What questions should be asked to diagnose ADHD?

Diagnosing ADHD: Specific Questions and Assessment Approach

The diagnosis of ADHD requires a structured approach using DSM-5 criteria through multiple information sources including parents/guardians, teachers, and other clinicians to gather comprehensive information about symptoms across different settings. 1

Core Diagnostic Questions Based on DSM-5 Criteria

Inattention Symptoms (≥6 required for diagnosis)

• Does the patient often fail to give close attention to details or make careless mistakes?
• Does the patient have difficulty sustaining attention in tasks or play activities?
• Does the patient seem not to listen when spoken to directly?
• Does the patient often not follow through on instructions and fail to finish tasks?
• Does the patient have difficulty organizing tasks and activities?
• Does the patient avoid or dislike tasks requiring sustained mental effort?
• Does the patient often lose things necessary for tasks or activities?
• Is the patient easily distracted by extraneous stimuli?
• Is the patient often forgetful in daily activities?

Hyperactivity/Impulsivity Symptoms (≥6 required for diagnosis)

• Does the patient often fidget or tap hands/feet or squirm in seat?
• Does the patient often leave seat in situations when remaining seated is expected?
• Does the patient often run about or climb in situations where inappropriate?
• Is the patient unable to play or engage in leisure activities quietly?
• Is the patient often "on the go," acting as if "driven by a motor"?
• Does the patient talk excessively?
• Does the patient often blurt out answers before questions are completed?
• Does the patient have difficulty waiting their turn?
• Does the patient often interrupt or intrude on others?

Essential Diagnostic Requirements

• Symptoms must be present before age 12 1
• Symptoms must be present in two or more settings (e.g., home, school, work)
• Clear evidence that symptoms interfere with functioning
• Symptoms not better explained by another mental disorder

Age-Specific Assessment Considerations

For Children (6-12 years)

• Use parent and teacher Vanderbilt ADHD Rating Scales to assess DSM-5 criteria 1
• Ask about classroom behavior, ability to complete assignments, and peer relationships
• Inquire about homework completion and academic performance
• Ask about behavior during structured vs. unstructured activities

For Adolescents (13-17 years)

• Be aware that hyperactive symptoms may be less apparent 1
• Obtain multiple teacher reports due to changing classes 1
• Ask specific questions about:
  • Organization and time management skills
  • Ability to complete long-term projects
  • Risk-taking behaviors
  • Driving safety if applicable

For Adults

• Verify presence of symptoms before age 12 1
• Ask about workplace functioning and relationship impacts
• Inquire about financial management, time management, and organization
• Ask about driving history (accidents, tickets)

Assessment of Functional Impairment

• Academic/occupational: "How have these symptoms affected school/work performance?"
• Social: "How do these symptoms affect relationships with peers/colleagues/family?"
• Daily functioning: "How do these symptoms impact daily activities and responsibilities?"
• Self-esteem: "How do these difficulties affect how you/your child feels about yourself/themselves?"

Screening for Comorbidities

• Screen for emotional/behavioral comorbidities (anxiety, depression, oppositional defiant disorder, conduct disorder) 1
• Screen for developmental comorbidities (learning disabilities, language disorders, autism spectrum disorders) 1
• Screen for physical comorbidities (tic disorders, sleep disorders, seizure disorders) 1
• For adolescents, specifically screen for substance use 1

Diagnostic Tools

• The Vanderbilt ADHD Rating Scale should be completed by both parents and teachers 1
• Neuropsychological testing is not routinely recommended for ADHD diagnosis 1
• Medical history should include assessment for cardiac disease and family history of tics or Tourette's syndrome 2

Common Diagnostic Pitfalls to Avoid

• Relying on a single informant's report rather than gathering information from multiple sources
• Failing to assess for functional impairment across settings
• Not screening for common comorbidities that may better explain symptoms
• Diagnosing based solely on parent/teacher concerns without systematic assessment
• Not considering developmental appropriateness of behaviors

Final Diagnostic Decision

The clinician must determine if the patient meets full DSM-5 criteria for one of three ADHD presentations:

1. Predominantly inattentive presentation
2. Predominantly hyperactive/impulsive presentation
3. Combined presentation

Remember that ADHD is a clinical diagnosis with no definitive diagnostic test 3, making a thorough, systematic assessment using structured criteria essential for accurate diagnosis.