ADHD Diagnosis: The Most Accurate Assessment Tools (2022)

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A review of the available measures and performance tests for Attention Deficit Hyperactivity Disorder – and what evaluators need to know about their limitations to make an accurate diagnosis.

Article by:

  • Randy Bressler, PsyD

Jump to: ADHD Treatment Costs ADHD Classification ADHD Assessment Accuracy ADHD Assessment Tool List ADHD Clinical Evaluation ADHD Testing Invalid Presentation of ADHD Most Effective ADHD Diagnosis Tools

Assessing children and adults for Attention Deficit Hyperactivity Disorder (ADHD) can offer crucial insight into one’s functioning and, thereby, guide life-impacting treatment decisions. These include providing input into educational interventions, determining eligibility for disability requirements, and evaluating therapeutic or scholastic outcomes.

Finding and utilizing reliable assessment tools – along with therapeutic supports to efficiently address ADHD – is key. This process begins with understanding the multitude of factors that can impact an ADHD diagnosis:

  • high prevalence rates (more on this below)
  • concerns about over-diagnosis
  • the adverse influence ADHD can have on functioning at home, school, work, and in social relationships
  • the fact that ADHD often coincides with another disorder.

These factors collectively provide an impetus for developing and implementing measures that can accurately diagnose this condition from the onset. This article reviews widely recommended professional guidelines in the scientific literature – that is, best practices – to assess ADHD and the limitations often faced with evaluating ADHD.

(Video) How to Diagnose Attention Deficit Hyperactivity Disorder (ADHD) in Adults? - Dr Sanil Rege

Prevalence and Costs Associated with ADHD

ADHD is the most common behavioral condition seen in children and adolescents in the United States, affecting 10% of those ages 4 to 17 years old. Compare this to 7% seen in 1998 to 2000 and a worldwide prevalence rate of 5%, the latter explained by different diagnostic instruments and guidelines and access to healthcare.1

It is notable that incidence rates increase with age. Estimates of ADHD among those 10 to 17 years old are almost twice as high as those for children 5 to 9 years old.1

In 2013, US healthcare expenditures for ADHD totaled $23 billion.2 Societal costs – such as healthcare, education, and reduced family productivity associated with childhood ADHD – have been estimated to range from $38 billion to $72 billion per year.3

Long-term studies show that “children and adolescents with ADHD are more likely to experience a variety of negative outcomes compared to their peers without the disorder, including lower academic attainment, impaired social functioning, increased risk of hospital admissions and injuries, increased substance use and risk of a substance use disorder, and reduced income and participation in labor markets as adults.”4-8

Classifying an ADHD Diagnosis: Current Understandings, Overlapping Disorders

ADHD is now more accurately viewed as a neurodevelopmental disorder. This conceptualization has been widely supported by more than two decades of research noting how the condition often, but not always, is diagnosed in childhood and is intricately connected to brain-behavior relationships involving executive functioning (eg, attention, impulse control, self-regulation, organization/planning, and working memory) that presents differently across the lifespan. The American Psychological Association recognized and codified these distinctions in the DSM-5.

This shift in appreciating the connection between executive functioning and ADHD over the past 20-plus years has translated to the development of neuropsychological batteries to evaluate the disorder. In addition, current understandings have influenced targeted areas measured in continuous performance tests and led to appreciable revisions of rating scales. (See Table I below on the various assessment tools available.)

A challenge with diagnosing ADHD is that the characteristics associated with the disorder – such as difficulties with focusing, shifting/dividing attention, managing frustration, organization/poor time-management, working memory, and staying engaged – are common symptoms that could have a breadth of etiologies.

As noted, more often than not, ADHD coincides with another disorder. As per a national 2016 parent survey, 6 in 10 children with ADHD had at least one other mental, emotional, or behavioral disorder.9 The most common co-occurring conditions reported with ADHD include: 9

  • 52% behavioral or conduct problems
  • 33% anxiety disorders
  • 17% depression
  • 14% autism spectrum disorder
  • 1% Tourette syndrome

A small percentage (1.0%) of adolescents aged 12 to 17 years with ADHD also had a parent-reported current substance use disorder (SUD).

ADHD Assessment: Current Evaluation Tools and Their Limitations

Clinicians Involved in ADHD Diagnosis

Assessment of ADHD is conducted within a wide range of professions, that include, but are not limited to:

  • clinical psychologists
  • school psychologists
  • neuropsychologists
  • psychiatrists
  • neurologists
  • pediatricians/neurodevelopmental pediatricians
  • internists/family physicians.

Evidence-Based ADHD Assessment: False Positives and False Negatives

Regardless of the healthcare expert charged with diagnosing/evaluating potential ADHD, a well-regarded and arguably gold standard approach is using an evidenced-based assessment that involves adherence to the DSM-5 diagnostic criteria along with the inclusion of multi-informant/multimethod methods. Such methods should incorporate empirically validated research and, when possible, test data about key clinical populations to guide and increase confidence with clinical impressions.

