Attention-Deficit/Hyperactivity Disorder (ADHD)

Deciding if a child has ADHD is a process with several steps.  Many Symptoms may be nonspecific, may have many causes, psychiatric, medical and/or environmental.  There is no single test to diagnose ADHD, and many other problems, like sleep disorders, anxiety, depression, and certain types of learning disabilities, can have similar symptoms.

The American Academy of Pediatrics (AAP) recommends that healthcare providers ask parents, teachers, and other adults who care for the child about the child’s behavior in different settings, like at home, school, or with peers. 

The healthcare provider should also determine whether the child has another condition that can either explain the symptoms better, or that occurs at the same time as ADHD.

People with ADHD show a persistent pattern of inattention and/or hyperactivity–impulsivity however may present differently over the time.

DSM 5-TR ADHD Diagnostic Criteria

Diagnosis of ADHD DSM 5-TR-CDC

Inattention: Six or more symptoms of inattention for children up to age 16 years, or five or more for adolescents age 17 years and older and adults; symptoms of inattention have been present for at least 6 months, and they are inappropriate for developmental level:

• Often fails to give close attention to details or makes careless mistakes in schoolwork, at work, or with other activities.
  • Often has trouble holding attention on 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, chores, or duties in the workplace (e.g., loses focus, side-tracked).
  • Often has trouble organizing tasks and activities.
  • Often avoids, dislikes, or is reluctant to do tasks that require mental effort over a long period of time (such as schoolwork or homework).
  • Often loses things necessary for tasks and activities (e.g. school materials, pencils, books, tools, wallets, keys, paperwork, eyeglasses, mobile telephones).
  • Is often easily distracted.
  • Is often forgetful in daily activities.
• Hyperactivity and Impulsivity: Six or more symptoms of hyperactivity-impulsivity for children up to age 16 years, or five or more for adolescents age 17 years and older and adults; symptoms of hyperactivity-impulsivity have been present for at least 6 months to an extent that is disruptive and inappropriate for the person’s developmental level:
  • Often fidgets with or taps hands or feet, or squirms in seat.
  • Often leaves seat in situations when remaining seated is expected.
  • Often runs about or climbs in situations where it is not appropriate (adolescents or adults may be limited to feeling restless).
  • Often unable to play or take part in leisure activities quietly.
  • Is often “on the go” acting as if “driven by a motor”.
  • Often talks excessively.
  • Often blurts out an answer before a question has been completed.
  • Often has trouble waiting their turn.
  • Often interrupts or intrudes on others (e.g., butts into conversations or games)

In addition, the following conditions must be met:

• Several inattentive or hyperactive-impulsive symptoms were present before age 12 years.
• Several symptoms are present in two or more settings, (such as at home, school, or work; with friends or relatives; in other activities).
• There is clear evidence that the symptoms interfere with, or reduce the quality of, social, school, or work functioning.
• The symptoms are not better explained by another mental disorder (such as a mood disorder, anxiety disorder, dissociative disorder, or a personality disorder).  The symptoms do not happen only during the course of schizophrenia or another psychotic disorder.

Based on the types of symptoms, three kinds (presentations) of ADHD can occur:

• DSM F90.2 Combined Presentation: if enough symptoms of both criteria inattention and hyperactivity-impulsivity were present for the past 6 months
• DSM F90.0 Predominantly Inattentive Presentation: if enough symptoms of inattention, but not hyperactivity-impulsivity, were present for the past six months
• DSM F90.1 Predominantly Hyperactive-Impulsive Presentation: if enough symptoms of hyperactivity-impulsivity, but not inattention, were present for the past six months.
• DSM F90.8 Other Specified Attention-Deficit/Hyperactivity Disorder
• DSM F90.9 Unspecified Attention-Deficit/ Hyperactivity Disorder

Because symptoms can change over time, the presentation may change over time as well (American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, 5th edition, Text Revision. Arlington, VA., American Psychiatric Association, 2022.).

ROUTINE PCP VISIT – GENERAL SCREENING For Behavioral Health Issues

General Office Screening –

• Consult ACCESS MH-CT as needed.
• Screen for Behavioral Health concerns during PCP well check and other appointments.
• If ADHD suspected, schedule a focused appointment.
• Always screen for safety and assess and follow up immediately with crisis assessment and referral as indicated.

NICHQ_Vanderbilt_Assessment_Scales.pdf

• For children 6-12 years old
• Parent form: 55 items; Teacher form: 43 items
• 10 minutes to complete.
• Parent and teacher complete questionnaire
• Free
• Used for information about symptoms and performance in different settings; not intended for diagnosis.

Swanson, Nolan, and Pelham (SNAP-IV)

SNAP_ADHD Rating_Scale.pdf )   26 item Form

SNAP-IV 90   90 Item Parent Teacher Rating Scale and instructions.

• For children and adolescents 6-18 years old
• Free 90 item and 26 item versions
• 10 minutes to complete.
• Parent and teacher complete questionnaire
• Contains items pertaining to DSM criteria for ADHD; measures impairment and functioning at home and at school

Pediatric Symptom Checklist (massgeneral.org)

• Free 35 item and 17 item questionnaire, public domain, parent report and youth self-report versions, available in multiple languages.
• PSC 17 Cut points: 15 total, 7 attention, 7 behavior

ASEBA – The Achenbach System Of Empirically Based Assessment
Formerly known as CBCL, 113-item questionnaire, parent report, youth self-report, and teacher report versions generate comprehensive profiles with normed subscales when the instrument is scored; requires data entry for computer scoring or fairly complex hand-scoring. ($ Must be purchased)