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How is ADHD diagnosed?

Because symptoms may vary across settings, ADHD can be difficult to diagnose. A diagnosis of ADHD is based on the number, persistence, and history of symptomatic behaviors, and the degree to which they impede a child's performance in more than one setting. Parents or teachers may be the first to notice possible signs of ADHD. Diagnosis of adult ADHD is based on symptoms, impairments, and history. Adults with ADHD might experience symptoms such as lack of focus, disorganization, restlessness, difficulty finishing projects, and/or losing things. They may also have difficulties at work, at home, or with personal relationships. Also, adults diagnosed with ADHD must have had symptoms prior to age 7 that continued for at least 6 months.

Diagnosis should be made by a professional with training in ADHD or mental disorders. Physical examinations are given to exclude such things as undetected seizures, temporal lobe seizures and middle ear infections: psychological tests can rule out conditions such as specific learning disabilities, anxiety, or affective disorders. Ideally, reviews are made of school records, which include evaluations by teachers and others about a child’s behavior based on rating scales.

Parents and others who know the child well may be interviewed. Intelligence and learning tests may be administered. The specialist uses all this information to make a diagnosis of ADHD.

Children mature at different rates and have different personalities, temperaments, and energy levels. Most children get distracted, act impulsively, and struggle to concentrate at one time or another. Sometimes, these normal factors may be mistaken for ADHD.

ADHD symptoms usually appear early in life, often between the ages of 3 and 6, and because symptoms vary from person to person, the disorder can be hard to diagnose. Parents may first notice that their child loses interest in things sooner than other children,  or seems constantly “out of control.” Often, teachers notice the symptoms first, when a child has trouble following rules, or frequently “spaces out” in the classroom or on the playground.

No single test can diagnose a child as having ADHD. Instead, a licensed health  professional needs to gather information about the child, and his or her behavior and environment. A family may want to first talk with the child’s pediatrician. Some pediatricians can assess the child themselves, but many will refer the family to a mental health specialist with experience in childhood mental disorders such as ADHD. The pediatrician or mental health specialist will first try to rule out other possibilities for the symptoms. For example, certain situations, events, or health conditions may cause temporary behaviors in a child that seem like ADHD.

Between them, the referring pediatrician and specialist will determine if a child:

  • Is experiencing undetected seizures that could be associated with other medical conditions
  • Has a middle ear infection that is causing hearing problems
  • Has any undetected hearing or vision problems
  • Has any medical problems that affect thinking and behavior
  • Has any learning disabilities
  • Has anxiety or depression, or other psychiatric problems that might cause ADHD-like symptoms
  • Has been affected by a significant and sudden change, such as the death of a family member, a divorce, or parent’s job loss.

A specialist will also check school and medical records for clues, to see if the child’s home or school settings appear unusually stressful or disrupted, and gather information from the child’s parents and teachers. Coaches, babysitters, and other adults who know the child well also may be consulted. The specialist also will ask:

  • Are the behaviors excessive and long-term, and do they affect all aspects of the child’s life? 
  • Do they happen more often in this child compared with the child’s peers?
  • Are the behaviors a continuous problem or a response to a temporary situation?
  • Do the behaviors occur in several settings or only in one place, such as the  playground, classroom, or home?

The specialist pays close attention to the child’s behavior during different situations. Some situations are highly structured, some have less structure. Others would require the child to keep paying attention. Most children with ADHD are better able to control their behaviors in situations where they are getting individual attention and when they are free to focus on enjoyable activities. These types of situations are less important in the assessment. A child also may be evaluated to see how he or she acts in social situations, and may be given tests of intellectual ability and academic achievement to see if he or she has a learning disability.

Finally, if after gathering all this information the child meets the criteria for ADHD, he or she will be diagnosed with the disorder.

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