With all assessment measures, an overriding goal is to improve the sensitivity and specificity of the instrument. Sensitivity is the ability of a test, such as a rating scale, to correctly identify those with the condition, whereas specificity is the ability of a test to correctly identify people without the condition. These statistics are of particular concern with ADHD given its impact across the lifespan.

Erroneous diagnostic impressions have real-world consequences. A false negative could impede necessary treatment efforts (eg, academic/occupational accommodations, medication, counseling) for one who is struggling at home, school, or work. False-positive errors can lead to inappropriate provisions of medication, academic accommodations, diminish educational resources, as well as provide an unfair advantage to those without disabilities.10,11

Table I: A Quick Look at Available ADHD Assessment Tools.

Rating Scales

Neuropsychological Measures/Batteries

The Clinical Interview

Narrow Band (ADHD symptom-specific):
  • Barkley Adult ADHD Rating Scale-IV (BAARS-IV)
  • Brown Attention/Executive Function Scales
  • Behavior Rating Inventory of Executive Function 2 (BRIEF-2)
  • Conners Adult ADHD Rating Scales (Conners-3, CAARS*)
  • Comprehensive Executive Function Inventory (CEFI)

Broadband (behavioral conditions in addition to core ADHD symptoms):

  • Behavior Assessment System for Children (BASC-3)
  • Child Behavior Checklist (CBCL)
  • Connors Comprehensive Behavior Scale (CBRS)

These information-gathering tests can provide information related to brain function and help to identify weaknesses associated with ADHD in specific areas (eg, working memory, impulsivity, poor concentration) as well as the potential real-world consequences of them (eg, reading comprehension difficulties). The results can inform treatment recommendations (eg, medication, academic accommodations, counseling).

(Video) New Brown Executive Function/Attention Scales: Theory and Clinical Applications for Assessing ADHD

Examples include:

  • Delis-Kaplan Executive Function System (D-KEFS) (Ages 8 through adulthood, up to 90 minutes)
  • Subtests from the NEPSY-2 especially the subtests from the Attention/Executive Functioning domains, which include Animal Sorting, Auditory Attention/Response Set, Clocks, Design Fluency, Inhibition; Inhibition, and Statue
  • Neuropsychological Assessment Battery (NAB) Attention module (Ages 3 to 16, 45 to 90 minutes)
  • Rey Osterrieth Complex Figure ( ROCF) (Ages 6 through adulthood, 45 minutes with a 30-minute interval)
  • Wisconsin Card Sort Test (WCST) (Ages 6.5 through adulthood 20 to 30 minutes)
  • Wechsler Intelligence Scale for Children- Fifth Edition Working Memory Scale: Digit Span, Picture Span, Letter-Number Sequencing
  • Continuous performance tests
    • Conners’ Continuous Performance Test 3rd Edition (Connors CPT-3)
    • Test of Variables of Attention-9 (TOVA-9)
    • Evaluate Visual and Auditory Attention (IVA-2)
    • Qb Test
Used to solicit information about – and observe – executive functioning deficits; to be done in combination with one or more measures/tests above and patient’s history for a full assessment.

ADHD Presentations, Measures, and Assessment Tool Accuracy

While knowing whether an assessment tool (eg, a rating scale, continuous performance test, or neuropsychological testing battery) can correctly discriminate between those who have a disorder from those who do not is a fundamental objective of its design, it is equally important to know the probability of that test’s diagnostic formulation being correct. Such information can be attained if the base rate of a condition is known.

Marshal et al discussed that assessment tools increase their diagnostic accuracy when incorporating positive predictive power (PPP) and negative predictive power (NPP).12 Having data regarding the prevalence of ADHD within a particular population across settings –whether in school, clinic, or at home – enhances the utility of the measure being used.

There is a growing focus on improving healthcare diagnostic skills through the application of probabilistic reasoning to the interpretation of diagnostic tests, using classification statistics, which allow clinicians to make highly informative and scientifically responsible statements regarding the probability of a particular diagnosis given the test finding.13 In essence, these statistics use the knowledge of the base rate within a population to determine the probability of whether a person identified by a measure is showing signs of a condition, actually has the condition (PPP), or when they do not meet criteria for a disorder – the likelihood (NPP) that they do not have it.

