ADHD: Assessment Process / Tools
"Why do people get misdiagnosed? I just don't understand it. How is misdiagnosis possible? It just shouldn't be this hard to figure out what is going on with me." My neighbour's daughter had been living with ADHD symptoms for as long as she could remember and was upset her doctor thought it was normal adolescent anxiety. "I'm honestly disappointed in my doctor", she said. ADHD can be tricky to diagnose. "Because many of the symptoms of ADHD overlap with those of many other conditions, misdiagnosis can occur." (Sissons & Legg, 2019)
In this post, you will find information about the assessment process and the assessment tools used for diagnosing ADHD in Canada.
Assessment Process
Determining if a child or youth has ADHD is a process and includes several steps. No single test can diagnose ADHD. To make it even more complicated, many other issues such as anxiety, depression, lack of sleep and even, learning disabilities can have similar symptoms. (CDC - National Center for Health Statistics, What is ADHD?, 2021)
ADHD assessment begins with an Initial Screening Evaluation. During this evaluation, you will begin with an initial interview to determine if ADHD may be the cause of an individual's social, emotional, behavioural, academic or work challenges. The next step in the assessment process is checking to see if the individual is presenting with the criteria in the Diagnostic and Statistical Manual V (DSM-5). If the individual presents a certain amount of the symptoms indicating that ADHD could be present, you then proceed to the full evaluation.
Full Evaluation
In the full evaluation there, will be in-depth interviews conducted with the individual indicating the possibility of ADHD. The interview will consist of questions such as family history, main symptoms, impact on daily activities, etc. Some of the questions they could ask are:
- What are the specific symptoms?
- When are the symptoms present?
- Do they occur in different situations or the same one?
- At what age did the symptoms start?
- How long do the symptoms typically last? Are they pervasive?
- Are there any precipitants to the symptoms?
- Is there anything that seems to lessen the symptoms?
- To what degree do the individual's symptoms interfere with routine and age-appropriate functioning?
A complete bio-psycho-social assessment will be conducted. This includes history related to:
- Prenatal and early developmental history and milestones
- Medical history, including illness, injuries and hospitalisations
- Family history, including incidents of violence, disruption or separation
- Any co-occurring concerns: depression, anxiety, learning disabilities, anger management challenges, oppositional behaviour, etc.
- Academic or work history challenges and areas of success
- Strengths, talents, unique abilities and coping skills
- Family and social relationships
- Substance use
- Temperament and mental status
- Any history of ADHD in the family or co-occurring disorders.
Tools
The Diagnostic and Statistical Manual V (DSM-5) provides the diagnostic criteria for determining if someone has ADHD.
"When evaluating for ADHD, clinicians will use a variety of clinical practice tools to gather information, including standardised clinical rating and self-report checklists, behaviour questionnaires and/or rating scales. These tools are an essential component of a comprehensive evaluation for ADHD and provide the information needed to screen, diagnose and develop a treatment plan." (Bogard, Clinical practice tools, 2019)
Scales and checklists help clinicians obtain information from adults, parents, teachers, and others about symptoms and functioning in various settings. Symptoms must be present in more than one setting (such as both at home and in school or work) to meet DSM-5 criteria for an ADHD disorder. (Bogard, Clinical practice tools, 2019)
Some scales and checklists for assessing ADHD in children and youth are: