ADHD—How Is Attention-Deficit/Hyperactivity Disorder Diagnosed?

How is ADHD diagnosed?

Your child's or teen's doctor will determine whether your child or teen has ADHD by using standard guidelines developed by the American Academy of Pediatrics specifically for children, teens, and young adults 4 to 18 years of age.

It is difficult to diagnose ADHD in children younger than 4 years. That is because younger children change very rapidly. It is also more difficult to diagnose ADHD once a child becomes a teen.

There is no single test for ADHD. The process requires taking several steps and involves gathering information from multiple sources. You, your child, your child's school, and other caregivers should be involved in observing your child.

Children with ADHD show signs of inattention, hyperactivity, and/or impulsivity in specific ways. (See the behaviors listed in Table 1.) Your child's doctor will consider how your child's actions compare with other children's their age by using the information reported about your child by you, their teacher, and any other caregivers who spend time with your child, such as coaches, grandparents, or child care providers.

Here are guidelines used to confirm a diagnosis of ADHD.

• Some symptoms occur in 2 or more settings such as home, school, and social situations and cause some impairment.

• In a child or teen 4 to 17 years of age, 6 or more symptoms must be identified.

• In a teen or young adult 17 years or older, 5 or more symptoms must be identified.

• Symptoms significantly impair your child's ability to function in some daily activities, such as doing schoolwork, maintaining relationships with parents and siblings, building relationships with friends, or having the ability to function in groups such as sports teams.

Your child's doctor will conduct a physical and neurological assessment. A full medical history is needed to put your child's action into context and screen for other conditions that may affect behavior. Your child's doctor will also talk with your child about how they act and feel.

Your child's doctor may refer your child to a pediatric subspecialist or mental health care professionals if there are concerns of

• Intellectual disability (formerly called mental retardation)

• Developmental disorder, such as in speech, coordination, or learning

• Chronic illness being treated with a medication that may interfere with learning

• Trouble seeing and/or hearing

• History of abuse

• Major anxiety or major depression

• Severe aggression

• Possible seizure disorder

• Possible sleep disorder

How can parents help with the diagnosis?

As a parent, you can provide crucial information about your child's actions and how they affect life at home, in school, and in other social settings. Your child's doctor will want to know what symptoms your child is showing, how long the symptoms have occurred, and how these affect your child and your family. You will likely be asked to fill in checklists or rating scales about your child's actions.

In addition, sharing your family history can offer important clues about your child's behavior.

How will my child's school be involved?

For an accurate diagnosis, your child's doctor will need to get information about your child directly from their classroom teacher or another school professional. Children at least 4 years and older spend many of their waking hours at preschool or school. Teachers provide valuable insights. Your child's teacher may write and send a report or discuss the following topics with your child's doctor:

• Your child's actions in the classroom

• Your child's learning patterns

• How long the symptoms have been a problem

• How the symptoms are affecting your child's progress at school

• Ways the classroom program is being adapted to help your child

• Whether other conditions may be affecting the symptoms

• If there are evaluations and support the school can provide

In addition, your child's doctor may want to see report cards, standardized test results, and samples of your child's schoolwork.

How will others who care for my child be involved?

Other caregivers may also provide important information about your child's actions. Former teachers, religious and scout leaders, grandparents, or coaches may have valuable input. If your child is homeschooled, it is especially important to assess their actions in settings outside the home.

Your child may not behave the same way at home as they do in other settings. Direct information about the way your child acts in more than one setting is required to make a diagnosis. It is important to consider other possible causes of your child's symptoms in these settings.

In some cases, other mental health care professionals, such as child psychologists or psychiatrists, may also need to be involved in gathering information for the diagnosis.

Are there other tests for ADHD?

You may have heard theories about other tests for ADHD. There are no other proven diagnostic tests at this time.

Many theories have been presented, but studies have shown that the following evaluations add little value in diagnosing the disorder:

• Screening for thyroid problems

• Computerized continuous performance tests

• Brain imaging studies, such as computed tomography (CT) and magnetic resonance imaging (MRI)

• Electroencephalography (EEG) or brain-wave testing

Although these evaluations are not helpful in diagnosing ADHD, your child's doctor may see other signs or symptoms in your child that warrant additional tests.

What are coexisting conditions?

As part of the diagnosis, your child's doctor will look for other conditions that cause the same types of symptoms as ADHD does. Your child may simply have a different condition or ADHD combined with another condition (a coexisting condition). Most children with a diagnosis of ADHD have at least one additional condition.

Common coexisting conditions include learning disabilities; oppositional defiant disorder or conduct disorder; anxiety disorders; mood disorders, including depression; and language disorders.

Visit HealthyChildren.org for more information.