Notably, Gioia et al recently asserted that leveraging classification statistics (involving base rates) in their rating scale (BRIEF-2 ADHD Form) increases the efficiency of this instrument by not only distinguishing those with characteristics of ADHD from other psychiatric conditions but also by helping to delineate the different ADHD presentations (ie, impulsive/hyperactive [ADHD-HI], predominantly inattentive/distractible [ADHD-I], and combined [ADHD-C]).14

Gioia et al further noted that multiple studies using the BRIEF and BRIEF-2 have found distinctive profiles for ADHD within a clinical population. Those with ADHD-I had elevations in working memory, planning/organizing, and initiation. A similar pattern emerges with those with ADHD-C, yet they also had an elevation on a scale that measures inhibitory control.

The DSM-5 uses a dimensional approach with diagnoses. In the current manual, ADHD is viewed as a constellation of attentional and hyperactive-impulsive symptoms that must occur “often” and “interfere with, or reduce the quality of, social, academic, or occupational functioning.”15 This leaves room for the healthcare professional to use their clinical acumen to determine whether an individual presentation seems to fit this referenced diagnostic conceptualization.

It is widely known that while interviewing is the most commonly employed approach to ascertain an ADHD diagnosis, it is quite flawed and additional steps are required for diagnostic accuracy. In short, clinical interviews are troubled by issues with validity due to an individual’s poor recall of childhood experiences, lack of insight about ADHD symptoms, and/or the possibility of positive illusory bias.16

(See also, Psycom Pro’s series on the external factors that may influence an ADHD diagnosis).

There are considerable questions involving diagnostic formulation when left to simply rely on information gleaned from personal accounts, outside observers, and/or medical/educational records to depict an individual’s functioning. Marshall et al contend that assessing ADHD on professional judgment “is not enough and the implementation of behavioral rating scales are warranted since they are more precise in quantifying symptom experiences and are therefore potentially more helpful than a clinical interview in clarifying whether the patient experiences ADHD symptoms that meet these two specific criteria.”12

Validity Versus Sensitivity and Specificity

Rating scales often accompany clinical interviews as methods to assess ADHD. There are several broadband and narrowband rating scales that are widely used and well regarded (*see Table I on available assessment tools). The advantages of many of the aforesaid standardized questionnaires include standardization in how they are administered. For instance, multiple sources of feedback are solicited (ie, parent, self, teacher, observer) across a variety of settings (eg, home, school, work) and they can be administered to individuals across the lifespan in person or remotely online (which has been particularly useful during the COVID-19 pandemic). In addition, the completion time for the narrowband measures are reasonable (10 to 20 minute) and validity measures are embedded.

Even with these favorable assets in rating scales, however, there are limitations that hinder this type of assessment tool. Issues involving sensitivity to detect ADHD and specificity to rule out ADHD are arguably a work in progress with all rating scales, particularly with those whose studied comparison groups were typically developing individuals or members of the general population. Marshall et al commented on this shortcoming regarding those in college (although this is applicable to a pediatric population as well), stating that such stu­dents are generally more intelligent and higher functioning in many respects than the general population.12 Consequently, students with ADHD may have scores in the aver­age range on ADHD-related measures while their scores would fall in the impaired range relative to those in college.17

Thus, there continue to be challenges with rating scales involving the accuracy of arriving at ADHD presentations when information is obtained through multiple sources (self, parent, teacher, significant other). As noted, Gioia et al address this in their BRIEF-2 ADHD Form using base rates to enhance the predictive power of impressions by not only identifying those with characteristics of ADHD from other psychiatric conditions but also by using it to delineate the different ADHD presentations.14

The ADHD Clinical Interview

As noted, of the methods used to diagnose ADHD, the clinical interview is the most common approach but it is fraught with concerns given considerable deficiencies involving validity and reliability. Neuropsychological testing employed to help diagnose ADHD does improve upon the weaknesses of a clinical interview in both internal and external validity. Where clinical interviews often fall short, neuropsychological measures provide standardization of the administration of the instruments.

In recent years, there has been an emphasis on ensuring that a normative sample is reflective of the testing population across the lifespan (often based on age, gender, ethnicity, and education) with both typically developing individuals and those within a clinical population. This push facilitates greater confidence in generalizing findings. In other words, whereas a clinical interview assessing ADHD solicits information about executive functioning deficits, neuropsychological testing or performance-based measures affords the evaluator with an opportunity to observe it in action.

(Video) How to Get an Accurate ADHD Diagnosis

Neuropsychological Testing and Performance-Based Measures for ADHD

Impressions from neuropsychological testing can yield fruitful insight for an individual, caregivers, a school, or an employer by identifying weaknesses associated with ADHD in specific areas, the likely real-world consequences of them, and accompanying treatment recommendations based on these challenges. However, research on the diagnostic utility of neuropsychological testing as the sole method to determine ADHD is mixed at best.

