Tests and Assessments for Diagnosing ADHD
ADHD stands for attention deficit hyperactivity disorder. It typically affects children and teenagers, although it can continue into adulthood.
The most common symptoms include:
- Inattention, in which the person lacks persistence to complete a task, is disorganized, and wanders away from tasks
- Hyperactivity, in which the individual moves their body constantly, especially fidgeting, tapping, pacing, or talking excessively
- Impulsivity, such as hasty decision-making, sudden changes in desire or goal activity, or interrupting a conversation as new thoughts emerge.
These general symptoms appear in both children and adults with ADHD, but they can be displayed in slightly different ways, which leads to different diagnostic criteria. There are also different types of ADHD, which can present in children or adults, that have different symptoms.
Types of ADHD
There are three types of ADHD, according to the Centers for Disease Control, which can present in both children and adults. These types are:
- Predominantly inattentive:People have trouble organizing, cannot finish tasks, have difficulty paying attention to details or following instructions, and have trouble maintaining conversations. They are easily distracted by new stimuli, and often forget items or parts of daily routine.
- Predominantly hyperactive-impulsive:This is characterized with excessive fidgeting, twitching, or talking. People have trouble sitting still for long enough to complete a task. In small children, constant running, jumping, or climbing on things may indicate ADHD; adults with this type of ADHD may interrupt conversations, speak at inappropriate times, or be unable to stay in a meeting or at their desk without fidgeting. They have trouble waiting their turn. People with this type of ADHD may suffer accidents or injuries more often, compared to the general population.
- Combined presentation:This occurs when most symptoms of both types of ADHD appear in one individual.
Because ADHD often continues into adulthood, it is important to understand symptoms and get children diagnosed as soon as possible. An appropriate treatment plan, including medication and therapy, can help prevent difficulties later in life.
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Specific Tests and Assessments
The following specific tests and assessments are used to diagnose ADHD.
Criteria to Diagnose Childhood ADHD
Determining whether a child has ADHD takes a lot of information and a persistence of symptoms. The DSM-5 outlines the requirements for a diagnosis of childhood ADHD: six or more symptoms must be present before the child reaches age 12; they must persist for at least six months, in at least two different settings (e.g., both at school and at home); and they must lead to inappropriate reactions or conduct for the child’s developmental age. In order to rule out other underlying causes, a medical professional will conduct a physical exam, take a medical history, and may use blood work or a brain scan to back up the diagnosis.
ADHD-like symptoms can present in children who have experienced a major negative life event, such as the loss of a parent, or abuse; these symptoms can also indicate a larger health issue. It is important to rule these possibilities out.
Symptoms of predominantly inattentive ADHD in children are:
- Careless mistakes in class or on homework
- Failure to follow directions in class, on tests, on homework assignments, or during social or family events
- Daydreaming a great deal
- Does not appear to be listening
- Forgetting daily activities or objects associated with daily activities (e.g., backpack, shoes, etc.)
- Trouble organizing daily tasks
- Losing things repeatedly or frequently
- Disinterest in participating in activities that require sitting still
Symptoms of predominantly hyperactive ADHD in children are:
- Bouncing when sitting, squirming a lot in chairs, or fidgeting
- An inability to stay seated
- An inability to play quietly
- Constantly moving, especially running, jumping, and climbing
- Excessive talking and interrupting others in conversation
Symptoms of impulsivity in children with ADHD are:
- Cannot wait for their turn
- Blurting out answers or thoughts as they occur
- Interrupting others or cannot maintain the thread of a conversation
Children will receive a diagnosis of one of the three types of ADHD depending on how their symptoms cluster together.
Tests to Diagnose Childhood ADHD
Ratings scales given to parents, guardians, and teachers can help the therapist determine the severity and consistency of the child’s symptoms. Some of these tests include:
- The Vanderbilt Assessment Scale:This is a ratings system of 55 questions that ask the adults in a child’s life to rate, from 1 to 3, how serious the child’s symptoms are. This scale helps to rule out other conditions that can display like ADHD, including oppositional defiant disorder, conduct disorder, depression, or anxiety.
