- Decide to Evaluate ADHD or Refer for Neurodevelopmental Psychological Testing and/or Other Providers
Clinicians should determine if they believe they can provide an ADHD evaluation or not. Diagnostically complex presentations may require more comprehensive neurodevelopmental testing or diagnostic services by other clinicians to determine if they have true ADHD and/or other conditions.
- Explain the Evaluation Process
If an evaluation will occur, clinicians should explain the details about the testing process, including how many sessions this may require, expectations about parental participation, and if a letter will be sent to the child’s physician, other providers, and/or school.
- Conduct the Clinical Diagnostic ADHD Interview
This may take one or more sessions to complete.
- Use ADHD and Other Measures
The use of standardized rating scales and measures from multiple sources is an important component of an evidence-based ADHD evaluation. Rating forms can be very helpful in determining if unwanted symptoms and behaviors are at statistically significant levels above the expected age-based norms. Measures should be given to parents, teachers, and children/adolescents.
- Screen for Other Possible Conditions
To improve diagnostic accuracy, medical, sleep, neurodevelopmental, sensory processing, psychological, trauma, and fetal substance exposure conditions should be explored to identify those that may coexist with true ADHD or cause ADHD-like symptoms when true ADHD does not exist. Clinicians can use the Comprehensive Diagnostic ADHD Screening System (CDASS) checklists from the book Evaluating ADHD in Children and Adolescents to screen for these conditions. CDASS checklists can also help to identify the types of ADHD, suggestive ADHD indicators, risk factors associated with ADHD, and common coexisting conditions with ADHD.
If there are other possible conditions, referrals can be made to other providers. This can be helpful with diagnostically complex presentations and when evaluators are unclear if true ADHD and/or other conditions exist. Other evaluations include:
- Psychological testing by clinical psychologists (to explore trauma, psychological conditions, and giftedness)
- Neurodevelopmental assessments by neuropsychologists (for ADHD, learning disorders, non-verbal learning disorder, intelligence levels, autism, processing speed and other neurodevelopmental concerns),
- Occupational therapy evaluations (for sensory processing and motor coordination conditions)
- Speech-language pathologist evaluations (for speech deficits and expressive language issues)
- Developmental or behavioral optometrist evaluations (for visual processing deficits)
- Audiologist evaluations (for auditory processing deficits)
- Ears, Nose, and Throat (ENT) physician examinations (to explore sleep apnea, chronic mouth breathing, allergies, and congestion)
- Sleep studies (for sleep-disordered breathing and other sleep conditions)
- Autism and fetal alcohol spectrum disorder evaluations by neurodevelopmental specialists
- Neurologist examinations (for head injuries, seizures, and tic disorders)
- Medical examinations by developmental or primary care physicians (to rule out certain medical conditions, including vision and hearing problems, asthma, allergies, hypoglycemia, diabetes, anemia, thyroid disorders, toxic heavy metal exposure, food allergies and sensitivities, chronic pain conditions, and deficiencies in zinc, iron, magnesium, and B and D vitamins).
- Obtain School Information
Information about grades, academic and learning difficulties, and behavioral problems may be received from parental reports, school documents, or contact with school staff.
- Obtain Prior Behavioral Health Diagnostic and Treatment Information (if this exists)
- Synthesize and Formulate Findings
After obtaining the information from the evaluation process, clinicians should decide if the child or teen has true ADHD and/or other conditions. Coexisting conditions are common with ADHD, can worsen true ADHD, and can make the diagnostic process more difficult. Some conditions can cause ADHD-like presentations when true ADHD does not exist. Clinicians will need to determine if other evaluation and clinical services now needed. Treatment recommendations should be provided as well. Evaluators should take time to conceptualize and organize their findings so they can present these to families and share their findings with other providers and schools in letters.
- Review ADHD Evaluation Results and Recommendations With the Family
Clinicians should discuss their findings and recommendations. If other conditions are suspected, clinicians should explain their concerns and make referrals for additional diagnostic and treatment services.
- Write Letters to Child’s Primary Care Physician, Other Providers, and School
If desired by the family and after release of information forms are obtained, clinicians can share their findings in letters with appropriate others as a best practice. Evaluation letters to physicians and other providers can include evaluation results, full diagnoses and possible other rule-out conditions, and recommendations for additional diagnostic services from additional providers and treatment. Evaluators can also suggest physicians explore a number of specific medical conditions that may cause ADHD-like symptoms or coexist with true ADHD (see these listed in number 5 above). Letters to schools can include the student’s conditions, school difficulties, and recommendations for the school to conduct a case study or psychoeducation evaluation to determine if the student is eligible for a 504 Plan or Individual Education Program (IEP).
