental health professional may be required. ADHD treatment can be hampered when there are untreated emotional issues, for example, a child with depression may not respond well to treatment until the symptoms of depression have been addressed.

Many children with ADHD have learning problems. Neuropsychological testing is not required for an ADHD diagnosis but might be appropriate in cases where learning disabilities are suspected (see below)1. There are various reading, writing, and math evaluations that schools can administer to find strong and weak areas.

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

2. Educational Evaluations in Children

Up to 45 percent of children with ADHD also have one or more learning disabilities2. 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 can perform the educational assessment, either through the school or a private evaluation.

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. Children are not usually subjected to all of the following assessments. The professional chooses which tests are appropriate based on the child’s specific difficulties.

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

*Note: IQ tests are not always included in assessments for ADHD and learning disabilities because these conditions are not a result of intellectual ability but are a result of brain functioning or processing.

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 could choose to break up testing into several separate sessions.

The Outcome

When testing is complete, the evaluator scores the assessments, analyzes the information gathered, and writes 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 can help the student achieve academic success

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

3. Occupational Therapy Evaluation for Children

Occupational therapy evaluations take 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 identify treatment strategies.

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

The Time Required

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

The Outcome

When the evaluation is complete, the occupational therapist scores the assessments, analyzes the information gathered, and writes 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

4. Speech-Language Evaluation

Many children with ADHD also have speech-language delays and/or disorders. These are different than language learning disabilities, though some symptoms can be similar. If your child is significantly behind in developing language and communication skills when compared to developmental milestones, a speech-language evaluation might be necessary. Some schools complete this type of evaluation, if not, you might need to pursue this evaluation privately. Your child’s doctor or therapist might refer you to a specialist for further evaluation and assessment, or, if you have concerns, you can request it yourself.

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 begins 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 scores the assessments, analyzes the information gathered, and writes 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

5. Autism Spectrum Disorder (ASD) Evaluations

The latest Diagnostic and Statistical Manual of Mental Disorders (DSM-5) allows for an individual to 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 also have symptoms of ADHD, and estimates suggest that up to 60 percent of individuals with ADHD have features of autism3. 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 in children.

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 can 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 provides 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.

[Everything You Need to Know About ADHD]

Sources

1Pliszka, Steven. “Practice Parameter for the Assessment and Treatment of Children and Adolescents With Attention-Deficit/Hyperactivity Disorder.” Journal of the American Academy of Child & Adolescent Psychiatry, Volume 46, number 7, 2007, pp. 894-921. doi: 10.1097/chi.0b013e318054e724.
2DuPaul, George. “Comorbidity of LD and ADHD: implications of DSM-5 for assessment and treatment.” Journal of Learning Disabilities, Volume 46, number 1, 2013, pp.43-51. Jan-Feb 2013. doi: 10.1177/0022219412464351
3Leitner, Yael. “The Co-Occurrence of Autism and Attention Deficit Hyperactivity Disorder in Children – What Do We Know?.” Frontiers in Human Neuroscience, Volume 8, 2014, pp.268. 2014. doi: 10.3389/fnhum.2014.00268

Updated on July 25, 2019

3 Related Links

    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

  1. Disappointed that you include examples of standardized tests and lists of what kinds of observations are made by every profession except OT. You make it sound like OTs are unprofessional, only asking questions and making observations. Here is a partial list of tests OTs use:
    Bruininks-Oseretsky Test of Motor Proficiency
    Peabody Developmental Motor Scales
    Beery-Buktenica Developmental Test of Visual-Motor Integration
    Sensory Processing Measure
    The Sensory Profile
    Sensory Integration and Praxis Tests (SIPT)
    Motor-Free Visual Perception Test
    Evaluation of Childrens Handwriting (ETCH)
    along with clinical observations, parent/teacher interviews, etc

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