- Behavioral Assessment System for Children (BASC):This ratings scale examines learning problems, aggression, hyperactivity, conduct problems, and potential symptoms of depression and anxiety.
- Child Behavior Checklist/Teacher Report Form (CBCL):This scale looks at physical complaints, delinquent behavior, social withdrawal, and aggression or outbursts.
In addition, a physician may conduct a Neuropsychiatric EEG-Based Assessment Aid (NEBA) System scan, to examine the child’s brainwaves. Children and adolescents who have ADHD display higher levels of certain types of brainwaves. This test is approved to diagnose children ages 6-17, and it is one aspect of a more complete medical exam.
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Criteria to Diagnose Adult ADHD
All adults who are diagnosed with ADHD developed the condition as children. Some children do grow out of ADHD, but about 60 percent continue to manifest the condition as adults. They may have been appropriately diagnosed and treated as children, and ADHD persisted into their adult years, or they may not have received an appropriate diagnosis or treatment as children and are just now learning how disruptive the condition can be. ADHD affects 4-5 percent of US adults. In order for an adult to receive a diagnosis of ADHD, according to the DSM-5, the individual must experience five or more symptoms for six months or more.
A medical professional or therapist will gather information about the adult, including the persistence of symptoms, as well as medical history. A doctor may perform a physical exam, which could include blood tests and brain scans to rule out other underlying physical conditions. The doctor or therapist may also ask their patient to find out about potential childhood symptoms from their parents, siblings, guardians, or other relatives; determining if the person has undiagnosed ADHD in childhood can lead to an adult diagnosis. The doctor or therapist may also ask to interview the individual’s partner in order to get an outside perspective on behavior.
Adults who struggle with ADHD may drop out of school; could have repeated grades while in school; have a history of underachievement; get more speeding tickets; suffer more physical injuries due to car accidents or physical impulsiveness; use alcohol or drugs more often; struggle to maintain employment; experience depression or anxiety; and have trouble in marriages, get divorced soon after marriage, or have multiple marriages.
Untreated symptoms of ADHD can get worse in adults and lower the person’s self-esteem and quality of life. Adult symptoms of ADHD can include:
- Being chronically late
- Forgetfulness about events or necessary items
- Mood swings
- Low self-esteem
- Difficulty at work
- Easily frustrated
- Difficulty controlling anger
- Impulsiveness or sudden decisions
- Procrastinating on projects
- Chronic boredom
- Difficulty concentrating on reading, especially long articles or books
- Difficulty maintaining non-family relationships
- Substance abuse or addiction
- Physical impulsiveness, or an inability to understand appropriate levels of physical movement or exercise
- Excessive talking or interrupting during conversations
Tests to Diagnose Adult ADHD
Adult tests for ADHD can include the Vanderbilt Assessment Scale, given to friends or romantic partners; however, it is more likely to involve the following steps:
- Diagnostic interview with the patient:This helps the medical provider or therapist determine the individual’s experience of symptoms.
- Interview to screen for other psychiatric disorders:The therapist or physician will screen their adult patient for symptoms of other psychiatric problems.
- Interviews with friends, family, and other loved ones:This helps the physician determine severity and frequency of symptoms, outside of the individual client’s experience.
- Medical examination and other testing:These procedures help rule out other underlying conditions, such as brain chemistry, brain structure, illness, or injury issues.
Get Help for ADHD
Untreated ADHD in adulthood can lead to psychiatric problems, such as depression or anxiety, which may lead to self-medication through substance abuse. People who struggle with impulsiveness may develop problems around substance abuse too. If ADHD receives appropriate treatment in childhood, or even a successful diagnosis in adulthood, substance abuse can be reduced and appropriately treated. Rehabilitation facilities help people struggling with substance abuse successfully detox, then receive customized therapy to better understand their addiction and substance abuse patterns. For people who have both ADHD and a substance abuse problem, treatment for co-occurring disorders is needed to effectively address both disorders.