ADHD Assessment
Understanding ADHD diagnostic criteria, what assessment should include, and what quality diagnosis looks like.
ADHD diagnosis requires a persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning and is present across multiple settings.
- 1Often fails to give close attention to details or makes careless mistakes
- 2Often has difficulty sustaining attention in tasks or play activities
- 3Often does not seem to listen when spoken to directly
- 4Often does not follow through on instructions and fails to finish tasks
- 5Often has difficulty organising tasks and activities
- 6Often avoids or is reluctant to engage in tasks requiring sustained mental effort
- 7Often loses things necessary for tasks and activities
- 8Is often easily distracted by extraneous stimuli
- 9Is often forgetful in daily activities
- 1Often fidgets with or taps hands/feet or squirms in seat
- 2Often leaves seat when remaining seated is expected
- 3Often runs about or climbs in inappropriate situations
- 4Often unable to play or engage in leisure activities quietly
- 5Is often "on the go" or acts as if "driven by a motor"
- 6Often talks excessively
- 7Often blurts out answers before questions are completed
- 8Often has difficulty waiting their turn
- 9Often interrupts or intrudes on others
Additional requirements
Several symptoms present before age 12 years
Symptoms must have been present in childhood, though diagnosis can be made at any age.
Symptoms present in two or more settings
E.g., home AND school/work. Can't just be a problem in one environment.
Clear evidence of clinically significant impairment
In social, academic, or occupational functioning. Having symptoms isn't enough.
Not better explained by another condition
Must not be explained by other mental health conditions, though ADHD can co-occur with other disorders.
ADHD presentations
Meets criteria for both inattention AND hyperactivity-impulsivity
Most commonly diagnosed. Classic ADHD presentation.
Meets criteria for inattention but NOT hyperactivity-impulsivity
More common in girls. Often missed or diagnosed later. Previously called ADD.
Meets criteria for hyperactivity-impulsivity but NOT inattention
Less common. More often seen in younger children.
What assessment should include
- Current symptoms in detail
- Developmental history
- Family history of ADHD
- Academic and social history
- Previous interventions tried
- Impact on daily functioning
- Parent rating scales (Conners, Vanderbilt, SNAP-IV)
- Teacher rating scales
- Self-report (older children/adults)
- Scales should cover both settings
- Teacher observations and concerns
- Academic performance data
- Behaviour in classroom
- Social functioning at school
- Vision and hearing screening
- Sleep assessment
- Thyroid function if indicated
- Review of medications that might cause symptoms
- Academic functioning
- Family relationships
- Peer relationships
- Self-esteem and wellbeing
- Safety concerns
Note:
Differential diagnosis
Many conditions can look like ADHD or co-occur with it. Good assessment considers alternatives.
| Condition | Overlapping features | How to distinguish |
|---|---|---|
| Anxiety | Difficulty concentrating, restlessness | Anxiety causes concentration problems due to worry. ADHD concentration problems are interest-driven. |
| Depression | Poor concentration, low motivation, forgetfulness | Depression has mood component. ADHD symptoms predate mood changes. |
| Sleep disorders | Inattention, hyperactivity, irritability | Sleep problems can mimic ADHD. Always assess sleep. May co-occur. |
| Autism | Social difficulties, difficulty with transitions, executive function problems | Different pattern of social difficulties. Can co-occur (50%+ overlap). |
| Learning disabilities | Academic difficulties, avoidance of schoolwork | Learning disabilities cause specific skill deficits. May co-occur. |
| Trauma/PTSD | Hypervigilance, concentration problems, emotional dysregulation | Trauma symptoms are reactive to reminders. Need careful history-taking. |
Who commonly gets missed?
Less hyperactive presentation. May mask symptoms. Teachers less likely to refer.
Compensate academically. Difficulties may not emerge until later. "Too smart to have ADHD" myth.
Childhood not documented. Symptoms attributed to character. Compensatory strategies mask difficulties.
Doesn't disrupt class. May be seen as "dreamy" or "lazy". Less obvious than hyperactivity.
- ADHD can be diagnosed in children aged 5 and over
- Diagnosis requires comprehensive assessment by specialist
- Multi-informant evidence essential (home and school)
- Should screen for co-occurring conditions
- Watch and wait not appropriate if significant impairment
- Environmental interventions should be offered first
- Medication can be considered for moderate-severe ADHD
- GP must process valid Right to Choose requests
- Can choose private provider for NHS-funded assessment
- Must be on NHS pathway first
- Waiting times often shorter
- Assessment should meet same standards
Right to Choose applies to England only. Scotland, Wales, and Northern Ireland have different systems.
ADHD diagnosis requires impairment, not just symptoms. Many people have some ADHD-like symptoms. Diagnosis is appropriate when those symptoms are persistent, present across settings, and cause significant problems in daily life.
Good assessment focuses not just on whether criteria are met, but on understanding how ADHD affects your specific child and what support they need.