Diagnosing ADHD in Children

Diagnostic Approach

The American Academy of Pediatrics recommends diagnosing ADHD using DSM-5 criteria, with documentation of symptoms and impairment in more than one setting, obtaining information primarily from parents/guardians, teachers, and other school personnel through standardized rating scales and interviews 1, 2
Initiate evaluation for any child 4-18 years of age who presents with academic or behavioral problems and symptoms of inattention, hyperactivity, or impulsivity, using a comprehensive assessment approach 3, 2
Determine that DSM-5 criteria have been met, documenting symptoms and impairment in more than one major setting, and rule out alternative causes for symptoms before confirming ADHD diagnosis 1, 2
Collect information from multiple sources including parents/guardians, teachers, and other school personnel, using standardized rating scales such as the ADHD Rating Scale-5 1, 4

DSM-5-based ADHD rating scales completed by parents and teachers are the most efficient and effective assessment method, with the ADHD Rating Scale-5 being a commonly used tool 1, 5

For preschool-aged children (4-5 years), conduct clinical interview with parents, examine and observe the child, and use DSM-based ADHD rating scales with preschool norms when available 5, 2
For school-aged children (6-12 years) and adolescents (12-18 years), obtain information from both parents and teachers using standardized rating scales, and include self-report measures and assessment for substance use for adolescents 1, 6

Assessment for other conditions that might coexist with ADHD is essential, including screening for emotional or behavioral disorders such as anxiety disorders, depression, oppositional defiant disorder, and conduct disorder 7, 6
Evaluate for developmental and learning disorders, including learning disabilities, language disorders, and other neurodevelopmental disorders 6
Assess for physical conditions, including sleep disorders, tics, and seizures 6

Collect information using DSM-5-based rating scales from both parents and teachers, conduct clinical interviews with parents, examine the child and observe behavior when possible, screen for comorbid conditions, rule out alternative causes for symptoms, confirm that DSM-5 criteria are met, and document specific impairments in social, academic, or occupational functioning 1, 2, 5, 6