Structures ADHD evaluation with symptom scales, behavioral observation, and differential diagnosis. Use when evaluating ADHD, administering rating scales, or documenting ADHD assessments.
Structures ADHD evaluation with DSM-5-TR criteria application, validated symptom rating scales, behavioral observation, and systematic differential diagnosis for children, adolescents, and adults.
ADHD is among the most commonly diagnosed psychiatric conditions, affecting approximately 9.8% of children and 4.4% of adults in the United States. It is also among the most controversial, with significant concerns about both overdiagnosis in some populations and underdiagnosis in others (women, adults, ethnic minorities). The APA Practice Guidelines and AACAP Practice Parameters require that ADHD diagnosis be based on comprehensive evaluation — not a single screening instrument or brief clinical interview. Diagnosis requires documented evidence of symptoms in multiple settings, onset before age 12, clinically significant impairment, and exclusion of alternative explanations.
The controlled substance status of first-line ADHD medications (stimulants, Schedule II) creates additional documentation requirements. DEA regulations, state prescription drug monitoring programs, and payer prior authorization processes all require documentation of a thorough diagnostic evaluation. Prescribing stimulants without adequate diagnostic evaluation exposes prescribers to DEA scrutiny, malpractice liability, and licensing board complaints — particularly for adult-onset presentations where the differential diagnosis is broader.
Inattention Symptoms (6+ for children, 5+ for adults ≥17, persisting ≥6 months):
Hyperactivity-Impulsivity Symptoms (6+ for children, 5+ for adults ≥17, persisting ≥6 months):
Additional Required Criteria:
Presentation Specifiers:
Children and Adolescents:
Adults:
Administer at least one validated rating scale from the patient and one from a collateral informant. Document scores and interpret against normative data for the patient's age and sex.
Document observed ADHD-consistent behaviors: fidgeting, difficulty staying on topic, losing train of thought, frequently checking phone, difficulty with sustained conversation, impulsive interruptions. Also document the absence of such behaviors — ADHD symptoms may not be evident in a novel, stimulating, one-on-one setting.
ADHD has extensive symptom overlap with multiple conditions. Systematically evaluate:
Document each differential considered, the clinical reasoning for inclusion or exclusion, and any conditions that co-occur with ADHD (comorbidity rates: anxiety 30-40%, depression 20-30%, ODD/CD 40-60% in children, SUD 25-40% in adults).
Integrate all data sources into a formulation:
Diagnostic statement example: "Based on multi-informant rating scales (Vanderbilt Parent: 8/9 inattention items endorsed at 'often' or 'very often'; Teacher: 7/9 inattention items; performance impairment in 3/8 areas), clinical interview confirming onset before age 12, corroborating school records demonstrating consistent pattern since 2nd grade, and systematic exclusion of anxiety (GAD-7 = 3), depression (PHQ-9 = 4), sleep disorder, and thyroid dysfunction (TSH normal), the patient meets DSM-5-TR criteria for ADHD, Predominantly Inattentive Presentation, Moderate severity."
Treatment recommendations (per AACAP/APA guidelines):