Diagnosing ADD & ADHD

Diagnosing ADD / ADHD in children

If you suspect that your child has ADD / ADHD, schedule an appointment with a for a diagnostic assessment. At present, no laboratory or imaging test exists to determine if your child has ADD / ADHD. Clinicians base their diagnosis on the behavioral symptoms they observe and by and ruling out other disorders.

Diagnosing ADD / ADHD in adults

Many people only learn that they have ADD / ADHD when they become adults. Some find out after their children receive the diagnosis; as they become educated about the condition, they realize that they also have it. For others, the symptoms finally outpace their coping skills, causing significant enough problems in their daily life that they seek help. If you recognize the signs and symptoms of ADD / ADHD in yourself, schedule a visit with a mental health professional for an assessment.

Because ADD / ADHD often co-occurs with other conditions such as anxiety and depression, it is best to see a psychiatrist or psychologist who has experience diagnosing and treating the disorder. To determine if you have ADD / ADHD, the specialist will:

• Ask you about your symptoms, including how long they’ve been bothering you.
• Administer ADD / ADHD tests, such as symptom checklists and attention-span tests.
• Ask you about problems the symptoms are causing or have caused in the past.
• Talk to family members or someone close to you about the symptoms.
• Give you a medical exam to rule out other physical causes for the symptoms.

ADD / ADHD Diagnostic Criteria

To be diagnosed with ADD / ADHD, both children and adults must exhibit multiple symptoms of hyperactivity, impulsivity, or inattention. In addition, the mental health professional assessing the problem will also look at:

• The severity of the symptoms – To be diagnosed with ADD / ADHD, the symptoms must have a negative impact on the person’s education, career, relationships, or social life.
• When the symptoms started – Since ADD / ADHD starts in childhood, the doctor or therapist will look at how early the symptoms appeared. To receive a diagnosis, the symptoms must have been present before age seven.
• How long the symptoms have been present – The symptoms must have been going on for at least 6 months before ADD / ADHD can be diagnosed.
• When and where the symptoms appear – The symptoms of ADD / ADHD must be present in multiple settings, such as at home and school. If the problem only appears in one environment, it is unlikely to be caused by ADD / ADHD.

Choosing a specialist to evaluate you or your child

When choosing a specialist, it’s a good idea to get recommendations from other doctors, therapists, and parents. Talk to former patients and clients, if possible, and find out what their experience was. It’s also important to find out what’s covered by insurance. Will your health insurance cover part or all of the ADD / ADHD evaluation?

Find out:

• the professional certification and academic degrees of the specialist
• the procedural code (CPT code) and diagnostic code (ICD code) that the specialist will use to bill for the evaluation
• how comprehensive the evaluation is
• how much the specialist will charge

Then talk with your health insurance provider about what your plan covers for evaluation for ADHD. Some insurance policies cover evaluation for ADHD from one kind of specialist, but not from another.

Co-existing conditions and ADD / ADHD

Major stressful life events can result in temporary symptoms that look like ADD / ADHD. These events include divorce, child abuse, death of a loved one, a move, or a sudden traumatic experience. Under these circumstances, symptoms of inattention and hyperactivity may arise suddenly and, therefore, would have no long-term history. Remember, ADD / ADHD symptoms must exist for at least six months and cause some difficulty before the age of seven. Of course, a child can have ADD / ADHD and experience a stressful event, so such events do not automatically rule out the existence of ADD / ADHD.

Other mental health conditions and disorders also commonly co-occur with ADD / ADHD. They may also be mistaken for ADD / ADHD, and making the distinction can be difficult. That is why evaluations need to be conducted by a professional who is trained in a wide variety of child and adolescent disorders.

• Oppositional Defiant Disorder - A pattern of negative, hostile, and defiant behavior. Symptoms include frequent loss of temper, arguing (especially with adults), refusal to obey rules, intentionally annoying others, blaming others. The person is angry, resentful, possibly spiteful, and touchy.
• Conduct Disorder - A pattern of behavior that persistently violates the basic rights of others or society's rules. Behaviors may include aggression toward people and animals, destruction of property, deceitfulness or theft, or serious rule violations.
• Anxiety - Excessive worry that occurs frequently and is difficult to control. Symptoms include feeling restless or on edge, easily fatigued, difficulty concentrating, irritability, muscle tension, and sleep disturbances.
• Depression - A condition marked by trouble concentrating, sleeping, and feelings of dejection and guilt. There are many types of depression. With ADD / ADHD you might commonly see dysthymia, which consists of a depressed mood for many days, over or under eating, sleeping too much or too little, low energy, low self-esteem, poor concentration, and feeling hopeless. Other forms of depression may also be present.
• Learning Disabilities - Problems with reading, writing, or mathematics. When given standardized tests, the student's ability or intelligence is substantially higher than his or her achievement. While children with ADD / ADHD frequently have problems with reading fluency and math, these problems have to do with attention and memory, rather than a learning disability.

Getting help for ADD / ADHD

Treatment options for ADD / ADHD

Once you or your child has received an ADD / ADHD diagnosis, it’s time to explore the treatment options. There are many effective treatments that can help, including behavior therapy, support groups, social skills training, and ADD coaching.

Read: ADD / ADHD Treatment

Medication for ADD / ADHD

Medication–when used as part of a comprehensive treatment plan–can improve symptoms of hyperactivity, impulsivity, and inattention. However, all drugs should be approached with caution, as they have side effects that may prove to be more difficult than the problem they are supposed to be treating. Furthermore, medication for ADD / ADHD is not a cure and should not be used by everyone.

Read: Medications for Treating ADHD

Related links for ADD / ADHD diagnosis

Diagnosing ADD & ADHD

How Is Attention-Deficit Hyperactivity Disorder Diagnosed? – Detailed article about the criteria and methods used in screening for ADD / ADHD. (University of Maryland Medical Center)

Identifying and Treating ADHD: A Resource for School and Home (PDF) – In-depth guide to the diagnosis and treatment of ADD / ADHD in children. (U.S. Department of Education)

ADHD: Diagnosis Dilemma – Explore the complexities of diagnosing ADD / ADHD in adults. (Psychology Today)

Defining and Diagnosing ADHD – Offers several brief, informative articles describing the diagnostic criteria for ADHD, how children are diagnosed, and the challenges of diagnosing and treating ADD / ADHD. (PBS.org)

Getting a Diagnosis– See “AAP Guidelines,” “Getting a diagnosis through the school system,” and “Specialists for diagnosing ADHD.” (MyADHD.com)

Finding professional help for your child

CHADD Professional Directory – Once you accept the CHADD agreement, choose a type of professional from the dropdown menu beginning with Any Category. (Children and Adults with Attention-Deficit/Hyperactivity Disorder)

Attention Deficit Disorder Resources – A directory of providers for professional help with ADD / ADHD. Broaden your search if you don’t get enough providers in your initial search. (Attention Deficit Disorder Resources)

Delving deeper into ADD / ADHD diagnosis

Summary Of The Practice Parameters For The Assessment And Treatment Of Children, Adolescents, And Adults With Attention-Deficit/Hyperactivity Disorder – Written for psychiatric practitioners, this article is a complex but comprehensive discussion of ADD / ADHD diagnosis. (American Academy of Child & Adolescent Psychiatry)

Melinda Smith M.A., Ellen Jaffe-Gill, M.A., Robert Segal, M.A, and Jeanne Segal, Ph.D., contributed to this article. Last modified on 6/26/08.