ADHD (Attention-Deficit Hyperactivity Disorder) isn’t simple to diagnose. There isn’t a physical test, such as an X-ray or blood test, which can determine if you or your child has ADHD. But this doesn’t mean it’s impossible to diagnose ADHD. Instead of a medical test, therapists or psychiatrists diagnose ADHD through an evaluation process.
The evaluation process is designed to help the therapist or psychiatrist collect information about you or your child, so they can determine if the symptoms meet the requirements for an ADHD diagnosis. The official diagnostic guide used in the US is included in the DSM (the Diagnostic and Statistical Manual of Mental Disorders). Remember that people with ADHD tend to be impulsive or angry but most are not violent.
Diagnostic requirements
Regardless of which form of ADHD you think you or your child may have, a therapist or psychiatrist will look for the same set of characteristics to diagnose ADHD. These include:
- The onset of symptoms before age 12
- Experiencing symptoms in different environments (home, school, work, etc.)
- Severe symptoms that disrupt everyday life
- Symptoms that are not accounted for by another mental health condition
If the above requirements are met, there’s a chance you or your child has ADHD. To determine which type of ADHD (there are 3) it is, the therapist or psychiatrist will ask a series of questions to confirm if the following symptoms are present and how severe they are:
For Predominantly Inattentive Presentation
- Make careless mistakes
- Disregard details
- Have difficulties paying attention when completing tasks
- Struggle to listen when spoken to
- Fail to follow instructions
- Have difficulties staying organized
- Avoid long-term tasks
- Lose track of essential items
- Are easily distracted
- Forget things often
Predominantly Hyperactive-Impulsive Presentation
- Regularly fidget
- Struggle to remain in one place
- Feel restless in situations when movement is inappropriate
- Can’t participate quietly in leisure activities
- Talk excessively
- Interrupt when others are talking
- Blurt out answers before the question is finished
- Find it difficult to wait your turn
For either of the above ADHD diagnoses to be made, symptoms must be present for at least six months. In children under 17 years old, six or more symptoms are needed for a diagnosis. In adults aged 17+, five or more symptoms are required for a diagnosis.
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Severity
As well as determining the type of ADHD, a therapist or psychiatrist will also specify its severity in one of the following ways:
- Mild — symptoms cause minor impairment in day-to-day functioning while also displaying sufficient symptoms to meet the diagnosis requirements.
- Moderate — symptoms cause more impairment to daily life than a mild diagnosis but more minor impairment than a severe diagnosis.
- Severe — many symptoms are present, and everyday life is significantly impaired as a result.
Diagnostic questions
To determine if the above criteria are met, a therapist or psychiatrist will ask you a series of questions, usually over several interviews. Dr. Scott Shapiro lists some things you might be asked in his post on diagnosing adult ADHD:
- Do you have difficulty reading magazines, books, or maps?
- Do you have a messy office or home?
- Do you have trouble starting and/or completing projects?
- Do you often feel mentally “foggy” or “in a haze”?
- Do others say you tend to jump from topic to topic in conversation
- Have you received negative feedback in your school or work reviews, such as inconsistent performance?
- Have you had any or all of these problems since childhood?
- Which family members, if any, have depression, anxiety, mood swings, or problems with attention and focus?
Low self-esteem
While the above list of symptoms will help a therapist or psychiatrist determine if you or your child has ADHD, they’re not definitive. Other symptoms aren’t on either of the above lists that still point to an ADHD diagnosis. ADHD coach Jacqueline Sinfield wrote about such a thing in her post on a common ADHD symptom:
“A common ADHD symptom I see amongst adults with ADHD is low self-esteem. One of the ways self-esteem is shaped from the messages we receive from the outside world, mainly the people we interact with.
When you have ADHD, you tend to experience more criticism and ‘unpleasant’ situations in your life than your non-ADHD peers. These experiences begin as a very young child, through teenage years, and into adulthood.
Low self-esteem can result in impaired academic and job performance, problems in relationships with the people in your life, anxiety, stress, depression, and drug and alcohol abuse.”
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Different symptoms
It’s also important to remember that different people display different symptoms and at different levels. Just because you don’t experience the same severity of the same symptoms as someone you know with ADHD, it doesn’t mean you don’t also suffer from it.
Dr. ED S. Jesalva explains it well in a post on five facts from an ADHD psychiatrist:
“ADHD often presents differently in men and women, boys and girls. Men and boys tend to have more hyperactive and impulsive symptoms, while girls often have symptoms of inattention.
Unfortunately, because symptoms in girls often are a bit more subtle, they often are overlooked. Of course, females certainly can have impulsive and hyperactive symptoms, and males can have showcase symptoms of inattention; every person is unique.”
Ruling out other conditions
ADHD symptoms aren’t exclusive to ADHD — they can also be symptoms of other conditions. Before ADHD can be diagnosed, a therapist or psychiatrist must confirm that the symptoms aren’t caused by something else.
Psychiatrist Matthew Goldenberg explains it well in his post on how a psychiatrist diagnoses and treats ADHD in adults:
“A mental health professional should both establish an accurate diagnosis of ADHD (if it is present) and also rule out other psychiatric diagnoses that can mimic ADHD symptoms. For example, the symptoms of ADHD can be mimicked by Post Traumatic Stress Disorder (PTSD), mood spectrum disorders (depression and bipolar disorder), substance use disorders, and many others.
Therefore, when a patient presents for the first time, I always conduct an extensive interview to collect the patient’s history related to ADHD. Additionally, I also get a complete psychiatric history which always includes screening for mood, anxiety, psychotic, and substance use disorders.
In some cases, the symptoms of ADHD are a manifestation of another psychiatric diagnosis. In other cases, patients have presented with partially improved ADHD symptoms, and once their other psychiatric diagnoses were identified and treated, their ADHD symptoms fully resolved.”
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Talk to a therapist or a psychiatrist
It’s natural to be scared of the unknown. And if you think you might have ADHD, talking to a therapist or a psychiatrist and seeking a diagnosis might seem like too much to handle. Marla Cummins, an ADHD coach, and productivity consultant has some advice to persuade you in her post on when an ADHD diagnosis is a great thing:
“Having an ADHD diagnosis can be incredibly empowering. Because, once you have the diagnosis, you can choose to access the plethora of excellent resources, including those that will explain some of the reasons you operate in the way you do or have in the past.
Then with this information in hand, you might say, ‘Oh, that’s why I do….’
And then not only will you come to realize you are not lazy, stupid, or crazy, but you also have more options open to you about what to do with this information.”
Psychotherapist Terry Matlen further stresses the importance of seeking help if you think you may have ADHD or any other kind of mental illness in her post on deciding if you should see a therapist to get DBT ADHD therapy.
“Without proper treatment for ADHD, symptoms can get entirely out of hand. Adults lose jobs, marriages, friendships, and whoa…so much more. And what a hit that takes on your self-esteem!
I feel that just about anyone, ADHD or not can benefit from psychotherapy. I have. I also believe that everyone who provides psychotherapy ought to experience it themselves and work out their issues before working on other people’s issues. That said, what is holding you back?”
