Diagnosis and management

About ADHD

Diagnosis and management

This section helps parents, carers and teachers to:

  • Recognise the main ADHD symptoms
  • Start to recognise symptoms of conditions commonly seen alongside ADHD in children
  • Understand how a diagnosis of ADHD is made, and who is involved
  • Understand the management and treatment options for children with ADHD.

On this page:

  1. Identifying ADHD symptoms ↓
  2. Getting a diagnosis ↓
  3. Common related conditions ↓
  4. Getting support for treatment and management ↓

Identifying ADHD symptoms

ADHD symptoms can be mistaken for other conditions. Here is a simple checklist to download that helps to sort the common ADHD symptoms into the following categories:

  • Inattention
  • Hyperactivity/Impulsivity.

Spotting ADHD symptoms

A simple checklist tool to help sort the common ADHD symptoms into categories, either inattention or hyperactivity/impulsivity

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Children may present with symptoms of both inattention and hyperactivity/impulsivity, or it may be one that predominates. While it is normal for children to behave in these ways from time to time, a child with ADHD will display many of these symptoms, for at least 6 months to a level that is not consistent with children of the same age.

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Getting a diagnosis

First recognition of symptoms

A teacher can sometimes be the first person to recognise that a child is hyperactive, inattentive or impulsive in class: they are experienced in understanding how a child should behave in situations requiring concentration and self-control.

If there are continued symptoms of ADHD, they may contact the parents/carers to discuss their observations. These discussion guides help teachers, parents and carers to:

  • Meet when teachers have spotted symptoms in a child which could indicate ADHD
  • Discuss the child’s behaviour
  • Agree action if the behaviour continues.

How ADHD is diagnosed in children

There is no quick and simple test to confirm ADHD and the process varies. If parents/carers suspect ADHD, they should arrange to see a healthcare professional, such as a family doctor or a school physician. Diagnosis is a lengthy process that includes a number of symptoms being observed at home and school for at least 6 months.

A healthcare professional may ask:

  • What symptoms the child has
  • When the symptoms started
  • Where they occur e.g. at home and/or at school. They may ask for a questionnaire to be completed by the child’s teacher to get a full insight into the child’s behaviour at school
  • How the symptoms affect the child’s quality of life e.g. their ability to make and keep friends
  • If the child has experienced any significant recent changes
  • If there is any family history of ADHD or other mental health conditions
  • If the child has any other health problems.

Parents/carers may be offered training or an education programme to learn techniques so that they can manage behaviour more effectively.

If the healthcare professional suspects that a child has ADHD, they may refer to a specialist who can make a definitive diagnosis. One or more of the following people may be involved:

  • The family doctor
  • A school physician
  • A paediatrician
  • A child psychiatrist
  • A clinical psychologist
  • An educational psychologist.

The specialist will look for key symptoms (discussed above in ‘Identifying ADHD symptoms’) and exclude other possible conditions. The specialist may then ask the child to undertake tests and questionnaires to further assess attention and behavior. Parents and teachers may also be asked to complete questionnaires to get a more accurate picture.

The key criteria for the specialist to diagnose ADHD are: 

  • Display of either inattention or hyperactivity-impulsivity (or both)
  • Symptoms must:
    • Have been present for at least 6 months
    • Have started before the age of 12
    • Be present in two or more places, such as at school and in the home
    • Negatively affect day-to-day life
    • Not occur solely due to a psychotic disorder
    • Not be better explained by another mental disorder.

Which healthcare professionals can help, children with ADHD, paediatrician, clinical psychologist, family doctor, school physician, child psychiatrist

Which healthcare professionals can help?

Family doctor/school physician:

  • Starting point for most parents
  • Can assess basic symptoms
  • If they believe the child may have ADHD can refer them to an appropriate specialist.

Paediatrician:

  • Can prescribe treatment for ADHD, including medication where appropriate
  • Developmental paediatricians can also be part of the referral process as they specialise in problems associated with development, including behavioural problems.

