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The ADHD Diagnostic Process

An evaluation for ADHD should be comprehensive and multidimensional and capture home, school or work and social functioning.  The process for diagnosing ADHD may include the following:

  1. Initial Screening Evaluation



    • Begin with an initial interview to determine if ADHD may be contributing to an individual’s social, emotional, behavior, academic or work challenges.
    • Using the presentation criteria in the DSM-5, determine if the individual exhibits the number and type of symptoms indicating that ADHD may be present.If so, proceed to a full evaluation.



  2. Comprehensive Evaluation for ADHD



    1. Conduct in-depth interviews with the individual and the people knowledgeable about the individual: for children and teens include parents and caregivers; for adults consider a separate interview with spouses or partners. The interview should include a thorough history of the individual’s core symptoms:
      • What are the specific symptoms?
      • When are the symptoms present?
      • Do they occur in different situations or the same one?
      • At what age did the symptoms start?
      • How long do the symptoms typically last? Are they pervasive?
      • Are there any precipitants to the symptoms?
      • Is there anything that seems to lessen the symptoms?
      • To what degree do the individual’s symptoms interfere with routine and age appropriate functioning?



    2. Complete a bio-psycho-social assessment that includes history related to:
      • Prenatal and early developmental history and milestones
      • Medical history, including illnesses, injuries and hospitalizations
      • Family history, including any incidents of violence, disruption or separation
      • Current functioning: describe a typical day
      • Any co-occurring concerns: depression, anxiety, learning disabilities, anger management challenges, oppositional behavior, among others
      • Academic or work history:challenges and areas of success
      • Strengths, talents, unique abilities and coping skills
      • Family and social relationships
      • Substance use
      • Temperament and mental status
      • Any history of family ADHD or co-occurring disorders



    3. For child or teen patients/clients, conduct a separate interview or child play session to discuss and/or observe the concerning behaviors.



    4. Administer ADHD behavior and self-report rating scales.



    5. Ask that relevant rating scales be completed by others who interact regularly with the individual (family members, school or daycare providers), as appropriate.



    6. If possible, observe child patient/client in school or “natural” setting



    7. Make referrals, as appropriate, for additional assessments:
      • A medical, pediatric or neurodevelopmental screening to rule out any ADHD-like medical conditions
      • A psychiatric evaluation for co-occurring disorders that may be present and to assess for the need/benefit of medication treatment
      • Psychological testing for possible learning disabilities
      • A vision, speech/language and/or hearing screening



    8. Schedule subsequent appointment to:
      • Review rating scales completed by those involved in the individual’s daily life
      • Review school records
      • Review any pertinent medical records
      • Review other assessment information
      • Finalize the assessment process and share findings, including diagnosis
      • Develop joint treatment plan with adult or family

 

What else should I consider when diagnosing ADHD?

Since many symptoms of ADHD resemble those of other co-occurring disorders, it is important to assess for these to ensure an accurate diagnosis.  These can include:

  • Oppositional defiant disorder
  • Intermittent explosive disorder
  • Specific learning disorder
  • Autism spectrum disorder
  • Intellectual disability
  • Reactive attachment disorder
  • Bipolar disorder
  • Disruptive mood dysregulation disorder
  • Personality disorders
  • Substance use disorders
  • Depressive disorders
  • Anxiety disorders
  • Other neurodevelopmental disorders
  • Psychotic c disorders
  • Medication-induced symptoms
  • Neurocognitive disorders
  • Post-traumatic event symptoms/disorder
     


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