What does good look like for an ADHD evaluation?
ADHD is a common yet often misunderstood neurodevelopmental condition. While the understanding of ADHD is growing, stigma still exists. Girls and women, in particular, are often diagnosed later in adulthood or misdiagnosed with other conditions. So, what does a good standard for an ADHD evaluation look like? What are the processes involved, and how are objective tests shaping ADHD care?
How is ADHD currently evaluated?
There is often a varied standard of care in the US and many clinicians take different approaches and procedures to ADHD evaluations. These may include objective tests, interviews, observations, questionnaires, standardized rating scales, and information from teachers and/or parents.
Who can diagnose ADHD in adults and children?
Only qualified medical professionals specializing in ADHD should see patients for evaluation. This includes psychologists, psychiatrists, and psychiatric nurse practitioners (PMHNP) or equivalent. If the patient is very young, a pediatrician may see them instead. However, there are limitations to what ADHD specialists can do and provide. A psychologist may have experience diagnosing ADHD and providing counseling but is not licensed to prescribe. In contrast, a primary physician can prescribe medication but lacks ADHD training. It is worth asking your healthcare provider common questions about their experience in evaluating ADHD.
What does a typical ADHD evaluation include?
- QbTest: Many clinicians have already incorporated objective testing into their ADHD evaluation, completely reshaping how they approach ADHD for better patient outcomes. QbTest produces comprehensive reports that can be instantly analyzed and compared to a group of similar age and sex without ADHD, helping clinicians fill any gaps in their assessment.
- DSM-V: Although it varies, children and adolescents who may have ADHD must have six or more ADHD symptoms, listed in the Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition (DSM-V), such as inattentiveness or six or more symptoms of impulsiveness and hyperactivity. The medical professional will need to verify this as part of the primary step.
- In-clinic interviews: ADHD specialists will often conduct interviews with adult patients alone or with their companions. While children should be accompanied by their parents or teachers. The interview should ask about:
- Medical history
- Current difficulties they are experiencing
- How they think others perceive them to be
- Living arrangements
- Family history
- Moods and many others
These interviews should try to identify patterns in their symptoms by asking relevant questions. However, it is worth highlighting that having symptoms that occur very rarely does not mean you have ADHD and needs to occur over different environments. Overall, the interview should aim to develop a better understanding of the patients’ biggest challenges. This should include:
- Daily stress aggressors
- School performance
- Ability to meet deadlines and overall productivity
- Work performance and history
- General well-being and more
An interview should typically last 30–90 minutes. However, certain ADHD specialists, such as pediatricians may require patients to attend multiple interviews. Furthermore, ADHD specialists may conduct multiple children observations at school.
- Standardized rating scales: ADHD specialists should use questionnaires such as Conners, Barkley, and BASC to capture qualitative data. Psychoeducation tests may also be carried out.
- General health exam: The clinician may recommend the patient rule out other conditions that cause ADHD-like symptoms such as thyroid issues. This should also determine if the patient can safely take ADHD medication.
- Comorbid conditions and learning difficulties: It is also important to find out if the patient has learning difficulties and common comorbidities such as anxiety, depression, and ASD.
How is ADHD evaluation rapidly changing for the better?
More and more clinicians are using QbTest in their practice, reducing wait times and waitlists, improving decision-making and medication monitoring, and providing better psychoeducation for everyone involved.
“QbTest has been helpful where there have been differences in opinions between schools and parents (about ADHD symptoms). Even in cases where you’ve got parents that are separated and co-parenting. Both parents may have different views about the child’s presentation. It was hard to navigate these conversations because the information we’ve had has been so subjective.
“We often find that when you’ve got objective data, you can have these conversations easier and you’ve got more robust evidence to back up the decision that you’ve made. It helps break down the three areas of ADHD and look at whether inattention was highlighted as difficult or whether it was hyperactivity,” says Dr. Nicola Reynolds, Clinical Lead at Oxleas NHS Trust.
If you are a clinician, take a look at our page on clinical research and how objective testing has helped in the assessment of ADHD.