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Tests and diagnosis
By Mayo Clinic staffThere's no specific test for ADHD. Gathering as much information as possible about your child is the best way to get an accurate diagnosis and rule out other possible causes of your child's symptoms.
An appointment to check for ADHD usually begins with a complete medical exam and a number of questions about your child's health, medical problems, difficulties, and issues that occur at school and at home.
Children diagnosed with ADHD have symptoms over a long period of time and have particular trouble in stressful, demanding situations or in activities that require sustained attention, such as reading, doing math problems or playing board games.
In general, a child shouldn't receive a diagnosis of ADHD unless the core symptoms of ADHD start early in life and create significant problems at home and at school on an ongoing basis.
Diagnostic criteria for attention-deficit/hyperactivity disorder
To be diagnosed with ADHD, your child must meet the criteria spelled out in the Diagnostic and Statistical Manual of Mental Disorders IV (DSM-IV). This manual is published by the American Psychiatric Association. For a diagnosis of ADHD, a child must have six or more signs and symptoms from one of the two categories below (or, six or more signs and symptoms from each of the two categories).
Inattention
- Often fails to give close attention to details or makes careless mistakes in schoolwork and other activities
- Often has difficulty sustaining attention in tasks or play activities
- Often does not seem to listen when spoken to directly
- Often does not follow through on instructions and fails to finish schoolwork or chores (not due to oppositional behavior or failure to understand instructions)
- Often has difficulty organizing tasks and activities
- Often avoids, dislikes or is reluctant to engage in tasks that require sustained mental effort (such as schoolwork or homework)
- Often loses things necessary for tasks or activities (for example, toys, school assignments, pencils, books)
- Is often easily distracted
- Is often forgetful in daily activities
Hyperactivity and impulsivity
- Often fidgets with hands or feet or squirms in seat
- Often leaves seat in classroom or in other situations in which remaining seated is expected
- Often runs about or climbs excessively in situations in which it is inappropriate
- Often has difficulty playing or engaging in leisure activities quietly
- Is often "on the go" or often acts as if "driven by a motor"
- Often talks excessively
- Often blurts out answers before questions have been completed
- Often has difficulty awaiting turn
- Often interrupts or intrudes on others (for example, butts into conversations or games)
In addition to having at least six signs or symptoms from one of the two categories, a child with ADHD:
- Has inattentive or hyperactive-impulsive signs and symptoms that caused impairment and were present before age 7
- Has behaviors that aren't normal for children the same age who don't have ADHD
- Has symptoms for at least six months
- Has symptoms that affect school, home life or relationships in more than one setting (such as at home and at school)
A child diagnosed with ADHD is often given a more specific diagnosis, such as:
- Predominantly inattentive-type ADHD — a child has at least six signs and symptoms from the inattention list above.
- Predominantly hyperactive-impulsive-type ADHD — a child has at least six signs and symptoms from the hyperactivity and impulsivity list above.
- Combined type ADHD — a child has six or more signs and symptoms from each of the two lists above.
Other conditions that resemble ADHD
Your child's doctor will want to check for all possible causes of your child's behavior. A number of medical conditions or their treatments may cause signs and symptoms similar to those of ADHD, including:
- Learning or language problems
- Mood disorders (such depression)
- Anxiety disorders
- Seizure disorders
- Vision or hearing problems
- Tourette syndrome
- Sleep disorders
- Thyroid medication
Not only can some of these conditions cause symptoms that mimic ADHD, but these and other coexisting conditions also are found in children with ADHD.
Diagnosing ADHD in young children
Although signs of ADHD can sometimes appear in preschoolers or children even younger, diagnosing the disorder in very young children is difficult. That's because developmental problems such as language delays can be mistaken for ADHD. For that reason, children preschool age or younger suspected of having ADHD are more likely to need evaluation by a specialist such as a psychologist or psychiatrist, speech pathologist or developmental pediatrician.
Questionnaires and interviews
Because ADHD symptoms may not be obvious in a medical office, the doctor is likely to use questionnaires and interviews to learn more about your child's behavior. Your child's doctor may want to interview or send questionnaires to your child's teachers or other people who know your child well, such as baby sitters and coaches. Your child's doctor may also use ADHD rating scales to help collect and evaluate information about your child.
- Attention deficit/hyperactivity disorder. National Institute of Mental Health. http://www.nimh.nih.gov/health/publications/attention-deficit-hyperactivity-disorder/adhd_booklet.pdf. Accessed Nov. 10, 2010.
- Attention-deficit/hyperactivity disorder. In: Diagnostic and Statistical Manual of Mental Disorders DSM-IV-TR. 4th ed. Arlington, Va.: American Psychiatric Association; 2000. http://www.psychiatryonline.com. Accessed Nov. 10, 2010.
- Rucklidge JJ. Gender differences in attention/deficit hyperactivity disorder. Psychiatric Clinics of North America. 2010;33:357.
- Clinical practice guideline: Treatment of the school-aged child with attention-deficit/hyperactivity disorder. Elk Grove Village, Ill. American Academy of Pediatrics. Subcommittee on Attention-Deficit/Hyperactivity Disorder and Committee on Quality Improvement, et al. Pediatrics. 2001;108:1033.
- Rader R, et al. Current strategies in the diagnosis and treatment of childhood attention-deficit/hyperactivity disorder. American Family Physician. 2009;79:657.
- Spencer T. Attention-deficit/hyperactivity disorder. In: Ebert MH, et al. Current Diagnosis & Treatment: Psychiatry. 2nd ed. New York, N.Y., McGraw Hill Medical; 2008. http://www.accessmedicine.com/content.aspx?aID=3290305. Accessed Nov. 10, 2010.
- Wilms Floet AM, et al. Attention-deficit/hyperactivity disorder. Pediatrics in Review. 2010;31:56.
- Krisanaprakornkit T, et al. Meditation therapies for attention-deficit/hyperactivity disorder (ADHD). Cochrane Database of Systematic Reviews. 2010:CD006507. http://www.cochrane.org/reviews. Accessed Nov. 10, 2010.
- Larzelere MM, et al. Complementary and alternative medicine usage for behavioral health indications. Primary Care Clinics. 2010;37:213.
- Swintak CC (expert opinion). Mayo Clinic, Rochester, Minn. Nov. 19, 2010.
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