Although many attempts have been made to identify ADHD using standardized psychological testing, there is no standard test or set of tests to diagnose ADHD. The diagnosis is a matter of degree and must be made by a mental health professional with experience in this area who has thoroughly assessed your child’s behavior in a variety of situations.
Family and teachers or employers (in the case of teens or adults) must be involved in this process. All the elements of the evaluation are matters of opinion, expectation, and comparison. Furthermore, all the behaviors associated with ADHD are normal, to some degree, in all children at certain stages of development.
It is important to identify other possible causes for the inappropriate behavior. This may include:
Physical conditions such as
- Environmental challenges such as family problems
- Psychiatric disorders
- Learning disabilities
Children with ADHD often have other problems, such as:
Comprehensive testing and evaluation is key to properly assessing your child.
The most detailed diagnostic criteria are found in the
Diagnostic and Statistical Manual of Mental Disorders. Because most cases of ADHD are diagnosed in childhood, diagnostic criteria are geared toward children.
The American Academy of Pediatrics recommends that the following guidelines be used for diagnosis in children 4-18 years old:
Evaluation should be initiated if a child shows signs of:
- Poor school performance
- Behavior problems
During diagnosis, the following information should be gathered directly from parents, caregivers, teachers, or other school professionals:
- Assessment of symptoms of ADHD in different settings (home and school)
- Age at which symptoms started
- The degree to which the behavior affects the child's ability to function
The healthcare professional should examine the child for other conditions that might be causing or aggravating symptoms, such as:
For a diagnosis of ADHD to be made, symptoms must:
- Be present in two or more of the child's settings (home, school, activities)
- Have started by the time the child is seven years of age
- Make it hard to function at school, at home, and/or in social situations
- Interfere with the child's ability to function for at least six months
Connors Continuous Performance Testing (CPT), a computerized attention test, is often used to help confirm the diagnosis of ADHD. Examples of standardized behavior checklists that also assist in diagnosing ADHD include:
- Achenbach Behavioral Checklist
- ADD-II Comprehensive Teacher Rating Scale (ACTeRS)
- Child Behavior Rating Scale
- Copeland Symptom Checklist for Attention Deficit Disorder
- Conners Rating Scales
- Vanderbilt Rating Scale
ADHD basics. American Academy of Pediatrics Healthy Children website. Available at:
http://www.healthychildren.org/English/health-issues/conditions/adhd/Pages/ADHD-Basics.aspx. Accessed August 14, 2012.
The Nemours Foundation website. Available at:
http://kidshealth.org/parent/medical/learning/adhd.html. Accessed August 14, 2012.
Attention-deficit hyperactivity disorder (ADHD) in children. EBSCO DynaMed website. Available at:
http://www.ebscohost.com/dynamed/what.php. Updated April 11, 2012. Accessed August 14, 2012.
Attention-deficit hyperactivity disorder (ADHD) in adults. EBSCO DynaMed website. Available at:
http://www.ebscohost.com/dynamed/what.php. Updated April 25, 2012. Accessed August 14, 2012.
Attention deficit hyperactivity disorder (ADHD). National Institute of Mental Health website. Available at:
http://www.nimh.nih.gov/health/publications/attention-deficit-hyperactivity-disorder/what-is-attention-deficit-hyperactivity-disorder.shtml. Accessed August 14, 2012.
Attention-Deficit/Hyperactivity Disorder: Management. American Family Physician. Available at:
http://familydoctor.org/familydoctor/en/diseases-conditions/attention-deficit-hyperactivity-disorder-adhd.html. Accessed August 14, 2012.
American Psychiatric Association.
Diagnostic and Statistical Manual for Mental Disorders. 4th ed. Text Revision. Washington, DC: American Psychiatric Association; 2000.
Stern T, Rosenbaum J, Fava M, Biederman J, Rauch S.
Massachusetts General Hospital Comprehensive Clinical Psychiatry.
Philadelphia, PA: Mosby Elsevier; 2008.
10/28/2011 DynaMed's Systematic Literature Surveillance
http://www.ebscohost.com/dynamed/: Subcommittee on Attention-deficit/hyperactivity Disorder, Steering Committe on Quality Improvement and Management. ADHD: clinical practice guideline for the diagnosis, evaluation, and treatment of attention-deficit/hyperactivity disorder in children and adolescents.
2011 Oct 16. [Epub ahead of print]
AAP Recommendations and Diagnostic Guidelines for ADHD. American Academy of Pediatrics, Healthy Children website. Available at:
http://www.healthychildren.org/English/health-issues/conditions/adhd/pages/AAP-Recommendations-Diagnostic-Guidelines-for-ADHD.aspx. Updated October 24, 2011. Accessed October 28, 2011.
Last reviewed September 2013 by Kari Kassir, MD
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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