Data and Statistics
Cost of ADHD
The Science of ADHD
The Importance of Science
Understanding Research Studies
Levels of Evidence for ADHD Interventions
Treatment of ADHD
Complementary and Other Interventions
Neurofeedback (EEG Biofeedback)
Fish Oil Supplements and ADHD
Nutrition and ADHD
Carrying Your Medication
ADHD, Sleep and Sleep Disorders
Disruptive Behavior Disorders
Tics and Tourette Syndrome
Professionals Who Diagnose and Treat ADHD
Hospital and University ADHD Centers
Insurance and Public Benefits
The Insurance System
Paying for Medications
Private Health Insurance
Public Health Insurance
Frequently Asked Questions about ADHD
Myths and Misunderstandings
Glossary of Terms
ADHD in the News
Fact Sheets on ADHD
For Parents & Caregivers
Parent Training and Education
Social Skills Interventions
Coexisting Conditions in Children
Pediatric Bipolar Disorder
Substance Abuse and ADHD
Common Coexisting Conditions in Children
Preschoolers and ADHD
Behavioral Therapy for Young Children
ADHD and Childcare
Diagnosing ADHD in Adolescence
Treatment of Teens with ADHD
ADHD Information for Teens
Parenting Teens with ADHD
Teens with ADHD and Driving
Teens and Driving
Medication Abuse and Diversion
Individuals with Disabilities Education Act
Requesting an Evaluation in Public Schools
Tips for Working with the School
Tips for Talking to Teachers about ADHD
Finding the Right College
Disclosing ADHD During the Admissions Process
Succeeding in College with ADHD
Scholarships & Financial Aid
Tips for Completing Homework
How to Communicate with your Child’s Teacher
Homework Help for ADHD
Surviving the Holidays with ADHD
Diagnosis of ADHD
Diagnosing ADHD in Adults
ADHD and the Military
How to Succeed in the Workplace
Laws and Legal Protections
Americans with Disabilities - ADA & ADAAA
Legal Rights in Higher Education and the Workplace
Family and Medical Leave Act (FMLA)
Finding an Attorney or Legal Advocate
Living with ADHD: A Lifespan Disorder
Women and Girls
ADHD Medication and Pregnancy
ADHD and Driving
Organization and Time Management
Relationships & Social Skills
Marriage and Partnerships
Social Skills in Adults with ADHD
Mastering Social Skills
Time Management and Using a Day Planner
Apps for ADHD
For Healthcare Professionals
Clinical Practice Guidelines
The ADHD Diagnostic Process
Diagnosis in Adults
Diagnosis in Children
Clinical Practice Tools
Evaluation and Assessment Tools
Rating Scales and Checklists
Treatment of Adults
The Role of Medication
Teacher Training on ADHD
Tips for Teachers Video Series
Recursos en español
Tips and Resources
Medical Benefit Program
Start a Group
Current CHADD Volunteers
Volunteer Leader Center
Login to your CHADD email
Edit your website
Other Local Support Resources
Find a Study
Post a Research Study
Young Scientist Awards
CHADD's Amazon Store
P2P On Demand Webinars
CHADD Advocacy Manual
Training & Events
2017 Annual International Conference on ADHD
ADHD Awareness Month
ADHD Awareness Month Calendar
Ask the Expert
Ask the Expert Educator Edition
Parent to Parent Program
P2P On Demand Sessions
Family Training on ADHD In Your Community
Teacher to Teacher
Teacher to Teacher - School System
Calendar of Events
Training for Professionals
Health Care Providers
Training for Parents
Find a Chapter
Local Affiliate Resources
Tools and Resources
Start a Group
Recruitment & Retention Tools
Renew My Membership
The ADHD Tool Kit
Membership Types and Benefits
Get Listed in CHADD's Resource Directory
JOIN CHADD - International Membership
JOIN CHADD - US Membership
Attention Magazine - Digital Editions
Attention Magazine Subscriptions
CHADD Discount Advantage Programs
Mission and History
National Resource Center
Boards and Staff
Board of Directors
Professional Advisory Board
Public Policy Committee
CHADD Funding Sources
Advertise with CHADD
Jobs at CHADD
Report a Problem
Gifts that Lead
Gifts that Sustain
Gifts that Double
Other Ways to Donate
Corporate Partner Members
Donate Your Vehicle
ADHD Weekly Newsletter
Conflicting Diagnoses? Take the Time to Get It Right
Join the discussion.
