It seems like everyone is talking about ADHD diagnosis. As of October 2022, the term “#ADHD” has been searched on the social media platform TikTok over 16 billion times! Most people struggle with attention on occasion, and this causes many adults to wonder if they have undiagnosed ADHD. In this blog post, we’ll teach you how ADHD is diagnosed to get you better prepared for an evaluation with a professional.
At Benson Behavioral Health, a psychiatric practice serving Oregon, we are available for an initial evaluation within one week. Click HERE to request a consultation.
ADHD Diagnosis Step #1: Know the Symptoms
Attention-deficit/hyperactivity disorder is a mental health condition that can impair a person’s ability to maintain concentration on daily tasks. It can also lead to problems with time management and organization.
According to the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR), to be diagnosed with ADHD, an adult must have at least five symptoms of inattention and/or five or more symptoms of hyperactivity/impulsivity. According to the DSM, symptoms must be severe enough to cause impairment in at least two areas of a person’s life (e.g., school, work, relationships, etc.)
Inattentive symptoms include:
- Poor listening skills
- Losing important items frequently
- Easily distracted by unimportant stimuli
- Forgetting daily activities
- Poor attention span
- Lacking ability to follow instructions
- Procrastination of activities that require mental effort
- Carelessness in work
Hyperactive/Impulsive symptoms include:
- Squirming when seated
- Feeling restless
- Appears to be “driven by a motor”
- Lacking ability to engage in leisure activities quietly
- Incapable of staying seated
- Overly talkative
- Difficulty waiting turn
- Interrupting others
- Blurting out answers to questions
Make a note of which of these you struggle with. Try to think of frequent, specific examples.
ADHD Diagnosis Step #2: Know Your History (and Family History)
DSM-5-TR places ADHD into the category of mental disorders called neurodevelopmental disorders which are “characterized by developmental deficits or differences in brain processes.” This is really just a fancy way of saying “conditions that begin early in life and can persist into adulthood.”
Before sitting down with a clinician, give your family (or someone who has known you well since childhood) a call and ask about any challenges you had in childhood or early adolescence with:
- School performance (especially in areas requiring sustained concentration like mathematics)
- Impulsive behaviors
- Challenges with authority
While you’ve got them on the phone, ask them if anyone you are related to you by blood has ever been diagnosed with:
- Bipolar disorder
- Substance use disorders
Next, make a record of your teen and adult years. Think carefully. Do you recall any challenges with:
- Social or romantic relationships (especially if related to frequent forgetfulness or disorganization)
- Employment (Changing jobs frequently? Multiple “performance improvement plans?”)
ADHD Diagnosis Step #3: Understand the Assessment
There is no single psychological test for the diagnosis of ADHD. There are no definitive “biomarkers” either, meaning no MRI scan of your brain or test of your blood can prove or disprove the ADHD diagnosis.
There are several types of clinicians who can diagnose you with ADHD. They include:
- Psychiatric clinicians (e.g., psychiatric nurse practitioners, physician assistants, psychiatrists)
- Social workers
- Primary care providers (e.g., family practice doctors/nurse practitioners, etc.)
Most providers evaluate ADHD via what is known as a diagnostic interview: a structured appointment, or series of appointments, in which the clinician carefully works through your developmental history (all that information you gathered from your family!) as well as each of the symptoms of ADHD to see if the diagnosis aligns with you. Psychiatric disorders are generally highly heritable (ADHD itself is thought to be about 80% heritable!) so your clinician will also ask about your family’s mental health history. Our clinic also uses a brief objective test of inattentive/hyperactive symptoms called QbCheck which will be discussed in detail in a forthcoming blog post.
It is also important to note that inattentive or hyperactive symptoms are trans-diagnostic: they are often present many in conditions that are not ADHD. For example, inattentive symptoms are frequently seen in anxiety, depression, bipolar disorder, sleep disorders, and substance use disorders. Accordingly, your clinician will ask specific questions to attempt to rule out all other causes of inattention prior to diagnosing you with ADHD.
There are some situations in which a diagnostic interview may not be sufficient. For example, a diagnostic interview may not be able to differentiate ADHD from other common neurodevelopmental disorders including autism spectrum disorder, learning disabilities, (e.g., dyslexia, dyscalculia, etc.) tic disorders, and intellectual disability. It generally requires more than just a few probing questions to separate ADHD from these disorders as there tends to be tremendous overlap in their respective symptoms with ADHD.
In these situations, a formal neuropsychological evaluation with a psychologist may be necessary. This sort of testing is generally several hours long and may include general intelligence testing, academic strength testing, motor skills testing, personality testing, sensory processing testing, measures of sustained/selective attention, and more. These evaluations are generally not covered by insurance, often need to be scheduled months in advance, and can easily cost hundreds or even thousands of dollars. They are likely excessive for most clients.
Key Takeaways to Better Understand Diagnosing ADHD:
- ADHD is a neurodevelopmental condition that presents in childhood and can persist into adulthood.
- To meet the criteria for an ADHD diagnosis, adults must have at least five inattentive and/or hyperactive symptoms and significant impairment in their daily life.
- The more information you can bring to your clinician about your developmental history in childhood or early adolescence, (e.g., issues with inattention, impulsivity, defiance, hyperactivity, etc.) the better. It is also helpful to gather a detailed family mental health history.
- A diagnostic interview will be able to appropriately diagnose most people with ADHD with some rare exceptions.
- If a diagnostic interview is insufficient, your clinician may refer you to a neuropsychological evaluation with a psychologist.