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Diagnosing ADHD
Diagnosis Subtypes
Diagnosing ADHD in different age groups
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The first step in getting help for ADHD is ensuring the right diagnosis. After a diagnosis of ADHD, a number of different treatments can offer help.
Diagnosing ADHD can be difficult and requires information from a number of sources. It should be made in a timely, comprehensive assessment conducted by a child/adolescent psychiatrist or a paediatrician with expertise in ADHD. It should also involve the child, his/her parents and carers and the child's school, and take into account cultural factors in his/her environment. Assessment by a multidisciplinary team, including educational or clinical psychologists, clinical neuropsychologists, and social workers, is advisable, especially for children who show signs of other significant disease or conditions.
Not everyone who is overly hyperactive, inattentive, or impulsive has an attention-deficit hyperactivity disorder. Specialists and doctors must also consider following elements when diagnosing ADHD:
- The signs have persisted for at least six months to a degree that is impairing the child's development.
- There must be clear evidence of clinically significant impairment in social or academic functioning.
- Some impairment is present in two or more settings (usually at home and at school).
- Some of the signs that caused impairment were present before the age of seven.
- The signs do not occur exclusively during the course of a pervasive developmental disorder, schizophrenia or another psychotic disorder and are not better accounted for by other mental disorders, such as depression or anxiety.
The information below is intended to help you identify behaviours and signs that may indicate ADHD. Talk to your doctor if you recognise any of these symptoms. Printing the symptom checklist may be helpful in preparing your discussion with your doctor.
Diagnosis Subtypes
Most people with ADHD experience a combination of inattention and hyperactivity-impulsivity. In general, one symptom pattern tends to be more prominent. ADHD is classified into three subtypes.
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Predominantly hyperactive-impulsive
A person may be diagnosed as predominantly hyperactive-impulsive if s/he has:- Six (or more) symptoms of hyperactivity-impulsivity.
- Fewer than six signs of inattention that lasted for at least six months. It is important to note that inattention may still be a significant feature.
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Predominantly inattentive
A person may be diagnosed as predominantly inattentive if s/he has:- Six (or more) symptoms of inattention.
- Fewer than six signs of hyperactivity-impulsivity that lasted for at least six months.
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Combined type
A person may be diagnosed as the combined type if s/he has:- Six (or more) symptoms of hyperactivity-impulsivity.
- Six (or more) signs of inattention that lasted for at least six months.
The combined type is the most common subtype of ADHD, occurring in 61% of identified ADHD cases, compared to 30% for the predominantly inattentive type and 9% for the predominantly hyperactive-impulsive type.
Diagnosing ADHD in different age groups
Diagnosing ADHD in children
There are a number of medical conditions that may cause symptoms similar to those of ADHD. These include for example thyroid disorders, seizures, foetal alcohol syndrome (a spectrum of disorders due to prenatal alcohol exposure), vision or hearing problems, or Tourette syndrome (a genetic neurological disorder characterised by involuntary quick motor and vocal movements or expressions). The assessment of ADHD should also include checking for learning or language problems, depression, anxiety and sleep disorders. Assessing a child usually begins with gathering complete medical, school and family histories and doing a medical exam to exclude other conditions.
To allow for differentiating ADHD from other disorders as well as monitoring treatment results, questionnaires and interviews to learn more about the child’s behaviour or change in behaviour are applied. Parents, teachers, carers, baby-sitters and other people who know the child may be interviewed. These questionnaires will help determining how the child behaves and, more importantly, if the behaviour is long-lasting or temporary. Gathering as much information as possible about the child is the best way to ensure an accurate diagnosis.
However, it is difficult to diagnose ADHD in children before the age of 5. Young children generally have short attention spans, and their behaviour includes periods of high activity and impulsivity. If your child shows symptoms of ADHD before the age of 5, it is useful to keep records of his/her behaviour to see any changes or improvements. This may eventually help getting a diagnosis. If the symptoms continue, or get worse, don’t hesitate to talk to your doctor.
Diagnosing ADHD in teenagers
As ADHD cannot be determined by a simple blood test or physical evaluation, the diagnosis should only be made after symptoms have persisted over an extended period of time, and interfere with a teenager's ability to function. At that point, a doctor with experience in ADHD should be involved in assessing the symptoms to form a diagnosis and decide whether treatment may be necessary. The doctor may also request a neuropsychological evaluation to rule out associated learning disabilities or other illnesses, as well as identify areas of strength and weakness.
ADHD can be a hidden disorder in girls and women. They tend to appear "daydreaming", because symptoms consist rather of inattention than hyperactivity. Therefore it is often ignored or misdiagnosed by the educational and medical communities. Adolescent girls with ADHD are often not identified and diagnosed until their underachievement at school has become apparent and problematic. In view of the serious consequences of ADHD in adolescence and adulthood, there is an urgent need for increased awareness of this disorder in teenage girls.
Diagnosing ADHD in adults
To make a new diagnosis of ADHD in adults is generally more difficult than in children. Indeed, ADHD symptoms might change from childhood to adulthood. Adults are faced with ramifications from their behaviour on themselves, e.g. inattention, disorganization, poor time management, failure to complete projects etc and seek medical care. , Adults often cannot accurately remember when their difficulties started rendering the diagnosis difficult at times. And yet diagnosis of ADHD requires a persistent pattern of symptoms beginning before the age of 7. Finally, no single test or questionnaire can confirm the diagnosis.
A positive diagnosis may help explain many issues, actions and responses. It can also open the door to getting the right treatment. To form a correct diagnosis, the doctor will consider the following:
- Symptoms of disorders that can mimic ADHD symptoms or may co-exist (for example, learning disabilities, depression, bipolar disorder, substance abuse disorders)
- Past and present ADHD symptoms
- Information about childhood (old school records, information from everyone who knew the person in his/her childhood)
- Information from family, friends, and employers (to evaluate impact on current life)
- School, work, and social experiences
Note that if the difficulties are recent or occurred only occasionally in the past, they are not considered as being symptoms of adult ADHD.