There has been considerable discussion as to the clinical utility of neuropsychological evaluation for the diagnosis of ADHD. Sensitivity, specificity, and positive and negative predictive power of specific neuropsychological tests have been insufficient to propose using them as a sole determinant of ADHD diagnosis.1

Notably, neuropsychological testing in clinical practice is conducted without the inclusion of additional sources of information, including rating scales, a clinical interview, and/or a records review. Several studies have examined whether those with ADHD test differently across various facets involving intellect, memory/working memory, attention/concentration, impulse control, mental and motor processing speed and executive functioning. In fact, “the vast majority of individual cognitive tests clearly indicate that many adults with ADHD perform in the normal range and only a minority of them will ren­der an impaired performance on any specific test” according to Nigg et al.18

Further, Barkley has contended neuropsychological assessment may have limited ability to discriminate between adult ADHD and other psychiatric disorders in a psychiatric assessment.19 Yet, one pattern that emerges is that individuals with “ADHD are consistently inconsistent in their performance on neuropsychological tests over time”20 “as they can often rally to focus their attention for brief periods of time on any one test measure”21

By and large, the compositions of neuropsychological batteries differ between practitioners but will frequently include a measure that examines sustained attention and inhibitory response. Often, this measure is a continuous performance test, such as the widely used Conners CPT3 or TOVA-9, which are administered through a computer-based program and entail the rapid presentation of a series of visual or auditory stimuli (eg, numbers, letters, number/letter sequences or geometric figures) over a set timeframe.

Quantitative data on different variables of interest involving omission, commission, and reaction time are associated with inattention, impulsivity, and sustained attention. Among neuropsychological measures, continuous performance tests have been shown to be useful in augmenting the detection of ADHD but are poor ruling out other conditions.22-27

Further, a common criticism of continuous performance tests is that their ecological validity is low. They are unable to simulate the difficulties of patients in everyday life given that they are conducted in controlled settings that remove environmental distractions.28,29

Invalid Symptom Presentations of ADHD

Making testing more complicated is that, as stated throughout the literature, some “individuals may be motivated to feign or exaggerate ADHD symptoms in order to gain medication or accommodations on high-stakes examinations or to enhance their performance in school or at work.1 The percentage of young adults who exhibited invalid symptom presentations during a comprehensive ADHD assessment were considerably elevated from 31% to 53%.30,31

Among college students, the base rate of those malingering seeking medication for ADHD was 10% in a study by Weiss et al.32 Hirsch and Christiansen found that within a significantly older adult population, 32% conveyed an invalid presentation.33

While the data on examining feigning illness in children is an arguably recent body of research that is growing, there is evidence that some children and adolescents do engage in deceptive practices during assessments for secondary gain. In their work on developing the Pediatric Performance Validity Suite (PdPVT), a measure designed to assess the credibility of performance in children/adolescents, McCaffrey, Lynch, Leark, and Reynolds cite a variety of factors why some children and adolescents may malinger.34 Some reasons may relate to seeking a disability diagnosis in order that caregivers may receive disability benefits, to access special services or accommodations at school, or to qualify for various testing programs. In essence, the research has shown that it is rather easy to “fake” symptoms or present oneself in a way that is incongruent with how one is actually functioning.

The economic costs of those who engage in dissimulation are extraordinary. Even with the gains made in possessing representative samples requisite for generalizing findings derived from rating scales, neuropsychological batteries, and tests administered as part of the evaluation to assess ADHD, the accuracy of the diagnostic impressions are a function of whether the person performed or answered faithfully.

Questions as to whether one is being disingenuous during an evaluation have been a focus of research and clinical practice for more than 40 years. Research suggests that the accuracy of an ADHD diagnosis is contingent upon the employment of validity scales and whether they are delivered in freestanding instruments solely examining dissimulation or in integrated component/scales that examine a range of areas, such as sustained attention and socio-emotional/behavioral functioning. Clinicians have attempted to address the possibility of invalid presentations by implementing symptom validity, performance validity, or effort testing in the form of standalone instruments solely focused on this area (ie, deception). Some validation tools have been directly embedded in measures that attempt to elicit these response styles (eg, scales capturing faking good/bad or infrequency).

Discussion of ADHD Assessments: Which Tool is Best for Diagnosis?

In short, there is no one-size-fits-all diagnostic tool to assess ADHD. Myriad factors come into play including:

  • the psychometric properties of evaluation methods, including validity, sensitivity versus specificity, and positive and negative predictive power
  • the heterogeneity of neuropsychological test batteries based upon the evaluator’s training, familiarity with instruments, financial means, and challenges of complete objectivity
  • concerns about patients/clients feigning illness/symptoms

Kirk and Boada posit that the:

“complexity in this diagnostic process arises because clinically significant symptoms of inattention, hyperactivity, and impulsivity are not confined to ADHD. They occur in many other developmental psychiatric and neurological conditions. Additionally, children with ADHD often have comorbid learning and psychiatric disorders that require appropriate evaluation in their own right, so that a comprehensive treatment plan can be devised.”1

(Video) Assessment of Adult ADHD: Clinical Interview and Rating Scales

Given these factors, this writer supports the recommendation by Gioia et al that an evidenced-based assessment be carried out to make an accurate ADHD diagnosis.14 This means using one’s clinical expertise to integrate the best available research within the context of an individual patient’s history, observations, and test data to guide clinical decision-making.

