Diagnostic Evaluation

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Making an ADHD diagnosis requires a comprehensive evaluation of medical, developmental, educational, and psychosocial status to confirm the presence, persistence, pervasiveness, and functional complications of the core symptoms, along with the identification of any potential coexisting emotional/behavioral, developmental, and/or physical disorders (see Table below).1,2 In addition, the patient's family history and family functioning are also assessed, as symptoms may be seen in the patient's family members. Assessing the patient's family also may provide an understanding of the psychosocial context of the patient's disorder and may provide important information about possible resources as well as stressors.1

Table: Recommendations for Evaluating and Diagnosing Children and Teenagers With Suspected ADHD*1,2

  1. Initiate an evaluation to screen for the possible presence of ADHD in individuals who present with inattention, hyperactivity, impulsivity, and academic or behavior problems.
  2. Evaluate the individual to determine whether he or she meets the DSM® criteria for ADHD.
  3. Assess the family and obtain evidence directly from parents and caregivers regarding the core symptoms of ADHD in various settings, the age of onset, the duration of symptoms, and the degree of functional impairment.
  4. Assess school involvement by obtaining evidence directly from teachers and school professionals regarding the core symptoms of ADHD, the duration of symptoms, and the degree of functional impairment.
  5. Obtain a thorough history of the patient, including ADHD and/or other significant mental disorders within the family, perinatal history, developmental milestones, medical history, and mental health history.
  6. Rule out alternative causes of symptoms, academic/work underachievement, or behavior problems.

*Based on recommendations from the American Academy of Pediatrics (AAP) and American Academy of Child and Adolescent Psychiatry (AACAP).

References

  1. Pliszka S; AACAP Work Group on Quality Issues. Practice parameter for the assessment and treatment of children and adolescents with attention-deficit/hyperactivity disorder. J Am Acad Child Adolesc Psychiatry. 2007;46(7):894-921.
  2. Subcommittee on Attention-Deficit/Hyperactivity Disorder, Steering Committee on Quality Improvement and Management. ADHD: clinical practice guideline for the diagnosis, evaluation, and treatment of attention-deficit/hyperactivity disorder in children and adolescents. Pediatrics. 2011:128(5):1007-1022, SI1-SI21.