Key Questions for Evaluating a Teenager with ADHD
When evaluating a teenager with ADHD, clinicians should focus on comprehensive assessment across multiple settings using standardized rating scales and information from multiple sources, as recommended by the American Academy of Pediatrics. 1, 2
Core Symptom Assessment
Current Inattention Symptoms:
- Difficulty sustaining attention in tasks or activities
- Careless mistakes in schoolwork or other activities
- Problems following through on instructions and completing tasks
- Difficulty organizing tasks and activities
- Avoidance of tasks requiring sustained mental effort
- Frequency of losing items necessary for tasks/activities
- Distractibility by external stimuli or unrelated thoughts
- Forgetfulness in daily activities
Current Hyperactivity/Impulsivity Symptoms:
- Fidgeting or inability to stay seated
- Inappropriate running or climbing (or feeling restless in adolescents)
- Difficulty engaging in leisure activities quietly
- Talking excessively or blurting out answers
- Difficulty waiting turn
- Interrupting or intruding on others
Functional Impairment Assessment
Academic Functioning:
- Current grades and recent changes in academic performance
- Homework completion and study habits
- Need for extra time on assignments or tests
- Organization of schoolwork and materials
- History of detention, suspension, or expulsion
- Relationship with teachers and school staff
Social Functioning:
- Quality of peer relationships and friendship patterns
- Social rejection or isolation experiences
- Ability to maintain friendships
- Participation in extracurricular activities
- Social media use and impact
Family Functioning:
- Parent-teen relationship quality
- Compliance with rules and expectations at home
- Completion of chores and responsibilities
- Sibling relationships
- Family conflict related to ADHD symptoms
Developmental and Historical Assessment
Symptom History:
- Age of symptom onset (must be before age 12 per DSM-5)
- Consistency of symptoms across different settings
- Previous evaluations, diagnoses, and treatments
- Response to previous interventions (behavioral and pharmacological)
Developmental History:
- Early developmental milestones
- Academic history including previous accommodations or services
- Previous psychological or educational testing results
Comorbidity Screening
Mood Disorders:
- Persistent sadness, irritability, or mood swings
- Changes in sleep, appetite, or energy
- Loss of interest in previously enjoyed activities
- Suicidal thoughts or behaviors (critical to assess)
Anxiety Disorders:
- Excessive worry or fear
- Physical symptoms of anxiety
- Avoidance behaviors
- Social anxiety symptoms
Behavioral Disorders:
- Oppositional behaviors
- Conduct problems or rule violations
- Legal issues or involvement with juvenile justice
Learning Disorders:
- Specific academic difficulties
- Discrepancy between ability and achievement
- Reading, writing, or math challenges
Substance Use:
- Current or past substance use patterns
- Type of substances used and frequency
- Impact of substance use on functioning
- Risk for medication diversion or misuse
Medication-Specific Assessment
Current Medication Status:
- Current medications, dosages, and timing
- Perceived effectiveness of medication
- Side effects experienced
- Adherence patterns and challenges
- Coverage throughout the day (including after-school activities)
Physical Health:
- Height, weight, blood pressure, and heart rate
- Sleep patterns and appetite
- Physical activity level
- Other medical conditions
Driving and Risk Assessment
- Driving History (if applicable):
- Impact of ADHD symptoms on driving
- History of traffic violations, accidents, or "close calls"
- Medication coverage during driving times
Collateral Information
Parent/Guardian Report:
- Observations of symptoms at home
- Concerns about functioning and impairment
- Family history of ADHD or related conditions
Teacher Reports:
- Classroom behavior and academic performance
- Completion of assignments
- Peer interactions in school setting
- Standardized rating scales from at least 2 teachers
Self-Report:
- Teen's perception of symptoms and impairment
- Areas of concern from teen's perspective
- Treatment goals important to the teen
Important Considerations and Pitfalls
- Avoid relying solely on self-report from adolescents, as they often minimize their problematic behaviors 1, 2
- Obtain information from multiple sources including parents and at least two teachers or other observers 1
- Be aware that adolescents may feign symptoms to obtain stimulant medication for performance enhancement 1, 2
- Screen for substance use before initiating or continuing medication treatment 2
- Consider that hyperactive symptoms often decrease in adolescence while inattentive symptoms persist 1
- Assess for risk of medication diversion especially in school and college settings 2
- Document developmental history to establish symptom onset before age 12 as required by DSM-5 1, 2
Using these comprehensive assessment questions will help clinicians accurately diagnose ADHD in teenagers and develop appropriate treatment plans that address both core symptoms and functional impairments.