There is no single test for ADHD. Instead, a diagnosis is made after a child has shown some or all of the symptoms of ADHD on a regular basis for more than six months and in at least two settings—for example, at home and at school—using standard diagnostic guidelines from the American Academy of Pediatrics. This process involves gathering detailed information about the child's developmental, behavioral, and academic history. At least two sources are consulted and typically are asked to fill out detailed questionnaires about the child, these sources include parents, educators, and other caregivers. In addition, the healthcare professional making the diagnosis may directly observe the child in the classroom, for example. A pediatrician might handle all parts of the diagnostic process, or you might see a psychologist or psychiatrist for the psychological and educational assessments.
The next section contains information on several types of diagnostic tools:
- Physical exam and medical history
- Psychological, behavioral, and educational testing
- School assessments
- Diagnosing ADHD in adults
If ADHD is suspected, a physical examination is helpful in order to screen for hearing or vision problems, allergies, eczema, and epilepsy, all of which can produce ADHD-like symptoms, as well as other conditions that may affect a child's behavior, including:
- Thyroid disorders
- Lead toxicity
- Sleep dysfunction
- Anxiety disorders
- Mood disorders
In addition, a doctor will look for conditions that frequently coexist with ADHD, including learning disabilities, Tourette's syndrome, and oppositional defiant disorder (which results in disobedience and temper flare-ups). Anxiety or depression often plagues children with ADHD as well, in which case more than one condition may need to be addressed.
The physician will also delve into the child's medical history to see whether childhood disease, injury, or prenatal exposure to toxins may have caused developmental problems, in addition to researching the entire family's medical and personal history.
Specialists consider the following when diagnosing ADHD:
- What symptoms is the child showing?
- Are the behaviors more frequent or excessive than in others the same age?
- Did the behaviors begin early in life, before age 7? Have they been present for more than six months?
- Are the behaviors a continuous problem and not just a response to a temporary situation?
- Do the behaviors occur in several settings or only in one specific place or with one specific person?
- Do the behaviors impair at least two areas of a person's life, such as at home, in school, and in social settings?
After asking a series of questions like these, the doctor will compare the child's pattern of behavior to a set of criteria and characteristics of the disorder. He may then make a diagnosis himself or refer the patient to a specialist such as a child neurologist, child psychologist, or child psychiatrist for ultimate identification and treatment of ADHD. Pediatricians, neurologists, and psychiatrists can prescribe medication while behavior therapy might be facilitated by a psychiatrist, psychologist, or social worker.
Psychological, behavioral, and educational testing
Part of the process of diagnosing ADHD, which might be conducted by a pediatrician or a mental health professional, involves gathering detailed impressions of the child's behavior from parents, teachers, and sometimes other caregivers who have spent a great deal of time with the child. Each is asked to rate the child on standardized forms on a whole series of behaviors—such as the frequency of daydreaming, attentive listening, finishing tasks on time, and acting without thinking. Results on these behavior-rating scales are examined to see how they compare with the patterns of normal children of the same age. Sometimes they point to a different problem, such as anxiety or depression.
Your doctor may suggest psychological and psychoeducational tests to measure IQ and social and emotional adjustment, for instance, or to indicate the presence of specific learning disabilities. In addition to standard IQ tests, the battery might include assessments of executive functioning (the ability to plan and organize); achievement tests to assessof facility with reading, language, and math; and of tests to determine the child's ability to pay attention and stay on task. It's important to note that one of the difficulties in diagnosing ADHD is that it is often accompanied by other problems, such as a learning disability like dyslexia or difficulty mastering a certain academic skill. ADHD is not in itself a learning disability but can make it more difficult for the child with a learning disability to do well in school.
Once all of the medical, behavioral, and psychological test results have been digested, it may be readily apparent that the child's attention problems and hyperactivity are severe and consistent enough, long-standing enough, and have a sufficiently harmful impact on his or her life to be classified as ADHD.
If you believe that your child has an attention or hyperactivity problem and that his or her academic performance is being affected, you might want to first request that the school perform an official assessment. Schools are required by law to evaluate students from the ages of 3 to 21 if they are suspected of having a disability that is affecting the learning experience; this service is free and must involve more than one standardized test or procedure. Parents can be helpful by describing as specifically as possible the type of educational difficulties a child is experiencing. The school, however, cannot assign a diagnosis of ADHD (only a trained mental-health professional can do that) but may determine that the child is “other health impaired” (more information below under “Behavioral modification at school”).
It's not easy to diagnose ADHD in adults or even in teenagers, since a lack of focus, impulsive behavior, and an inability to organize and follow through might be explained by depression, substance abuse, or the stresses of a too-busy life. Sometimes an adult will recognize the symptoms in himself—or herself—when a child is diagnosed. Other times, adults will seek professional psychological help and find that their depression or anxiety is related to ADHD.
In order to be properly diagnosed with ADHD, an adult must have childhood-onset and persistent, current symptoms. For an accurate diagnosis, the following are recommended:
- A history of the adult's behavior as a child
- An interview with the patient's life partner, parent, close friend, or other close associate
- A physical exam
- Psychological tests to rule out competing causes, such as psychiatric disorders
Last reviewed on 08/18/2008
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