Although guidelines and criteria for diagnosing mental health conditions are defined in the
Diagnostic and Statistical Manual of Mental Disorders Fifth Edition
(DSM–5), it isn’t always simple to arrive at a conclusive diagnosis. Why might a person receive different diagnoses from different professionals, or at different times in his life? What can you do to ensure accurate diagnoses for your child or for yourself? We spoke with two experts from CHADD’s Professional Advisory Board for answers.
Background: What is ADHD?
ADHD is a neurodevelopmental disorder. Researchers:
have shown there’s a strong
abnormal brain structures
in people with ADHD, and
are investigating a number of
possible risk factors
such as brain injury, prenatal alcohol or tobacco use, premature delivery, low birth weight, exposure to environmental toxins (such as lead), etc.
However, diagnosis is determined from
The diagnostic criteria for ADHD
DSM-5 describes symptoms
of inattention and of hyperactivity/impulsivity that interfere with social, school or work functioning or development, and require for a diagnosis:
The person must experience a specific number of those symptoms for at least six months,
To a degree that is inconsistent with age-appropriate behavioral norm
Several of those persistent symptoms were present before the age of 12
Those symptoms be present in two or more settings
Those symptoms are not solely the result of, or better explained by, other disorders
Although these criteria are somewhat specific, and the DSM-5 provides examples of how symptoms manifest, there is opportunity for ambiguity:
Information regarding the patient’s behavioral symptoms rely on subjective reporting and longitudinal memory from people who know the person to one degree or another, each of whom come with their own expectations of appropriate behavior. Often family members or friends are asked to share their memories of the person’s behavior over time.
Some families and/or some cultures differ in what they consider to be age-appropriate behavior.
Assessment based on settings can be very general (school, home, work), whereas a specific context, such as subject in school (for example, in science class vs. art class) or conditions (with one friend vs. in the entire class, before vs. after lunch, etc.) may yield widely different assessments.
Several symptoms of ADHD are shared by other disorders. As one example, inattention is a symptom of ADHD but also of other disorders (such as anxiety, depression) and conditions. Steve Lee, PhD, a professor of Psychology at University of California at Los Angeles and a member of
CHADD’s Professional Advisory Board
, says that inattention is the “common cold” of mental disorder diagnostics.
The diagnostic process
no simple “test” for ADHD
; conditions in the DSM-5 are not classified by causes as are medical diseases. Instead, the disorder is diagnosed during an evaluation process following the DSM-5 criteria. Although there is variability among professionals who diagnose, there are recommended
procedures followed by professionals
Initial screening interview. While talking with the patient, the professionals will assess the level of impairment and symptoms experienced.
In-depth interview with patient and caregivers; address all DSM-5 symptom categories and conditions
Bio-psycho-social assessment to collect medical and mental history on the patient and the family
Order comprehensive medical exam and/or current records
Separate interview (with older child or adult patient), or observe play or school activity (with child patient)
For older children or an adult, administer behavior self-report rating scales
Give rating scales for parents/caregivers, teachers, spouse/partner, others who know the patient well to complete.
Review all data collected and make a diagnosis (which may be ADHD, other disorder, co-occurring disorders, or undiagnosed)
Develop a treatment plan
Behavioral therapy, for patient and for parents
Medication, if necessary
Recommendations for educational or workplace accommodations
Closely monitor outcomes of each part of the treatment plan, including any side effects of medication, and adjust accordingly.
What could go wrong?
Too little expertise.
Many pediatricians or primary care providers lack the expertise or the time to conduct the rigorous elements of diagnosing ADHD, and may not be able to refer the patient to an ADHD expert for any number of reasons. Misdiagnosis or missed diagnosis may result.
Too much information.
On the other hand, Dr. Lee notes the amount of information (not always science-based) on the internet and public media can lead to “do-it-yourself” diagnoses, thus short-circuiting an effective assessment. When parents or adults cherry-pick symptoms and conclude their problems are an indication of ADHD, they disregard the importance of the full diagnostic process, including the consideration of many other explanations for inattention and hyperactivity.
