The previous post described the specific symptoms that are needed for an Attention-Deficit Hyperactivity Disorder (ADHD) diagnosis. The goal of this post is to describe how healthcare providers establish an ADHD diagnosis.
There is no test (blood test, brain scan, etc.) that can diagnose ADHD. The diagnosis is made when patients have a pattern of inattention (difficulty staying focused on tasks) and/or hyperactivity (constant, sometimes disruptive, activity) and impulsivity (acting “on a whim” or without considering the consequences) that interferes with normal functioning or development. The specific symptoms needed for the diagnosis were described in a previous post and are listed in the DSM (Diagnostic and Statistical Manual of Mental Disorders, 5th Edition).1 To evaluate these symptoms, the healthcare provider will perform a thorough history and physical examination and often will ask that parents, teachers, and patients complete questionnaires about ADHD symptoms. Sometimes the healthcare provider will be able to observe signs of a child’s inattention and hyperactivity-impulsiveness in the office, but the lack of symptoms during the office visit does not exclude the diagnosis.
It is important that the healthcare provider is able assess ADHD symptoms fully across different settings including at home, during school, and during social activities. Functioning during home and during social activities can be reported by parents and by older patients. Teacher reports are helpful to address functioning in school. Grades alone do not provide a complete picture. The healthcare provider will want to know about symptoms of inattention, hyperactivity, and impulsivity while the child is in the classroom. It can be helpful to ask teachers to provide written letters describing the student’s classroom functioning or to complete ADHD-specific behavioral questionnaires. Often, your healthcare provider will give you copies of the teacher questionnaire(s).
Some medical disorders can cause ADHD-type symptoms or make symptoms worse for patients with ADHD. For example, sleep problems can affect daytime functioning. When patients with ADHD have sleep problems, the poor nighttime sleep can account for some of the daytime symptoms.2 Comorbid conditions can also be present. A comorbid condition is defined as an additional medical problem found commonly with the primary condition, in this case ADHD. Approximately one third of patients with ADHD have at least one comorbid condition.3 These include sleep problems, anxiety, depression, speech difficulties, conduct disorder, and learning disorders.
To identify medical problems that can worsen ADHD symptoms or are commonly seen as comorbid conditions, healthcare providers conduct thorough medical histories and physical examinations. The physical examination should include vision and hearing screens. Review of the family history is also important as genetics appear to play a role in ADHD.
The next posts will describe other features of ADHD and its treatment.
1American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 5th ed. Washington, D.C.: American Psychiatric Association; 2013
2Sung V, Hiscock H, Sciberras E, Efron D. Sleep problems in children with attention-deficit/hyperactivity disorder: prevalence and the effect on the child and family. Arch Pediatr Adolesc Med. 2008;162:336-342.
3Larson K, Russ SA, Kahn RS, Halfon N. Patterns of comorbidity, functioning, and service use for US children with ADHD, 2007. Pediatrics. 2011;127:462-470.