ADHD diagnosis

There is no one test used to diagnose¹⁴ ADHD. The first step if you suspect that you or your child has ADHD is to talk with a healthcare provider. A primary care provider or a mental health professional, such as a psychiatrist or psychologist, will be able to determine whether your signs and symptoms fit the criteria for a diagnosis.

Many other conditions (including sleep disorders, depression, anxiety, and certain learning disabilities) can present with symptoms similar to those of ADHD. Because of this, your healthcare provider will first determine whether you or your child has another condition that may better explain the signs and symptoms experienced, or whether a similar condition is occurring at the same time as ADHD.

The American Psychological Association describes the diagnosis of ADHD¹⁵ in the DSM-5 (the most recent Diagnostic and Statistical Manual of Mental Disorders), a manual that sets criteria for the diagnosis of mental health conditions, as a lifelong, persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development across time and settings.

In order to make an official diagnosis of ADHD, your provider must match up your symptoms to the DSM-5’s criteria.

The following criteria¹⁶ are used to diagnose ADHD:

Inattention: Children up to age 16 must show six or more symptoms, and adolescents/adults aged 17 and older must show at least five symptoms. Symptoms must have been present for six months or longer.

• Frequently failing to pay close attention to details or makes careless mistakes in school, work, or home environments
• Having frequent difficulty holding attention on tasks or play activities
• Often not appearing to be listening when spoken to directly
• Frequently failing to complete chores, schoolwork, or workplace duties due to being sidetracked or losing focus
• Experiencing frequent difficulty with organization in tasks or activities
• Frequent aversion to completing tasks that require sustained mental effort
• Often losing things that are needed to complete work or school tasks

Hyperactivity and Impulsivity: Children up to age 16 must show six or more of the following symptoms (and adolescents/adults 17 and older must show at least five symptoms) to be diagnosed with ADHD. These symptoms must have been present for at least six months.

• Frequent squirming while seated, fidgeting, or tapping hands/feet
• Difficulty staying seated; feeling the urge to get up while expected to stay sitting
• Trouble participating in leisure activities quietly
• Frequent interruption during conversation, talking excessively, and/or answering questions before they have been completed
• Difficulty waiting for one’s turn
• Appearing to always be moving or “on the go” (can present as restlessness in adolescents and adults)

There must also be clear evidence that the following¹⁷ have occurred in order to make a diagnosis:

• Multiple inattentive or hyperactive-impulsive symptoms seen prior to age 12
• Multiple symptoms seen in two or more settings (home, work, school, around family, etc.)
• Symptoms interfere with or negatively affect quality of work, school, or social functioning
• No other mental disorder (such as a mood disorder or generalized anxiety disorder) better matches the symptoms displayed

Types of ADHD

A diagnosis of ADHD may be categorized into one of three main types¹⁸:

• Predominantly hyperactive-impulsive presentation: Occurs when a sufficient number of symptoms of hyperactivity-impulsivity (but not inattention) have been present for at least the past six months.
• Predominantly inattentive presentation: Occurs when a sufficient number of symptoms of inattention (but not hyperactivity-impulsivity) have been present for at least the past six months.
• Combined presentation: Occurs when a sufficient number of symptoms of both hyperactivity-impulsivity and inattention have been present for at least the past six months.

ADHD testing

There is no one physical, medical, or genetic test¹⁹ for ADHD. Your mental health provider will perform a diagnostic evaluation that uses information such as an ADHD symptom checklist, standardized behavior rating scales, a detailed medical and behavioral history of your past and present functioning, and additional information from people who know you or your child well, such as friends or family.

A healthcare provider who specializes in psychiatric disorders may run tests of your cognitive (thinking) ability and academic/work achievement to make sure you do not have a learning disability. A provider cannot diagnose ADHD simply from a short clinic visit or from a brief conversation, as the symptoms of ADHD may not be apparent during a single visit.

Healthcare providers who are qualified to diagnose²⁰ ADHD include physicians (psychiatrists, neurologists, family practice providers), clinical social workers, and clinical psychologists.

Your provider will determine your diagnosis based on a combination of the number of symptoms, the severity and duration of your symptoms, and the extent to which your symptoms cause issues in your life (school, work, home, interpersonally, etc.).

Some of your symptoms must have been present in your life before the age of 12. Oftentimes, parents or close family can provide additional information to your healthcare provider to help support your diagnosis.

One central aspect of a diagnosis of ADHD is that you must have significant impairments in at least two major settings of your life (work, home, marriage, family, school, etc.). Some examples of significant impairment include:

• Being unable to pay bills on time
• Going into debt due to excessive impulsive spending
• Being let go from a job as a result of failing to complete required tasks
• Stress in a marriage or personal relationships

If you present with the signs and symptoms of ADHD, but they haven’t caused significant impairment in your life, you may not be diagnosed with the disorder by your healthcare provider.