. Craig Surman, MD, an ADHD specialist at Harvard Medical School is a co-chair of
CHADD’s Professional Advisory Board
. He emphasizes the role personality traits play in mental health conditions. These include processing styles and preferences that are internal to the person, versus the more easily identified external behaviors noted in the DSM-5 criteria. As such, traits are often unclear and hard to identify. Although personal traits can contribute to the impairment of disorders, they can also contribute to resilience, but are not typically included in diagnoses. They are a reflection of executive functions that can be nurtured, your “invisible scaffolding,” Dr. Surman says–what you want, are interested in, have support and capacity for.
Flawed inputs from families, teachers.
Dr. Lee supports the influence of personal traits in expression of ADHD symptoms when he notes that people with difficult temperaments can provoke negative responses from their caregivers and other people in their social environment. The frequency of such responses early in life affects the person’s neurocognitive development, shapes his self-image and perpetuates not only his difficult temperament but also others’ view of his behavior.
Because many ADHD symptoms are shared with other disorders, it is possible to either diagnose the wrong disorder or miss the possibility of co-occurring conditions. When there is a more severe impairment occurring, ADHD can be hidden beneath it.
Symptom variability through life stages.
Behavioral symptoms may fade or come out throughout the stages of a person’s life due to hormonal or other conditions and events, which can cause new diagnoses from new professionals.
What can you do?
“Don’t settle for a quick assessment,” advises Dr. Surman. He emphasizes the importance of following the DSM-5 criteria, which he says empowers parents and adults to bring the right information to the provider. He particularly notes the criteria of symptom persistence in multiple settings, including specific situations. You may not be attentive because you’re uninterested in the topic of discussion. You may be impulsive when you haven’t had a good meal.
Both Dr. Surman and Dr. Lee recommend you adopt a “detective mindset.” Keep a log of symptoms in the context of settings as well as conditions. For example, include not only general settings, but also time of day, small vs. large group, peers vs. strangers, outdoors vs. indoors, how close you are to having a meal, how close it is to bedtime, amount of sleep you have, subject/topic being addressed, and so on. Share that log with the professional doing your assessment.
Dr. Lee also recommends keeping a log of when specific symptoms began occurring; and when they developed relative to each other. This information can help your professional determine which is primary, which is secondary, and the influence of one symptom or condition on the other.
Dr. Lee says “words matter.” The way in which you think about and go about seeking an understanding of your child’s or your behavioral and cognitive conditions can skew outcomes. When you say, “I’m looking for an ADHD diagnosis,” that skews the symptoms you present toward ADHD, when in fact that might not be the right diagnosis. First get an unbiased assessment from a knowledgeable professional; that person will be more likely to develop an accurate diagnosis
ADHD or not.
Dr. Lee offers these additional recommendations:
Avoid labels–of your own or your child’s diagnosis. Labels drive behavior.
Interventions can be independent of diagnoses.
such as positive parenting can have a positive impact with or without an ADHD diagnosis.
Start with a
that is balanced and moves in a step-by-step manner. In some cases it may not be certain that you or your child requires medication, so where possible begin with behavioral interventions focused on specific behaviors, to see if that makes a big enough difference over time. If it does not, your health care provider may add a low dose of medication and to see if there is improvement in symptoms, and so forth, increasing dosage as necessary.
Steve S. Lee, PhD, is a member of CHADD’s Professional Advisory Board and a
professor of Psychology at the University of California
at Los Angeles. He is president-elect of the Society of Clinical Child and Adolescent Psychology (Division 53 of American Psychological Association). A former recipient of
CHADD’s Young Scientist Award
, Dr. Lee has researched and authored numerous studies.
Craig Surman, MD, is a co-chair of CHADD’s Professional Advisory Board. He is the scientific coordinator for the Adult ADHD Research Program of the Clinical and Research Programs in Pediatric Psychopharmacology and director of the Adult ADHD Clinic at Massachusetts General Hospital, and is an associate professor of Psychiatry at Harvard Medical School. He is also co-author of
Fast Minds: How to Thrive If You Have ADHD (Or Think You Might)
What was the evaluation process like for you or your child? Do you think the professional spent enough to properly understand your experience with symptoms?
“My child got different diagnoses from three different professionals. What can we believe?” We often hear this problem from callers to CHADD’s National Resource Center on ADHD. Continue reading to understand why this may occur, and what you can do about it.
This article appeared in
October 12, 2017.
The information provided on this website was supported by Cooperative Agreement Number NU38DD005376 funded by the Centers for Disease Control and Prevention (CDC). Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the CDC or the Department of Health and Human Services.