In doing so, more accurate clinical decisions are likely, ultimately improving patient outcomes. With this in mind, the following are considered best practices and recommended by Weiss et al to validate an ADHD diagnosis:32

  • Use norm-referenced scales to determine the presence of significant symptoms that are incongruent with developmental expectations. Author’s Note: these should include validity measures that assess for deception.
  • Use supplementary sources of information such as academic or medical records or even accounts of developmental history shared by caregivers than relying on self-report recall of childhood symptomology as the latter is not viewed as a reliable method.
  • Assess across settings (eg, school, home, work)
  • Examine the level of impairment with everyday functioning. It is arguably more important and reliable to consider functional impairment than solely assessing symptom count or severity. It is well known that some individuals with marked severity in symptoms have learned compensatory strategies to function effectively, whereas others who may not meet all symptom criteria on the DSM-V ADHD diagnosis, but have pronounced difficulties meeting expected daily demands.
  • Rule out alternative explanations that may account for symptoms associated with ADHD such as physical ailments (eg, endocrine disorders, hypoglycemia, hearing impairment, traumatic brain injury), reactions to medications/treatments (eg, chemotherapy/radiation), sleep disorder, and possibly feigning the condition.

Professional Takeaways

Since the year 2000, considerable advancements have been made in our clinical understanding of ADHD, including comprehending the neuroscience and genetic factors involved with this condition, its presentation and influence on development and functioning over the course of a lifespan, and the financial costs to our society. As a result of this knowledge and valid methodology, ADHD treatment methods have become more reliable.

That said, clinical assessment approaches to ADHD diagnosis remain a work-in-progress. In addition to the suggestions cited in this article to improve ADHD evaluations, forthcoming tools aim to delineate cultural and gender influences in ADHD presentations, recognize differences in the manifestation of ADHD over the lifespan, include questions about sleep disturbance (given the strong correlation), and encourage a shift to digital platforms. Digital technologies such as virtual reality for continuous performance tests, for example, may soon improve the ecological validity (eg, immersing one in a school or work environment) of assessment and potentially capture valuable and objective data involving head movement and visual scanning, thereby augmenting the sensitivity and specificity of ADHD assessment measures.

Part 2 of this special report will dive into what’s on the horizon for ADHD assessments.

Related Articles

More on ADHD diagnosis, assessment, and treatment.

ADHD Across the LifespanNew ADHD Medications

References

Last Updated: Mar 9, 2022

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FAQs

ADHD Diagnosis: The Most Accurate Assessment Tools? ›

ADHD cannot be diagnosed accurately just from brief office observations or simply by talking to the person. The person may not always exhibit the symptoms of ADHD during the office visit, and the diagnostician needs to take a thorough history of the individual's life.

What is the most accurate way to diagnose ADHD? ›

To diagnose ADHD, your child should have a full physical exam, including vision and hearing tests. Also, the FDA has approved the use of the Neuropsychiatric EEG-Based Assessment Aid (NEBA) System, a noninvasive scan that measures theta and beta brain waves.

Can ADHD be falsely diagnosed? ›

Overall, the study found that about 20 percent – or 900,000 – of the 4.5 million children currently identified as having ADHD likely have been misdiagnosed.

Is there a downside to an ADHD diagnosis? ›

The Cons. People with ADHD find that their thoughts don't really go at a gentle pace, and rarely stick to the same train of thought. Thoughts race and jumble, with focus skipping from one topic to another. Thoughts are sometimes unfiltered and even skipped over.

Can ADHD be seen on a brain scan? ›

Brain magnetic resonance imaging (MRI) can be used to identify people with attention-deficit/hyperactivity disorder from patients without the condition, according to a new study.

What is the gold standard for ADHD testing? ›

The “gold standard” for ADHD diagnosis includes a comprehensive clinical history and examination, rating scales, direct behavioral observations, neuropsychological testing, and objective, comparative analysis of different drug effects.

A thorough ADHD diagnosis includes symptom tests and interviews, plus a through medical history and evaluations for conditions commonly diagnosed alongside ADD — namely ODD, OCD, anxiety, depression, and autism spectrum disorder. It's a complicated process — as it should be to ensure accuracy. Here, learn what to expect from start to finish.

Testing alone cannot diagnose symptoms of ADHD.. You want to get an evaluation — to take an ADHD test .. If your child is being evaluated, the doctor will talk to you and your child, and get feedback through checklists and written information from teachers and other adults who spend a lot of time with your child.. By the time the clinical interview is over, most doctors with experience treating people with ADHD will have a good idea of whether you or your child has the condition.. “An accurate diagnosis is good news,” Hallowell says, “because things can only get better.

