How Is ADHD Diagnosed?
Some symptoms of ADHD are easier to spot than others. But even if your child is hanging from the chandelier, your doctor should follow this protocol when evaluating him for symptoms of ADHD — and other commonly overlapping or misdiagnosed conditions.
There’s no single, definitive diagnostic test for ADHD — no blood analysis, no brain scan, no genetic screening — so diagnosis of ADHD is not a quick or simple task. On top of that, doctors vary in their abilities to diagnose and treat the disorder, so it’s easy to go down blind alleys before getting the right evaluation and prognosis.
The good news: if you approach the ADHD diagnosis step by step, you can avoid some common pitfalls — and control ADHD symptoms more smoothly with fewer frustrations along the way.
The “Aha” Moment
Often, the ADHD diagnosis begins with an “Aha” moment, when it dawns on you that your or your child’s problems may be caused by ADHD or another biologically-based disorder.
For parents, this moment might come when a teacher calls to report a child being disruptive in class or falling behind academically. Adults might find that they’re concerned about losing their job after being consistently late to work and frequently missing deadlines or meetings.
Whatever triggers your “Aha” moment, seek help at once. Without a prompt diagnosis, individuals with ADHD are apt to be branded “lazy,” “careless,” or worse. Such labels undermine self-esteem and can lead to years of underachievement and family turmoil.
Above all, don’t panic. With appropriate treatment, people with ADHD do well. And don’t forget: ADHD is about biology and neurology; it is in no way your fault.
Consulting the Doctor
Most people follow an “Aha” moment with an appointment to see a pediatrician or general practitioner. That makes sense, but before agreeing to treatment, “ask how many other cases of ADHD the doctor has treated, and what the plans and outcomes were,” says Russell Barkley, Ph.D., a clinical professor of psychiatry and pediatrics at the Medical University of South Carolina. If the doctor has handled only a few cases, you might be better off going to a specialist — developmental pediatrician, psychiatrist, or psychologist — who has significant experience with ADHD.
As a rule, most general practitioners are not trained in the idiosyncrasies of ADHD and its overlapping conditions, or are not equipped to perform the in-depth evaluation needed. One reason is time. It can take several hours of talking, test taking, and analysis to diagnose someone with ADHD. Most general practitioners can’t give you or your child that much attention in a busy practice.
“Regardless of how experienced your [doctor] is,” says Barkley, “you should strongly consider a medical specialist if [your or] your child’s ADHD is accompanied by another diagnosed disorder, such as oppositional behavior, anxiety, or if there are urgent issues involved.” Professionals trained in diagnosing ADHD routinely screen for these problems.
Your family doctor or health insurer can probably steer you to a qualified ADHD specialist. If not, contact your local chapter of Children and Adults with Attention-Deficit Hyperactivity Disorder (CHADD).
How ADHD Is Diagnosed
When making an accurate diagnosis, your doctor will first want to determine whether you or your child has the ADHD symptoms listed in the Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition (DSM-V).
According to the latest DSM-V guidelines, in order to be diagnosed with ADHD, a patient must demonstrate at least six of the nine symptoms of inattention and/or hyperactivity/impulsivity prior to age 12. In addition, these symptoms must impair the person’s functioning in more than one setting — home, school, or work. 1
While the DSM-V outlines the basics for an ADHD diagnosis, there’s much more to an accurate diagnosis. 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 common coexisting conditions like learning disorders, anxiety, autism, and mood disorders.
Diagnosing an adult is trickier than diagnosing a child. The DSM-V symptom guide is really invalid for adults; almost all of its criteria is geared toward diagnosing children. An ADHD diagnosis in adulthood emerges only from a careful clinical interview conducted by a specialist in ADHD who takes his or her time with the evaluation.
Your doctor will interview you and someone who knows you well — your spouse, a sibling, or your parents. She may or may not use checklists designed to identify symptoms of adult ADHD. The doctor will use the patient interview to determine which, if any, tests might rule out other conditions that may be causing symptoms.
“The clinical interview is the core of any evaluation,” 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. “The more input from different sources, the better. Many adults come for a consultation alone, but it’s helpful to come with a spouse, sibling, or close friend.”
