How is it assessed?
Who should make the diagnosis?
According to the latest National Institute for Clinical Excellence (NICE) guidelines, the diagnosis of ADHD / ADD should only be given by accredited Child and Adolescent Psychiatrists, or Consultant Paediatricians with a special interest in these conditions. They normally work as part of a larger team known as the Community Adolescent Mental Health Services (CAMHS) team.
How is it made?
At present, no laboratory studies, imaging studies, or procedures help with the diagnosis of ADHD / ADD. A detailed psychiatric evaluation or involvement of a mental health team is usually necessary for a diagnosis of ADHD / ADD to be confirmed.
The diagnosis is made on the basis of -:
- a full clinical and psychosocial assessment of the person (including discussion about behaviour and symptoms in the different domains and settings of everyday life) and
- a full developmental and psychiatric history, and
- observer reports and assessment of mental state
The International Classification of Mental and Behavioural Disorders 10th revision (ICD-10) and the Diagnostic and Statistical Manual of Mental Disorders 4th edition (DSM-IV) are the two main diagnostic criteria which are in current use. The ICD-10 uses a narrower diagnostic category, which includes people with more severe symptoms and impairment. DSM-IV has a broader, more inclusive definition, which includes a number of different ADHD / ADD subtypes.
A diagnosis of ADHD / ADD under either ICD-10 or DSM-IV-TR can be made if symptoms:
- have been present for at least six months
- onset before 7yrs
- are greater than expected for the child’s age and intelligence (i.e. more than just being a busy toddler)
- have a significant negative impact in at least two settings, for example at home and school
Neuropsychological tests
These are valuable tools and can be supportive of the diagnosis in a full clinical evaluation; however, they should not be the sole basis for diagnosis. Examples include -:
- Conner’s Parent -Teacher Rating Scale (a questionnaire that can be given to both the parents and teachers)
- Continuous Performance Tests (computer-based tasks used to test attention and impulsivity).