Diagnosing ADHD in Adults You keep losing your keys, feel you can never finish anything at work, or maybe have had a family member say “you might have ADHD.”  Whatever the reason, getting a proper diagnosis of ADHD is the first step of getting treatment.  It is important to ultimately gaining control over symptoms that…

Although there is no single medical, physical, or genetic test for ADHD, a diagnostic evaluation can be provided by a qualified mental health care professional or physician who gathers information from multiple sources.. These sources include ADHD symptom checklists, standardized behavior rating scales, a detailed history of past and current functioning, and information obtained from family members or significant others who know the person well.. A diagnosis of ADHD is determined by the clinician based on the number and severity of symptoms, the duration of symptoms and the degree to which these symptoms cause impairment in various areas of life, such as home, school or work; with friends or relatives; or in other activities.. If the individual exhibits a number of ADHD symptoms but they do not cause significant impairment, s/he may not meet the criteria to be diagnosed with ADHD as a clinical disorder.. Although some ADHD symptoms are evident since early childhood, some individuals may not experience significant problems until later in life.. These include a thorough diagnostic interview, information from independent sources such as the spouse or other family members, DSM-5 symptom checklists, standardized behavior rating scales for ADHD and other types of psychometric testing as deemed necessary by the clinician.. The examiner will also conduct a detailed review to see if other psychiatric disorders that may resemble ADHD or commonly co-exist with ADHD are present.. Many of these conditions have symptoms that can mimic ADHD symptoms, and may, in fact, be mistaken for ADHD.. And, crucially, when the ADHD symptoms are a secondary consequence of depression, anxiety or some other psychiatric disorder, failure to detect this can result in incorrect treatment of the individual for ADHD.. Other times, treating the ADHD will eliminate the other disorder and the need to treat it independently of ADHD.. The examiner will look for patterns that are typical in individuals with ADHD and also try to determine if factors other than ADHD may be causing symptoms that look like ADHD.. These do not diagnose ADHD directly but can provide important information about ways in which ADHD affects the individual.. Some medical conditions, such as thyroid problems and seizure disorders, can cause symptoms that resemble ADHD symptoms.. Towards the end of the evaluation the clinician will integrate the information that has been collected through diverse sources, complete a written summary or report, and provide the individual and family with diagnostic opinions concerning ADHD as well as any other psychiatric disorders or learning disabilities that may have been identified during the course of the assessment.

After carefully evaluating your symptoms, a qualified healthcare provider can determine if a person has attention deficit hyperactivity disorder (ADHD).

If you suspect that you, your child, or a loved one may have untreated attention deficit hyperactivity disorder (ADHD) , a helpful first step is learning how to receive a diagnosis.. According to the American Psychiatric Association (APA), an estimated 5% of children and 2.5% of adults are living with ADHD at any time.. To determine whether you have ADHD, they’ll complete a comprehensive assessment using the diagnostic criteria set out in the APA’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the national standard for the appropriate diagnosis and treatment of mental health conditions in the United States.. For children and adolescents ages 4 to 18, healthcare providers such as pediatricians , psychiatrists, and child psychologists can screen for and diagnose ADHD, per guidelines from the DSM-5 and the American Academy of Pediatrics (AAP).. Children up to age 16 must often experience six or more symptoms of inattention and/or hyperactivity and impulsivity, while adolescents 17 years and older and adults must have five or more symptoms of inattention and/or hyperactivity and impulsivity.. Symptoms of inattention include:. They’re present in two or more settings (such as school, work, or social life).. To diagnose a child with ADHD, a healthcare provider will complete the following steps:. Interview parents or guardians, school staff, and mental health practitioners involved with the child about their academic or behavioral problems (such as struggles with grades or maintaining friendships) Assess the child’s symptoms using tools such as behavior rating scales or checklists to ensure DSM-5 criteria for an ADHD diagnosis are met Complete a physical exam and order laboratory or other tests to rule out other conditions with similar symptoms, such as a seizure disorder , thyroid disorder , sleep disorders , or lead poisoning Run additional screening tests for co-occurring or other mental health conditions, including depression , anxiety , learning and language disorders, autism spectrum disorder , oppositional defiant disorder, conduct disorder, and tic disorders. Depending on the child’s symptoms, you may also need a referral to meet with a pediatric specialist for additional screenings for conditions like developmental disorders or learning disabilities.. For adults, the process of receiving an ADHD diagnosis is similar.. Interview you about your symptoms in the present and during your childhood Assess your symptoms per DSM-5 criteria using diagnostic tools such as behavioral rating scales and symptoms checklists In some cases, request additional interviews with your partner, parent, close friend, or others Complete a physical exam to rule out other potential causes for symptoms Screen for co-occurring or other mental health disorders such as a mood disorder, anxiety disorder , dissociative disorder , or personality disorder. At the end of your appointment, your healthcare provider will share whether or not you have ADHD as well as other health conditions.. After that, they’ll discuss treatment options with you and, if necessary, refer you to specialists for further screening and care.. Diagnosis of ADHD in Adults .