Child psychiatrist:

  • Can prescribe treatment for ADHD, including medication where appropriate
  • Bases diagnosis on interviews with parents/carers and information from the school
  • Can also diagnose and treat related conditions.

Clinical psychologist:

  • In some countries can make a full diagnosis
  • Can give support for related conditions, such as depression and low self esteem
  • Can get involved in behavioural management/psychotherapy
  • Usually are not able to prescribe medication.

Discussing symptoms of ADHD with teachers

A discussion guide to help parents and carers discuss with teachers the symptoms of a child who potentially has ADHD

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Discussing symptoms of ADHD with parents

A discussion guide to help teachers discuss with parents and carers the symptoms of a child who potentially has ADHD

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Common related conditions

Many children with ADHD also have other health conditions/psychiatric disorders. This can make the diagnosis, treatment and management of ADHD more complex. It is useful to be aware of the conditions most commonly associated with ADHD, so that healthcare professionals can be made aware of any concerns or problems. 

This short presentation gives an overview of the main related conditions.

Spotting related conditions

A coaching tool providing an overview of the main conditions related to ADHD

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Getting support for treatment and management

Healthcare professionals, working with parents/carers will decide the most appropriate option or combinations of options for treating a child’s ADHD. The decision will depend on factors such as age, weight, other coexisting medical conditions, factors within the family and evaluating treatment effects. 

Typically, ADHD treatment and management involves a multi-modal approach with two important components:

  • Behaviour management, such as cognitive behavioural therapy (CBT) and social skills training
  • Medication.

Other treatment options, such as counselling, psychotherapy and family therapy, may be also be considered by the child’s healthcare specialists.

Using behaviour management

Behaviour management programmes offer parents/carers and teachers specific techniques for:

  • Giving commands
  • Reinforcing adaptive and positive social behaviour
  • Decreasing or eliminating inappropriate behaviour.

It can encourage parents/carers and teachers to:

  • Identify and understand a child’s behaviour
  • Learn how to handle more challenging behaviour.

The techniques take time and patience to adopt but can be extremely effective. Behaviour therapy is often the first-line treatment for a child or young person with moderate ADHD.Educational psychologists often advise parents on a behaviour management programme.

Using medication for ADHD

There is positive evidence that for many children, appropriately prescribed medication can reduce the core symptoms of ADHD. There are two main types of medication that can be prescribed, both of which can be either short- or long-acting:

  • Stimulants
  • Non-stimulants.

Healthcare professionals will consider the merits of medication in each child’s case, based on comprehensive assessment and diagnosis; balancing any potential side effects with the possible benefits of treatment.

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References 

American Academy of Pediatrics. Clinical practice guideline 2001; 108(4): 1033-44.

Burt SA. Psychological Bulletin 2009; 135(4): 608-37.

Coleman D, et al. Psychiatr Serv 2009; 60: 950-7.

Diagnostic and Statistical Manual of Mental Disorders, 5th Edition 2013. American Psychiatric Association.

Faraone SV, et al. Biol Psychiatry 2005; 57(11): 1313-23.

Kovshoff H, et al. Eur Child Adolesc Psychiatry 2012; 21(2): 87-9.

MTA Cooperative group. Arch Gen Psychiatry 1999; 56: 1073.

NICE Clinical guideline 72: Attention deficit hyperactivity disorder. 2008.

O’Regan F. How to teach and manage children with ADHD (2010). Nottingham, UK: LDA.

World Health Organisation. The ICD-10 Classification of Mental and Behavioural disorders 1993. Available at http://www.who.int/classifications/icd/en/bluebook.pdf. Accessed 26 June 2013.

Ziegler Dendy CA. Teenagers with ADD and ADHD (2006). Bethesda, US: Woodbine House.

These materials have been produced with practical advice and guidance provided by the expert European ADHD Awareness Taskforce.

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