What initial questions should be asked when evaluating teens with Attention Deficit Hyperactivity Disorder (ADHD)?

Initial Questions for Evaluating Teens with ADHD

When evaluating teenagers with ADHD, clinicians should screen for comorbid conditions including emotional/behavioral disorders (anxiety, depression, oppositional defiant disorder, conduct disorders, substance use), developmental conditions (learning and language disorders, autism spectrum disorders), and physical conditions (tics, sleep apnea). 1, 2

Core Assessment Components

Multiple Information Sources

• Obtain information from multiple sources:
  • Parents/guardians
  • At least two teachers or other observers (coaches, counselors, activity leaders)
  • The adolescent themselves (though self-report alone is insufficient)
  • School records documenting symptoms before age 12 1, 2

Key Screening Questions

Symptom Assessment

• Ask about specific inattention symptoms:

  • "Do you have difficulty maintaining focus during lectures or conversations?"
  • "How often do you make careless mistakes in schoolwork?"
  • "Do you struggle with following through on instructions or completing tasks?"
  • "How do you manage organizing tasks and activities?"

• Ask about hyperactivity/impulsivity symptoms:

  • "Do you feel restless or have difficulty sitting still?"
  • "Do you interrupt others in conversations?"
  • "Do you have trouble waiting your turn?"
  • "How often do you feel driven to be constantly active?"

Developmental History

• "When did these symptoms first appear?" (Must establish onset before age 12 per DSM-5) 1, 2
• "How have the symptoms changed over time?" (Hyperactive symptoms often decrease in adolescence while inattentive symptoms persist) 2

Functional Impairment

• "How do these symptoms affect your academic performance?"
• "How do these symptoms impact your relationships with friends and family?"
• "What challenges do these symptoms create in your daily activities?"

Comorbidity Screening

Substance Use

• "Have you used alcohol, marijuana, or other substances?" (Critical before initiating or continuing stimulant treatment) 2
• "How frequently do you use these substances?"
• "Has your substance use changed your ADHD symptoms?"

Mood Disorders

• "Have you experienced persistent sadness, hopelessness, or loss of interest?"
• "Do you have periods of unusually elevated mood or energy?"
• "Have you had thoughts of harming yourself?" 1, 2

Anxiety

• "Do you experience excessive worry or fear?"
• "Do you have physical symptoms like racing heart or trouble breathing when anxious?"

Learning Disabilities

• "Do you have specific subjects or types of assignments that are particularly difficult?"
• "Have you received any special education services?"

Risky Behaviors

• "How do your symptoms affect your driving?" (Ask about traffic violations or close calls) 2
• "Are you sexually active? How do you practice safe sex?" (Only ~50% of providers screen for this) 3
• "Has anyone ever asked you to share or sell your ADHD medication?" (Screen for medication diversion) 2, 3

Assessment Tools

• Use standardized rating scales from multiple sources:
  • Parent rating scales
  • Teacher rating scales (from at least two teachers)
  • Self-report scales (as supplementary information)
  • Behavioral observation forms 2

Common Pitfalls to Avoid

• Relying solely on adolescent self-report (teens may minimize symptoms or feign symptoms to obtain stimulants) 2
• Failing to screen for substance use before continuing stimulant treatment 2
• Not addressing potential for medication diversion 2, 3
• Inadequate assessment of comorbidities (present in majority of ADHD teens) 1
• Discontinuing treatment prematurely (increases risk for motor vehicle crashes, substance use disorders, depression, academic underachievement) 2
• Not monitoring for risky sexual behavior and driver readiness (documented in only about 50% of adolescents with ADHD) 3

Follow-up Assessment

• Establish clear follow-up schedule:
  • Monthly visits until symptoms stabilize
  • Adjust frequency based on medication response, side effects, and comorbidities
  • Document baseline measurements for ongoing monitoring 2

By systematically addressing these areas, clinicians can comprehensively evaluate teens with ADHD and develop appropriate treatment plans that address both core symptoms and comorbid conditions, ultimately improving long-term outcomes related to morbidity, mortality, and quality of life.