Attention deficit hyperactivity disorder, known as ADHD, is a complex condition that can be difficult to diagnose. There are several different types of ADHD rating scale used to diagnose the condition. These all look at the symptoms and behaviors that the person displays. Learn more about the ADHD rating scale here.

The ADHD rating scale uses questions about a person’s behavior to evaluate their likelihood of having attention deficit hyperactivity disorder.. To get a complete picture of an individual, it is essential that a variety of people, including relatives and teachers, complete the rating scale forms.. Doctors use the information collected from the rating scale forms to help them make a diagnosis and recommendations for treatment.. Share on Pinterest The ADHD rating scale will include questions about typical behaviors.. They will often include a selection of questions about how often the person in question displays ADHD-related behaviors and symptoms of hyperactivity, impulsivity, and inattentiveness.. The ADHD rating scale will contain questions about typical behaviors including:. There are different ADHD rating scale tests designed specifically for children, teenagers, and adults.. Behavior Assessment System for Children (BASC-3), designed for people aged 2 to 21 National Institute for Children’s Health Quality (NICHQ) Vanderbilt Assessment Scale, intended for ages 6 to 12 Conners Comprehensive Behavior Rating Scale (CBRS), intended for ages 6 to 18 Child Behavior Checklist (CBCL), created for ages 6 to 18 Swanson, Nolan, and Pelham-IV Questionnaire (SNAP-IV), for children aged 6 to 18 Conners-Wells’ Adolescent Self-Report Scale, specifically for teenagers. Brown Attention-Deficit Disorder Symptom Assessment Scale for Adults (BADDS) Adult ADHD Clinical Diagnostic Scale (ACDS) ADHD Rating Scale-IV With Adult Prompts (ADHD-RS-IV) Adult ADHD Self-Report Scale (ASRS). The scoring for ADHD rating scales varies according to the choice of test and the age of the person under consideration.. If a child displays at least six behaviors suggesting inattention or hyperactivity with a score of 2 or 3, the healthcare professional will consider diagnosing ADHD.. the behaviors must be present in two or more settings the behaviors must be inappropriate for the person’s age the behaviors must interfere with and reduce the quality of a person’s daily life or basic functioning in social settings there should be no other condition that could better explain the symptoms the person must have presented several behaviors before the age of 12. A doctor may request that parents ask their child’s teachers to fill out rating scales forms.. If the scores indicate ADHD, doctors are likely to begin a conversation about various ADHD treatment options.

Autism and ADHD coexist at significantly elevated rates, and adults with both disorders face unique challenges. Symptoms of both conditions can resemble one another – one reason why clinicians typically screen for both during assessment. While research on adult autism and ADHD is scarce, clinicians largely agree on best practices in the evaluation and treatment of patients with both disorders.

Autism spectrum disorders (ASD) and attention deficit hyperactivity disorder (ADHD) are commonly co-occurring conditions with significantly elevated prevalence rates.. Despite anemic research beyond childhood, there is a growing clinical consensus regarding approaches to evaluation, treatment, and support for autistic adults with a co-occurring ADHD diagnosis.. The Autism Diagnostic Observation Schedule-2 (ADOS) includes a clinical interview and observation of the patient’s non-verbal communication and other social skills, as well as observation of repetitive behaviors.. Common diagnostic differentials for autism include social anxiety, generalized anxiety disorder , ADHD , and obsessive compulsive disorder (OCD).. ADHD is characterized by symptoms of inattention, hyperactivity, and/or impulsivity – different from the social communication symptoms and restricted behaviors associated with autism.. Differential psychiatric assessments as well as other diagnostic tools can help clinicians determine whether this symptom stems from distractibility (which indicates ADHD) or from deficits in social-emotional reciprocity and nonverbal communication (which indicate autism).. That’s according to a recent study involving 724 autistic adults who were asked about the frequency and severity of behaviors associated with autism and ADHD, their quality of life, and other aspects of living.. There are currently no studies available on the use of ADHD treatments with adults with both ADHD and autism diagnoses.. Clinicians, however, generally agree on the supports and therapeutic interventions that matter most to autistic adults with ADHD — and which ones increase independence and improve quality of life, as highlighted in a recent paper authored by ASD and ADHD researchers.. Identifying realistic career goals Seeking volunteer opportunities to learn about the work environment Using supports for completing applications and job interviews Identifying and seeking adjustments and accommodations at work or school (Standardized accommodations like extended time on tests, for example, may not be suitable for autistic adults with an ADHD diagnosis, who may benefit more from a mid-point break) Coaching to support long-term goals Using strategies to aid concentration and reduce anxiety Adopting assistive technology devices Making use of organizational supports (peer systems, skills training)

ADHD and auditory processing disorder (APD) often occur together, and have some similar symptoms, making diagnosis difficult. Learn more.