Here’s what a thorough evaluation should include:
- TIME: An initial consultation could range from 45 minutes to two hours or more. That time should be spent with the patient (as well as the parents when the patient is a child) looking for signs of ADHD, and for other possible explanations for the symptoms. Your doctor may also arrange for intelligence tests or memory recall tests.
- PAPERWORK: Expect to fill out questionnaires, checklists, and/or ADHD rating scales. Teachers and caregivers will be asked to fill them out, too. The more input, the more likely you’ll receive an accurate diagnosis.
- PHYSICAL EXAM: This should include screening for hearing and vision problems to rule out physical causes for symptoms.
- SOCIAL HISTORY: Have you moved a lot? Are you financially challenged? Is there a family member who is ill? These and other factors can make an individual, especially a young child, anxious — and may cause behavior that mimics ADHD.
- FAMILY HISTORY: ADHD runs in families, so expect the doctor to ask questions about your or your parents’ and/or partner’s mental health. “If neither parent has ADHD, then ADHD drops to the bottom of the list,” Dodson says. “If one parent has ADHD, there’s a 50-50 chance that the child has it, too. If both parents have ADHD, it is a major contributor to the [individual’s] behavior.”
- SYMPTOM HISTORY: A child has to exhibit at least six of nine symptoms of inattention and/or hyperactivity/ impulsivity prior to age 12 in order to be diagnosed with ADHD. For adults, clinicians often alter the criteria of the DSM-V, since it’s really designed for diagnosing children. In addition, the symptoms should be exhibited in more than one setting (school, home, work), to a point where the symptoms affect normal functioning.
- Be speciﬁc when describing your problems. Figure out what concerns you want to address in your consultation. For instance: “At work, I find that I can’t stay on task or complete projects.” “I can’t find anything at home.” “My child is always losing toys and homework.”
- Consider your stance on medication before your appointment. If you’re opposed to taking medication, state your philosophy up front and ask your doctor if he or she can recommend other treatment options. Medication is entirely up to you — if your doctor insists on writing a prescription despite your aversion to medication, don’t be afraid to see someone else! Then, if you have decided on medication, remember that the prescription and dosing process varies with each individual. It’s likely that you’ll need to try more than one brand and experiment with different dosages to find the right one for you.
- Ask the doctor to talk about medication options. You want someone who will not just write a prescription, but who will also discuss the diagnosis and treatment process in detail. The following questions should be addressed: What medications are under consideration? Why start with a particular medication? What can you expect to happen? How should you evaluate the effect of the medication?
- Discuss follow-up. Your doctor should lay out a course of action, including treatment and follow-up appointments. Make sure that he or she is accessible. You’ll need to talk often on the phone in the weeks following the diagnosis as you work to find the right medication dosage. Will your doctor be available? Will he or she charge you to consult? Will he or she prescribe medication refills by phone, or do you need to visit the office every time you’re running low?
- Learn about alternatives to medication. Find out about behavioral therapies and modifications you might try. Can your doctor work with you on these? Is your doctor sympathetic to non-medical treatment? You may benefit from a referral to a psychologist who can offer behavioral help, such as ways to deal with problems at work, time-management techniques, and so on.
- Ask if he will meet with your family. A diagnosis of ADHD affects those you live with. Others in your or your child’s life need to learn about the condition and how it will be managed.
Awaiting the Diagnosis
At this point, most people are dying to know: “Does my child have ADHD?” or “Do I have ADHD?” But don’t expect an answer overnight. The diagnostic process typically takes at least a week or two.
If you’re awaiting a diagnosis for your child, inform your child’s teachers and any other school officials that your child is being evaluated for ADHD. Ask for a meeting with the school psychologist or special education teacher to discuss having your child evaluated for learning disabilities (which affect 30 to 50 percent of kids with ADHD).
If your school is unable or unwilling to administer the appropriate testing, you may have it done by a private educational psychologist — typically at a cost of several hundred dollars, or more.
1 Association, American Psychiatric, ed. Diagnostic and Statistical Manual of Mental Disorders: DSM-5. Washington: American Psychiatric, 2014.