ADHD Assessments – What are they?

Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder that affects children and adults. ADHD assessments are used to determine whether or not someone has this condition, as well as what type of treatment may be needed. In this blog post, we will discuss the definition of ADHD, how it’s diagnosed, and why an assessment is necessary.

 

What is ADHD?

Attention deficit hyperactivity disorder, or ADHD, is a chronic, neurobehavioral disorder that causes problems with attention and behavior. The National Institute of Mental Health (NIMH) estimates that ADHD is the most common mental disorder among children, with symptoms usually presenting when a child begins school at around age 4-6, then continuing through adolescence and into adulthood. Based on parent-report data from National Survey of Children’s Health (NSCH), the median age of diagnosis was 4 years old for severe ADHD, 6 years old for moderate ADHD, and 7 years old for mild ADHD.

According to a 2016 survey conducted by the Center for Disease Control and Prevention (CDC), approximately 6.1 million, or 9.4%, of children in the United States have been diagnosed with ADHD. This figure includes approximately 388,000 children 2-5 years old, 2.4 million children 6-11 years old, and 3.3 million children 12-17 years old. The same survey suggested that ADHD affects males at a greater rate than females, with about 12.9% of males diagnosed compared to only about 5.6% of females. However, it should be noted that research suggests there is a sex bias in the assessment and diagnosis of ADHD. A 2019 study found that females with ADHD are more likely to be overlooked in the ADHD diagnostic process than males and they are less likely to be prescribed appropriate medication unless they demonstrate   prominent externalized problems. Ultimately, ADHD presents itself differently in particular populations (males, females, children, adults, etc.) so it is important that psychiatric personnel are trained to assess ADHD properly in a variety of individuals.

Although ADHD is typically identified at some point in childhood (before age 18), it continues to affect several individuals well into adulthood; not to mention those who are not properly assessed as children and are eventually diagnosed with ADHD as adults. According to data collected by Harvard Medical School in 2007, the lifetime prevalence of ADHD in American adults ages 18-44 is approximately 8.1%, while the current prevalence is about 4.4%. Of adults with ADHD, it is estimated that only 11% receive treatment and proper work/school accommodations. By age group, the estimated percentage of adults with ADHD is about 4.5% ages 18-24, 3.8% ages 25-34, and 4.6% ages 35-44. One study found that approximately one-third of children with ADHD carried the diagnosis into adulthood. However, results of several other studies suggest the prevalence of childhood ADHD carrying into adulthood may be underreported because many adults learn their individual triggers and develop better coping mechanisms for their ADHD-related symptoms and behaviors. Overall, most research suggests ADHD does not truly go away, but adults report experiencing less severe symptoms or less symptoms altogether. Additionally, researchers have noted that ADHD in adults is likely underreported since the diagnostic criteria for ADHD in the DSM-5 was developed for children and since adults with ADHD often have comorbid mental disorders that can mask ADHD symptomology.

 

How is ADHD assessed?

The three primary characteristics or behaviors examined in the diagnosis of ADHD are inattention, hyperactivity, and impulsivity. Inattention refers to difficulty or inability to focus on a given task or event and/or a lack of attention to details.  Hyperactivity refers to a state of being abnormally active. Lastly, impulsivity refers to a tendency for one to act without thinking, planning, or consideration of potential consequences.

While ADHD is demonstrated differently person-to-person, some of the most common symptoms of the disorder by category (inattention, hyperactivity, and impulsivity) are:

Inattention

• being easily distracted
• making careless mistakes
• being forgetful and/or frequently losing things
• difficulty working on tedious or time-consuming tasks
• difficulty listening to instructions and/or carrying them out
• frequently changing between activities or unfinished tasks
• difficulty organizing or prioritizing tasks

Hyperactivity

• difficulty sitting still and/or quietly – especially in calm settings
• difficulty engaging in quiet activities, such as reading
• constantly fidgeting
• excessive physical movement
• excessive talking
• oversharing intimate details in conversation
• wandering

Impulsivity 

• interrupting conversations
• little to no consideration of the danger and/or consequences associated with a decision or action
• lack of patience or difficulty waiting their turn
• overindulging, such as with shopping/spending and eating
• temper outbursts – especially those that result in a physical outburst like hitting a wall

There are different types of assessments that can be used to diagnose someone with ADHD, and most often, multiple stages of assessment are used to gather sufficient information prior to formal diagnosis with the disorder. 

The health care professionals typically record a medical history first, which includes information about an individual’s presenting problems and symptoms. The professional will ask questions regarding any previous diagnosis of ADHD or other psychiatric illnesses as well as medications used to treat these disorders or symptoms. They may also explore family mental health history if relevant. According to the ADHD Institute, the primary goal of clinical assessment is to “identify the presence of other illnesses with symptoms that overlap with those of ADHD.” These examinations typically involve testing for vision of hearing impairments, fine motor skill function, motor or vocal tics, and neurodevelopmental anatomical immaturity. 

