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ADHD Diagnosis
Aka: ADHD Diagnosis, ADHD DSM V Criteria, Attention Deficit Hyperactivity Disorder Diagnosis, Attention Deficit Disorder Diagnosis
- See also
- Attention Deficit Disorder in Children
- School Problem Evaluation
- Attention Deficit Disorder in Adults
- ADHD Differential Diagnosis
- ADHD Comorbid Conditions
- ADHD Non-Pharmacologic Management
- ADHD Medications
- Dextroamphetamine (Dexedrine, Dextrostat, Adderall) or Lisdexamfetamine (Vyvanse)
- Methylphenidate (Ritalin, Methylin, Concerta)
- Atomoxetine (Strattera)
- Types
- Primarily Inattentive Type (314.00)
- Primarily Hyperactive-Impulsive Type (314.01)
- Combined Type (314.01)
- Not otherwise specified (314.9)
- Precautions
- Diagnosis should be based on evidence from both parents and at least 2 teachers
- Consider involving input from school coaches and group leaders in older children or adolescents
- Obtain self-report behavioral rating scale from adolescents
- Evaluate for ADHD Comorbid Conditions and for ADHD Differential Diagnosis
- Additional mood, behavioral or Developmental Disorder is present in 60% of ADHD children
- Initial screening for Attention Deficit should also include screening for other associated conditions
- Thorough initial evaluation is imperative (see ADHD)
- History: Development, Learning, Family History, Social environment
- Exam: Complete inclduing Vision, Hearing, Neurologic Exam
- Labs and diagnostics are not routinely recommended
- Age related precautions
- Attention Deficit Disorder cannot be reliably diagnosed under age 4 years old
- New onset of Attention Deficit Disorder is less common after age 12 years old
- Inattentive type may have a delayed diagnosis
- Increased academic demands, especially after fourth grade may unmask previously compensated ADD
- Consider alternative diagnoses
- See Attention Deficit Differential Diagnosis
- Learning Disorder
- Mood Disorder
- Sleep disorder (e.g. Sleep Apnea, Insomnia)
- Substance Abuse
- Diagnostics: Scales for Children - Narrow Focused on ADHD
- Vanderbilt ADHD Diagnostic Test
- Preferred option since it is freely available
- Test Sensitivity: 80% parent (69% teacher)
- Test Specificity: 75% parent (85% teacher)
- NICHQ Vanderbilt Scales for initial and follow-up parent and teacher evaluations
- http://www.nichq.org/childrens-health/adhd/resources/vanderbilt-assessment-scales
- Conners Parent and Teachers Questionnaires
- Gold standard survey, but copyrighted and expensive
- (1985) Psychopharmacology Bulletin 21:816
- Available from MHS
- http://www.mhs.com/product.aspx?gr=cli&prod=conners3&id=overview
- Connors Abbreviated Symptom Questionnaire (CASQ)
- Test Sensitivity: 83%
- Test Specificity: 84%
- May be preferred Connors Questionnaire (brevity, efficacy) but is also costly
- ADHD Rating Scale 5
- Dupaul (1998) ADHD Rating Scale, Guilford
- https://pcptoolkit.beaconhealthoptions.com/wp-content/uploads/2016/01/cms-quality-child_adhd_rating_scale_screener.pdf
- Brown ADD Rating Scales
- Purchased from Brown Clinic
- Copeland Symptom Checklist for ADD
- https://cookchildrens.org/SiteCollectionDocuments/pediatrics/ADHD-Checklist.pdf
- Diagnostics: Scales for Children - Broad Screening for ADHD and Comorbidity
- Child and Adolescent Behavior Inventory
- https://clinical-practice-and-epidemiology-in-mental-health.com/VOLUME/15/PAGE/44/FULLTEXT/
- Test Sensitivity 83%
- Test Specificity: 91%
- Child Behavior Checklist
- https://www.apa.org/depression-guideline/child-behavior-checklist.pdf
- Pediatric Symptoms Checklist
- https://www.brightfutures.org/mentalhealth/pdf/professionals/ped_sympton_chklst.pdf
- Strengths and Difficulties Questionairre
- https://sdqinfo.org/
- Diagnostics: Scales for adults
- Adult ADHD Rating Scale-IV
- Adult ADHD Self-Report Scale Symptom Checklist v1.1
- http://webdoc.nyumc.org/nyumc/files/psych/attachments/psych_adhd_checklist.pdf
- Brown Attention-Deficit Disorder Rating
- Connors Adult ADHD Rating Scales
- Current Symptoms Scale by Barkley and Murphy
- Wender-Reimherr Adult Attention-Deficit Disorder Scale
- Diagnosis: General Criteria
- ADHD Symptoms and signs onset before 12 years
- Symptoms and signs persists for 6 months or longer
- Impairment in more than 1 setting
- Severity beyond developmental level
- Interferes with social, academic or occupational functioning
- Not exclusively due to other mental health condition (e.g. Major Depression, Anxiety Disorder, Substance Abuse, Psychosis)
- Diagnosis: Inattentive ADHD Criteria (6 of 9 present)
- Fails to give close attention to details
- Difficulty sustaining attention
- Does not appear to listen
- Has difficulty following instructions
- Difficulty with organization
- Avoids tasks requiring sustained attention
- Often loses things
- Easily distracted
- Forgetful in daily activities
- Diagnosis: Hyperactive, Impulsive ADHD Criteria (6 of 9 present)
- Fidgets or squirms
- Difficulty staying seated
- Runs or climbs inappropriately (or feeling restless in adolescents and adults)
- Difficulty engaging in activities quietly
- Always "on the go", "driven by a motor"
- Talks excessively
- Blurts out answers
- Difficulty in waiting their turn
- Interrupts or intrudes upon others
- References
- (2013) DSM 5, APA
- Accardo (1999) Pediatr Clin North Am 46:845-56 [PubMed]
- Barbaresi (1996) Mayo Clin Proc 71:463-71 [PubMed]
- Chang (2020) Am Fam Physician 102(10):592-602 [PubMed]
- Felt (2014) Am Fam Physician 90(7): 456-64 [PubMed]
- Smucker (2001) Am Fam Physician 64:817-32 [PubMed]
- Post (2012) Am Fam Physician 85(9):890-896 [PubMed]