Attention deficit hyperactivity disorder (ADHD) and auditory processing disorder (APD) often occur together.. People with any learning disability, developmental diagnosis, or psychological condition — especially ADHD and autism — may need screenings for auditory processing disorder and additional support for APD symptoms.. Keep reading to learn more about ADHD and auditory processing disorder, including the key differences, diagnosis, and treatment and management for both conditions.. People with ADHD may have trouble processing sensory input, including auditory information.. Tests for auditory processing disorder may help distinguish ADHD from APD.. For example, the Sensory Processing 3-Dimensions Scale can detect sensory processing issues, including auditory processing challenges.. People with ADHD may experience sensory processing issues, while those with APD may have ADHD or symptoms similar to ADHD.

CDC uses datasets from parent surveys and healthcare claims to understand diagnosis and treatment patterns for ADHD.

1 Black, non-Hispanic children and White, non-Hispanic children are more often diagnosed with ADHD (12% and 10%, respectively), than Hispanic children (8%) or Asian, non-Hispanic children (3%).. 1 Estimates for ADHD vary by state: 2 ADHD diagnosis among children aged 3–17 years: State estimates vary from 6% to 16%.. Any ADHD treatment among children with current ADHD: State estimates vary from 58% to 92% ADHD medication: State estimates vary from 38% to 81% ADHD behavior treatment: State estimates vary from 39% to 62%. A national parent survey from 2016 1 reported on medication and behavior treatment for children 2–17 years of age with current ADHD:. About 32% children with ADHD received both medication treatment and behavior treatment.. About 23% children with ADHD were receiving neither medication treatment nor behavior treatment.. About 3 in 4 children ages 2–5 years who had clinical care for ADHD recorded in their healthcare claims from 2008–2014 received ADHD medication, and fewer than half received any form of psychological services.. Note: It is not known what types of psychological services these children received, or whether these children received behavior treatments that were not entered into the healthcare claims data.

"ADD" is an outdated term for "ADHD," but there is confusion. "ADD" is sometimes used to describe a type of ADHD. Learn about ADHD and its differences.

Attention deficit hyperactivity disorder ( ADHD ) is a behavioral condition that includes challenges relating to overactivity and difficulty paying attention to the point that it interferes with everyday life.. "Attention deficit disorder (ADD)" is an outdated term that is no longer officially used.. Learn about ADHD, the former subtypes of ADHD and why they are no longer officially used, how the term "ADD" is unofficially used, and more.. "ADHD" is the abbreviation for "attention deficit hyperactivity disorder"—the current, official term used to describe the behavioral condition of overactivity and difficulty paying attention.. Other people use the term "ADD" to describe a presentation of ADHD called inattentive ADHD, or inattentive and distractible ADHD.. Impulsive and hyperactive ADHD : May include difficulty with organization, paying attention, or listening Inattentive and distractible ADHD (sometimes unofficially called ADD) : May include difficulty being still, waiting, or remaining quiet Combined ADHD : Includes both impulsive and hyperactive ADHD and inattentive and distractible ADHD, and is the most common type of ADHD.. Presentation : People are diagnosed with the condition but it may show up in different ways, with different symptoms over the years.. It is no longer possible to be diagnosed with "ADD" because the term has been replaced with ADHD.. Some people may refer to the inattentive presentation of ADHD as ADD, but that is not an official term.. Predominantly hyperactive-impulsive : A person must show symptoms of inappropriate overactivity or a frequent tendency to act without thinking.. Attention deficit hyperactivity disorder, or ADHD, is a behavioral condition that may include difficulty paying attention, overactivity challenges, and issues with impulsiveness.. "Attention deficit disorder" and "ADD" are outdated terms for the condition that was replaced by "ADHD" in 1987.. If you or someone you know has or may have ADHD, help is available.

Videos

1. ADHD Diagnosis Criteria Explained
(Purple Ella)
2. Learn more about Conners CPT 3 & Conners CATA
(MHS Assessments - Clinical and Education)
3. Diagnosis, Evaluation, and Treatment of ADHD Under the BASC-3 Model of Assessment and Intervention
(Pearson Assessments US)
4. ADHD Tools
(CHADIS)
5. How to Get a Neurodivergent Diagnostic Assessment
(Exceptional Individuals)
6. QbTest - how it works
(Qbtech)

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