Behavioral observation is another essential component of assessment. Clinicians may observe the person’s behavior in social, working, or academic situations to determine if impulsivity, hyperactivity and/or impaired attention are often exhibited; or a report of symptoms from others observing the patient is used. Since ADHD symptoms are often exhibited by a young age, parent and teacher accounts of a child’s behavior are also very useful. Reports from teachers in particular are considered optimal sources of information on a child since the nature of their work environment allows them to see and assess a child’s social, working, and academic capacities. If ample resources are available, educational psychologists may also be utilized to report classroom observation from a trained perspective.

Lastly, rating scales are especially useful tools in assessing ADHD symptomatology in an individual. They are checklists or questionnaires that are used to measure the severity of ADHD symptoms. Usually, rating scales are completed by those close to individuals being tested for ADHD, or those that are frequently in their presence. For children, this is normally parents/caregivers and teachers. For adults, they may complete the rating scales themselves, but they are also encouraged to supplement their rating scale responses with someone close to them, such as sibling, coworker, or partner.

Ultimately, there is no single test used to diagnose ADHD in an individual, but below are a few of the most common rating scales used in the ADHD assessment and diagnostic process.

 

Types of Rating Scales

For children:

• Vanderbilt Assessment Scale. This 55-question interview is used by health care professionals to diagnose ADHD in children between ages 6-12. It is completed by parents/caregivers and teachers. It tests for conditions like conduct disorder, oppositional-defiant disorder, anxiety and depression.
• The Conners Rating Scales. These surveys vary in length and are used for children ages 0-18. They are completed by parents/caregivers and teachers, and the questions are different for parents/caregivers and teachers. They screen for ADHD, ODD and CD in children.
• Behavior Assessment System for Children (BASC). Depending on the age of the individual being assessed, this scale ranges from 105-165 questions in length. It tests for hyperactivity, aggression, and conduct problems, as well as anxiety, depression, attention, and learning problems.
• Child Behavior Checklist/Teacher Report Form (CBCL). This checklist has 113 questions and is used on children ages 6-18. It assesses behavior related to anxiety, depression, aggression, ADHD symptoms. It looks at physical issues, aggressive or delinquent behavior, and withdrawal.

For adults:

• Adult ADHD Clinical Diagnostic Scale. This 18 item questionnaire was originally used to assess ADHD symptoms in children but has since been adapted to provide information on current adult symptoms of ADHD. It involves an interview conducted by a healthcare professional with the individual being assessed for ADHD.
• Brown Attention-Deficit Disorder Symptom Assessment Scale (BADDS) for Adults. This is a self-report 40-question ADHD screener. The 40 questions cover 5 primary symptom areas: activation, attention, effort, affect, and memory.
• Conners Adult ADHD Rating Scales (CAARS). Similar to the Conners rating scales used to assess ADHD in children, this scale contains 136 questions and is completed by a close relative or friend who can provide insight into the individual’s behavior, as well as a significant other in their life. It can also be completed by the individual being assessed for ADHD.
• Barkley Adult ADHD Rating Scale (BAARS). This 30-item scale is meant for those ages 18-89 and assesses current ADHD symptoms and areas of impairment, as well as recollections of childhood symptoms. The scale is completed by both the individual being assessed for ADHD as well as someone close to them.

Neuropsychiatric Testing:

Often a series of standardized tests are administered by a psychologist to assess symptoms of ADHD. This is referred to as neuropsychiatric testing, and can be used in addition to the patient’s history and evaluation, in order to confirm a diagnosis of ADHD. 

 

ADHD Assessment and Diagnosis at Remedy

Here at Remedy, we aim to provide our clients with thorough, yet efficient mental health care. To assess you for ADHD, the Remedy team first gathers information to evaluate if your symptoms properly fit DSM-5-directed ADHD criteria. A full history and evaluation will be performed. Additionally, we may send you a digital set of questions for you and someone who knows you, to complete, regarding your symptoms. 

To ensure you are provided the most efficient mental health care possible, if you have it, please send us the following information before, or on the day of, your first appointment.

1. If you have already completed formal neuropsychiatric testing elsewhere, you may submit a copy of your prior assessment completed by a psychologist.
2. You may need to sign a release of information, which the Remedy team uses to contact your prior psychiatrist about any previous diagnoses. You can find the form here. 
3. You and someone who is often around you need to complete the BAARS evaluation, which is an ADHD rating scale described above. You may download the BAARS questionnaire here. Additionally, we can send this to you electronically after your first appointment. 

Providing the Remedy team with this information before or by your first visit can expedite the process and increase the likelihood that we can send in a prescription on your first day with us.

Please send your information through our patient portal here.