A patient’s developmental history can provide critical insights into early ADHD symptom presentation and is an important element of an ADHD assessment. In this blog, we explore the role of developmental history in ADHD diagnosis, how you can use developmental history to differentiate ADHD from other conditions, and what to do when historical records are unavailable.
Disclaimer – This blog is not intended as an exhaustive guide and is for general information only, based on reputable, reliable sources. It is not medical advice, nor should it be used as a substitute for professional guidance. Qbtech is not liable, and reader discretion is advised.
What is developmental history?
Developmental history is a record of a patient’s early development from birth through childhood. Mental health professionals often discuss it in terms of developmental milestones. These are a “set of goals or markers that a child is expected to achieve during maturation.” These may include speech and language, motor skills, attention, emotional regulation, social interaction, behavior, learning, and adaptive functioning.
If a child does not reach expected milestones at similar times to peers, or shows persistent differences in developmental patterns, this may indicate a possible neurodevelopmental difference or delay.
What role does developmental history play in ADHD diagnosis?
DSM-5 ADHD diagnostic criteria require that symptoms were present before age 12 for an ADHD diagnosis. Identifying early signs of ADHD in developmental history can contribute to diagnostic confidence that a patient’s symptoms are persistent and onset during childhood.
- Examples of excess activity, impulsive behaviors, emotional dysregulation, and difficulty sustaining attention from early childhood align with several of the symptom behaviors identified in DSM-5 for diagnosing ADHD
- School records can be a useful source when compiling developmental history and may document academic struggles, behavioral problems, or teacher concerns that help inform your diagnosis
- Parental feedback can also help, even when the patient has entered adulthood. For example, anecdotal evidence around delayed developmental milestones or challenges experienced in school or at home
In all these cases, the role of developmental history is to help you identify whether current struggles or symptoms were also present early in the patient’s life.
Developmental trajectory in ADHD patients vs typical development
Milestone trajectories vary across countries. However, they broadly follow a similar pattern linking expected developmental skills to specific age ranges. For example, the CDC’s developmental milestones describe behaviors from 2 months (e.g. reacts to loud sounds) through to 5 years (e.g. pays attention for 5 to 10 minutes during activities).
Comparing your patient’s developmental history with these expected milestones can help identify signs of atypical neurodevelopment, which, alongside rating scales, clinical interviews, and objective testing, can support your diagnostic decision-making.
How does developmental history help differentiate ADHD from autism?
Developmental history can help you differentiate ADHD from autism and other conditions by identifying when symptoms first appeared, how they’ve changed over time, and whether they show a consistent pattern across childhood. In ADHD, symptoms are usually present from an early age and across different settings.
The symptoms of autism, anxiety, or trauma may overlap at the point when a patient presents for assessment. However, the developmental pattern and context may look different. For example, in the case of trauma, there may be a specific trigger or series of events in the patient’s past after which symptoms started appearing.
How do I use developmental history to diagnose ADHD in children accurately?
When assessing children for ADHD, parent and teacher feedback from rating scales and clinical interviews can provide you with developmental history. Evidence of ADHD symptoms at home and in school may support an ADHD diagnosis. However, teacher and parent feedback on developmental history can sometimes conflict. Find out what you can do when teacher and parent reports on ADHD disagree.
How far back should developmental history go for ADHD?
A complete picture of a patient’s developmental history should cover birth through early childhood and school years, with particular focus on whether symptoms were present before age 12. Evidence of childhood onset is an important factor in core ADHD guidelines as follows:
DSM-5: Several inattentive or hyperactive-impulsive symptoms present before age 12.
ICD-11: Evidence of significant inattention and/or hyperactivity-impulsivity symptoms before age 12, typically by early to mid-childhood.
NICE: Symptoms evident in early life; for diagnosis using ICD-10 by age 7 and for DSM-5, by age 12.
Frameworks and guidelines like DSM-5, ICD-10, ICD-11, and NICE ADHD guidelines provide more information on the age of symptom onset for an ADHD diagnosis.
Prenatal and perinatal risk factors for ADHD
There is growing evidence that some prenatal, perinatal, and in-utero risk factors may indicate increased risk of ADHD. Several studies have made links between pre-birth health indicators, such as metabolic disorders during pregnancy, difficulties in childbirth, and maternal smoking during pregnancy, as risk factors for ADHD.
Another study followed 754 premature-born infants into childhood and adolescence. They linked elevated maternal BMI and maternal diabetes with a 55–65% increased risk of ADHD.
“We need to have an understanding of what went on pre-pregnancy. Was there gestational diabetes? Was there hypertension? Was there additional stress? Were there any things that could have affected the growth of this baby and therefore affect the neurodevelopmental growth in utero?”
– Penny Lazell, Gathering the developmental history podcast episode
Is family background important in building a complete developmental history?
Maternal and paternal lifestyle, habits, and risk factors hold significance when establishing a patient’s developmental history.
“A premature birth has a three times higher incidence of that child developing ADHD. If you add to that some birth trauma, if you add to that a parent who may be stressed or depressed – all these additional things all contribute to that clinical history of why you might have that patient in front of you at the age of 13 being assessed for ADHD.”
– Penny Lazell,
ADHD clinical approaches: Gathering the developmental history podcast episode
The home environment of the patient, both in the lead-up to birth and in early years, is a useful component in building a complete developmental history for ADHD assessment.
Are there limitations to using developmental history in ADHD diagnosis?
While developmental history can play an important role in diagnostic decision-making, it isn’t always available, or there may be an incomplete or unreliable record.
For example, the way developmental history is typically collected and stored can lead to information gaps that can make achieving a full diagnostic picture challenging.
“In the UK, the maternal and paternal health is captured in the parents’ health records. Baby’s health is captured from point of birth. So, we are missing data.”
For first-time diagnosis of ADHD in adults, obtaining developmental history often becomes more challenging. Feedback from parents and teachers may not be available, and older patients may struggle with recall bias and have a patchy memory of early years.
When patient history is missing or incomplete
How comprehensive, multi-source ADHD assessments help
When you assess a patient for ADHD, you are building a picture of symptoms from different sources. This can include developmental history, patient, parent, or teacher feedback, clinical interview, and rating scales. However, in some cases, particularly when diagnosing adults, an incomplete developmental history is coupled with unavailability of school records and an absence of parental feedback. This can make it difficult to identify when symptoms first appeared.
Adding an objective test to your diagnostic workflow may help. Qb testing can provide you with quantitative data on a patient’s symptoms that, when analyzed alongside subjective measures, provides you with a more complete picture and can help you to diagnose with increased confidence.
Frequently asked questions
Patient developmental history
5 domains of developmental milestones have been identified by a peer-reviewed clinical reference resource indexed by the US National Library of Medicine. They are gross motor, fine motor, language, cognitive, and social-emotional and behavioral.
Milestones that align with the three subtypes of ADHD: hyperactive-impulsive, primarily inattentive, and combined presentation, are most relevant. By referring to local milestones such as those set out by the CDC or NHS, you can identify specific milestones relating to sustaining attention, impulse control, following instructions, social communication, and conversational patterns.
It’s helpful to adopt a holistic approach to developmental history drawing on both parental and child backgrounds, according to field experts. Ask questions about early behavior in multiple settings (school, home, and varied social settings), emotional regulation, but also friendships, sleep, and conversational traits.
While parent feedback is often a useful element of an ADHD assessment, it may not always be fully accurate due to recall bias, accidental omissions, or challenges in recognizing symptoms in a family member. This is why ADHD assessment often uses multiple information sources, including clinical interview, rating scales, developmental history, and, in some settings, objective measures such as Qb testing.