How is ADHD Diagnosed?

By Ben Martin, Psy.D.

Table of Contents:

While the symptoms of attention deficit disorder (ADHD) may appear commonplace in many people’s behavior (as many symptoms for mental disorders are), there are a set of specific diagnostic criteria used by trained mental health professionals to make the diagnosis.

The official diagnostic criteria for ADHD state that the symptoms must occur beyond the extent that is normal for the person’s age, and must occur in a variety of different situations (e.g., not just school). For a diagnosis of ADHD, the symptoms must also have appeared before the age of 7 (for childhood ADHD), and have continued for at least 6 months.

Impairments due to the symptoms of ADHD must also have been observed in at least two different settings, such as at school, at work, in the community, at social events, or at home. For example, a child who is overly active in the playground but has no problems concentrating on their schoolwork may not be appropriate for a diagnosis of ADHD.

So the critical questions to consider before an ADHD diagnosis is made are whether the symptoms are: (a) excessive compared with what would be expected; (b) longer-term rather than in response to a recent change; and (c) pervasive rather than limited to one environment.

ADHD Diagnosed in Children

The signs of possible attention deficit disorder may first be noticed long before the child begins school. Their lack of attention, hyperactivity, and impulsivity may be seen when these lose interest in playing a game or watching a TV show, or if the child runs around and seems completely out of control. Parents may feel it is necessary to contact a pediatrician or a child psychologist to undergo an assessment of whether or not their child’s behavior is appropriate for their age. Often they will be reassured that the child is behaving within normal limits and is just unusually exuberant or a little immature for their developmental stage.

Sometimes it’s another adult who first suspects that a child may have attention deficit disorder, such as a babysitter or teacher. Teachers with experience of the disorder are particularly well-placed to identify the symptoms of ADHD, especially as the symptoms are particularly evident in the school environment when teachers have come to know how children “typically” behave. The inattentive form of ADHD may be missed for some time in pupils who are seemingly cooperative.

Once a specialist is consulted, the professional will begin to gather information on the child’s unusual behavior and rule out possible causes other than ADHD, for example:

  • A sudden change in the child’s life, such as death of a close relative, divorce, or a parent’s job loss
  • Previously undetected seizures
  • Middle ear infection, which can cause hearing problems
  • Other types of medical disorder that may be affecting the child’s brain
  • Learning disability
  • Anxiety and/or depression

These factors can usually be ruled out with help from the parents and school, but tests may be necessary. Alongside this information, the specialist will find out how the child’s behavior is currently being handled, and look into the nature of the child’s home and school to find out if they are unusually stressful or chaotic.

The child will then be assessed directly, and their behavioral symptoms will be observed in a range of environments and compared against those set out in the diagnostic manual. The specialist will give special attention to the child’s behavior during situations which call for the most self-control, and noisy or unstructured situations such as parties. Their response to during needing sustained attention (reading, working math problems, or playing a board game) will be observed.

This data will allow the specialist to pieces together a profile of the child, finding out which specific ADHD symptoms the child shows, how often, and in which situations. Children with ADHD will vary on their age when symptoms began, the pattern of symptoms – whether they are chronic or come and go in phases, and the extent to which they interfere with aspects of the child’s life such as friendships, school activities, home life, and community activities.

Other related problems, if they exist, may also be identified during diagnosis.

The assessment will include speaking with teachers who have taught the child since they began school. Standard evaluation forms — known as behavior rating scales — are filled in by the teachers, rating their observations of the child’s behavior. Results are then compared with what would be considered “normal”.

Interviews also take place with the child’s teachers, parents, and possibly other adults who know the child well. They will be questioned on how the child behaves in many settings, and may be given a rating scale to mark the severity and frequency of the behavior.

Further tests that are often given include: social adjustment, mental health, intelligence, and learning achievement.

 

APA Reference
Martin, B. (2007). How is ADHD Diagnosed?. Psych Central. Retrieved on October 24, 2014, from http://psychcentral.com/lib/how-is-adhd-diagnosed/0001203
Scientifically Reviewed
    Last reviewed: By John M. Grohol, Psy.D. on 30 Jan 2013
    Published on PsychCentral.com. All rights reserved.