From the Guidelines
ADHD is diagnosed by pediatricians or other primary care clinicians (PCCs) who should initiate an evaluation for any child or adolescent age 4 years to the 18th birthday who presents with academic or behavioral problems and symptoms of inattention, hyperactivity, or impulsivity. The diagnostic process typically involves a comprehensive evaluation including clinical interviews, behavioral assessments, medical history review, and standardized rating scales 1. Primary care physicians may identify symptoms initially but often refer to specialists for formal diagnosis. For children, pediatricians or child psychiatrists usually lead the assessment, while adults might see psychiatrists or neuropsychologists.
Key Points to Consider
- The evaluation considers symptom patterns across different settings (home, school, work), their impact on functioning, and rules out other conditions that might explain the symptoms.
- No single test diagnoses ADHD; instead, professionals use established diagnostic criteria from clinical guidelines to make an accurate diagnosis based on persistent patterns of inattention, hyperactivity, and impulsivity that significantly impair daily functioning 2.
- The diagnostic criteria for ADHD can be applied to preschool-aged children, and clinicians should conduct a clinical interview with parents, examine and observe the child, and obtain information from parents and teachers through DSM-based ADHD rating scales 3.
- Pediatricians and other PCCs should be aware that determining the presence of key symptoms in preschool-aged children has its challenges.
Important Considerations
- The American Academy of Pediatrics (AAP) recommends that pediatricians and other primary care clinicians play a significant role in the care of patients with ADHD and assist them to receive appropriate diagnosis and treatment 4.
- The AAP also recommends that primary care pediatricians should be prepared to diagnose and manage mild-to-moderate ADHD, anxiety, depression, and problematic substance use, as well as co-manage patients who have more severe conditions with mental health professionals 5.
From the FDA Drug Label
Adequate diagnosis requires the use not only of medical but also of special psychological, educational, and social resources. The diagnosis of ADHD is typically made by a physician, often in collaboration with other professionals, including:
From the Research
Diagnosis of ADHD
The diagnosis of Attention-Deficit/Hyperactivity Disorder (ADHD) is a complex process that involves multiple steps and stakeholders.
- Primary care physicians often play a key role in the initial evaluation of ADHD, as parents or caregivers typically present to them with concerns about behavior problems or poor school or social function 8.
- A comprehensive history and physical examination are essential in assessing for comorbid or other conditions that can mimic ADHD 8, 9.
- The combination of Diagnostic and Statistical Manual of Mental Disorders, 5th ed., criteria and validated screening tools completed by parents, teachers, or other adults can aid in establishing the diagnosis 8.
Role of Different Professionals
- Psychologists and psychiatrists may also be involved in the diagnosis and treatment of ADHD, particularly in cases where comorbidities or complex presentations are suspected 9.
- Teachers and other school personnel can provide valuable information about a child's behavior and functioning in the academic setting, which can inform the diagnosis and treatment plan 10, 11.
- Juvenile corrections staff may also play a role in identifying and managing ADHD in youth who are involved in the justice system 10.
Use of Rating Scales
- The Vanderbilt ADHD Diagnostic Parent Rating Scale (VADPRS) and the Vanderbilt ADHD Diagnostic Teacher Rating Scale (VADTRS) are commonly used rating scales that can help identify ADHD and comorbidities 10, 12, 11.
- These scales have been shown to have good psychometric properties, including reliability and validity, and can be used to inform diagnostic decisions and monitor treatment response 10, 12, 11.