Evaluation

A thorough evaluation is essential to make a diagnosis of ADHD. There are currently no medical or psychological tests to make such a diagnosis. Instead, the health care provider must evaluate the presence of symptoms; determine if they pose impairment; and judge they are not better accounted for by another diagnosis. A comprehensive patient history, including gathering information from the patient, parents, care providers, and teachers is necessary to gather complete diagnostic data.8 Physical or neurological exams may be performed to rule out other conditions and a psychological evaluation is conducted to rule out learning problems and determine comorbid mental health issues.7 DSM-IV criteria are applied to make the ADHD diagnosis. These criteria are summarized in Table 1.

Table 1. Diagnostic Criteria for ADHD6
  1. Either 1 or 2
    1. Six or more of the following symptoms of inattention that have persisted for at least 6 months to a degree that is maladaptive and inconsistent with developmental level. These symptoms represent the subtype of ADHD - primarily inattentive
    2. Inattention
      • Often fails to give close attention to details or makes careless mistakes in schoolwork, work or other activities
      • Often does not seem to listen when spoken to directly
      • Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace
      • Often has difficulty organizing tasks and activities
      • Often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort
      • Often loses things necessary for tasks or activities
      • Is often distracted by extraneous stimuli
      • Is often forgetful in daily activities
    3. Six or more of the following symptoms of hyperactivity-impulsivity that have persisted for at least 6 months to a degree that it is maladaptive and inconsistent with developmental level. These symptoms represent the subtype of ADHD - primarily hyperactive/impulsive.

    4. Hyperactivity
      • Often fidgets with hands or feet or squirms in seat
      • Often leaves seat in classroom or in other situations in which remaining in seat is expected
      • Often runs about or climbs excessively in situations in which it is inappropriate. In adolescents or adults, may be limited to subjective feelings of restlessness
      • Often has difficulty playing or engaging in leisure activities quietly
      • Is often 'on the go' or acts as if 'driven by a motor'
      • Often talks excessively

      Impulsivity
      • Often blurts out answers before questions have been completed
      • Often has difficulty awaiting turn
      • Often interrupts or intrudes on others
  2. When symptoms as described in both 1 and 2 are present, they represent the subtype ADHD - combined.
  3. Some hyperactive-impulsive or inattentive symptoms that caused impairment were present before age 7
  4. Some impairment from the symptoms is present in 2 or more settings (home, work, school, social)
  5. There must be clear evidence of clinically significant impairment in social, academic or occupational functioning
  6. The symptoms do not occur exclusively during the course of a pervasive developmental disorder, schizophrenia, or other psychotic disorder
  7. ADHD can range from mild to severe. No one person has all the symptoms of the disorder