ADHD Testing

• Testing for ADHD involves several screening tools, full history and physical, self-tests, observations, and other neurocognitive evaluations.
• Blood tests are frequently done as part of the initial assessment.
• Occasionally, an imaging study like an X-ray or CAT scan may be necessary.

Attention deficit hyperactivity disorder (ADHD) is a behavioral disorder associated with difficulties with attentiveness, impulsivity, and hyperactivity. There are several subtypes of the disorder that include varying expressions of the symptoms. Attention deficit disorder (ADD) is considered an inattentive predominant subtype.

There is a high frequency (>50%) of comorbid psychiatric disorders in children and adults with ADHD, including

• bipolar disorder,
• mood disorders,
• anxiety disorders, and
• others.

The diagnosis and treatment of ADHD are well established and are based on observations and subjective reports by the affected children, parents, teachers, and physicians.

There are a number of assessments that are completed by physicians, parents, and teachers. No single scale or source should be used to make the diagnosis of ADHD. It requires information from multiple sources. These include the following:

1. The Vanderbilt Assessment Scale is a tool that reviews symptoms associated with ADHD and other psychiatric diagnoses. This is generally completed by a teacher and a parent. This is primarily used for children in elementary school.
2. Conners Scale is a symptom rating tool that can be used for children aged 2-18 years and is completed by teachers, parents, and even self-administered by adolescents.
3. The child behavior checklist is also called the Achenbach Checklist and is completed by parents, teachers, and the child and is a subjective evaluation of behaviors consistent with ADHD.

According to the American Academy of Pediatrics, any school-aged child who has a history of academic or behavioral problems and also has symptoms of inattention, hyperactivity, or impulsivity should be evaluated for ADHD.

More specifically, symptoms that may suggest ADHD include

• being unable to sit still,
• having poor ability to concentrate,
• poor listening skills,
• daydreaming excessively,
• acting without thinking, and
• poor school performance.

These symptoms can prompt the child's healthcare professional to consider the diagnosis of ADHD.

All pediatricians are trained to screen for ADHD using readily available screening tools mentioned above. In addition to the screening, there are also developmental specialists, psychiatrists, psychologists, and other behavioral specialists who are trained to evaluate for other learning differences and associated mental-health problems. The pediatrician can refer the child to a specialist if needed.

Although the hyperactive and impulsive symptoms usually improve as children age, at least one-third of all children with ADHD continue to exhibit some symptoms into adulthood. Often adults can also be diagnosed with ADHD and ADD. That means that there are probably quite a few adults who haven't yet been diagnosed with ADHD who might benefit from evaluation and treatment.

The evaluation of adults with ADHD is not as well established as it is in children but has matured over the last 10 years. In general, it involves a complete developmental history, symptom review, objective assessment of intentional deficits, medication review, and evaluation of other mental health disorders. Some of these tools include

• the Childhood Symptom Scale,
• the Wender Utah Rating Scale,
• the Adult ADHD Rating Scale and Symptom Checklist, and
• the Connors Adult ADHD Rating Scale.

If this initial evaluation is unclear, patients should be referred to a psychiatrist or psychologist for a more complete study.

There are a number of medical conditions that can mimic ADHD symptoms in adults, including

• thyroid disease,
• liver disease, and
• some drug interactions, each of which is considered when evaluating an adult for ADHD.

If someone is diagnosed with ADHD or ADD, his or her healthcare professional will make a recommendation regarding treatment.

Typically this involves the use of a medication, such as

• a stimulant (methylphenidate [Ritalin, Concerta], amphetamine and dextroamphetamine [Adderall], lisdexamfetamine [Vyvanse]) or
• a nonstimulant (atomoxetine [Strattera]), and
• often some level of cognitive behavioral therapy as well.

A healthcare professional will then intermittently evaluate the patient's symptoms using modified (shortened) screening and rating scales and will adjust the therapy accordingly.