What are the requirements to confirm a diagnosis of attention deficit hyperactivity disorder (ADHD)?

Updated: Oct 01, 2019
  • Author: Stephen Soreff, MD; Chief Editor: Glen L Xiong, MD  more...
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The diagnosis requires the symptoms of ADHD to be present both in school and at home. Furthermore, all patients must have a full psychiatric evaluation and physical examination. Here is a cautionary note underscoring the need for a full assessment for late-onset ADHD in adolescents and young adults.

Adolescents and young adults without childhood ADHD often present to clinics seeking stimulant medication for late-onset ADHD symptoms and there is, indeed, a valid diagnosis of late-onset ADHD in many cases. However, diagnosis based on the traditional parameters for ADHD may be incomplete in their ability to make the proper determination. Researchers have found that a more thorough psychiatric history is called for.

In one study, researchers administered 8 assessments to 239 individuals without childhood ADHD. Assessments included parent, teacher, and self-reports of ADHD symptoms, impairment, substance use, and other mental disorders, with consideration of symptom context and timing. Results show that of the individuals who initially screened positive on symptom checklists, 95% were excluded from late-onset ADHD diagnosis. The most common reason for diagnostic exclusion was symptoms or impairment occurring exclusively in the context of heavy substance use. These findings suggest that clinicians should consider alternative causes of symptoms and carefully assess impairment, psychiatric history, and substance use. [30]

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