Key Questions to Ask When Assessing ADHD
The most effective ADHD assessment requires systematic questioning about specific symptoms, functional impairment across multiple settings, and screening for comorbid conditions to ensure accurate diagnosis and appropriate treatment planning.
Core Diagnostic Questions
- Ask about specific inattentive symptoms: difficulty sustaining attention, making careless mistakes, not following through on tasks, poor organization, losing things, being easily distracted, and forgetfulness 1, 2
- Inquire about hyperactive-impulsive symptoms: fidgeting/squirming, leaving seat inappropriately, running/climbing excessively, difficulty with quiet activities, talking excessively, blurting answers, interrupting others 3
- Confirm symptoms have been present before age 12 years and have persisted for at least 6 months 2
- Verify symptoms occur in multiple settings (home, school/work, social environments) and cause significant impairment 1, 2
- Assess the chronicity and severity of symptoms to determine appropriate treatment needs 3
Functional Impairment Assessment
- Evaluate academic performance: grades, teacher reports, homework completion, test performance 4
- Assess peer relationships and social functioning: ability to maintain friendships, social rejection experiences 4
- Inquire about family functioning: parent-child relationships, sibling interactions, family stress 4
- Determine adaptive skills impairment: organization, time management, self-care abilities 4
- For adolescents and adults, assess occupational functioning and driving safety 5
Screening for Comorbid Conditions
- Screen for emotional/behavioral conditions: anxiety disorders, depression, oppositional defiant disorder, conduct disorder 4, 1
- Assess for developmental conditions: learning disabilities, language disorders, autism spectrum disorders 4, 1
- Inquire about physical conditions: tics, sleep disorders (particularly sleep apnea), seizures 4, 1
- For adolescents specifically, screen for substance use disorders 1, 5
- Evaluate for executive functioning deficits: working memory, planning, organization, and self-regulation 6
Age-Specific Considerations
- For preschool children (4-5 years): focus on hyperactive-impulsive symptoms which are often more prominent than inattentive symptoms 1, 2
- For school-aged children (6-12 years): assess both inattentive and hyperactive-impulsive symptoms, with particular attention to classroom behavior and academic performance 1, 2
- For adolescents (12-18 years): incorporate self-report measures and assess for substance use as a complicating factor 1, 2
- For adults: focus on how childhood symptoms have evolved and adapted over time, and assess occupational impact 5
Information Gathering Process
- Collect information from multiple sources: parents/guardians, teachers, other school personnel, and any mental health clinicians involved in care 1, 2
- Use standardized DSM-5-based rating scales to systematically collect information (e.g., Adult ADHD Self-Report Scale, Conners Rating Scales) 2, 5
- Review medical history to rule out alternative causes for symptoms 1, 2
- Consider obtaining psychoeducational testing when learning disabilities are suspected 6
- Review previous treatment responses, if applicable 1
Treatment Planning Questions
- Ask about previous medication trials and responses, including benefits and side effects 7
- Inquire about family preferences regarding behavioral interventions versus medication 1
- For children, determine school resources available for behavioral interventions 4
- For patients with comorbidities, assess which condition causes the most significant impairment to prioritize treatment 1
- Discuss monitoring plans for medication side effects, particularly growth effects in children and cardiovascular effects 7
Common Pitfalls to Avoid
- Failing to screen for comorbid conditions, which can alter treatment approach 1
- Relying solely on subjective reports without systematic assessment 8
- Not recognizing ADHD as a chronic condition requiring ongoing management 1
- Discontinuing treatment prematurely, which places individuals at risk for adverse outcomes 1
- Missing substance use disorders in adolescents, which can complicate diagnosis and treatment 1, 5