How Does a Psychiatrist Diagnose ADHD?

How does a psychiatrist diagnose ADHD (attention-deficit/hyperactivity disorder)? There's no single test for this developmental disorder. Instead, a psychiatrist diagnoses ADHD through a comprehensive evaluation, which may involve interviews, questionnaires, and comparing your symptoms to the diagnostic criteria. 

It's normal to feel a bit overwhelmed by this process, but learning what to expect may help you feel less uncertain when you walk into your appointment. 

What is ADHD, and why does an accurate diagnosis matter?

Attention-deficit hyperactivity disorder (ADHD) is a neurodevelopmental condition that affects attention and impulse control. It's a lifelong disorder that doesn't have a cure. However, many people manage their symptoms with medication and other treatments. 

Undiagnosed ADHD in adults may affect many areas of daily life. For example, you may experience frequent mood changes or get frustrated easily, which could make it harder to maintain relationships. Symptoms such as difficulty focusing may also lead to challenges at work, such as missed deadlines or misplaced paperwork. ADHD may even impact self-esteem. 

ADHD sometimes gets confused with other mental health conditions, such as anxiety. An accurate diagnosis from a mental health professional will help you get the right treatment plan. 

How does a psychiatrist diagnose ADHD? 

Before you may receive an ADHD diagnosis and treatment, a psychiatrist will complete a thorough assessment. This process typically involves a clinical interview where they ask about your symptoms and history. They may also ask you, and sometimes a family member, to complete questionnaires about your behavior and daily functioning. 

People sometimes assume that only children may get ADHD assessments, but that's not true. While early diagnosis and treatment may help young people manage their symptoms sooner, it's never too late to get help if you suspect you have ADHD. 

In fact, the Centers for Disease Control and Prevention estimate that half of U.S. adults with ADHD were diagnosed in adulthood. 

What does a comprehensive ADHD evaluation include?

An ADHD evaluation may start with a clinical, medical, or neurodevelopmental exam to learn more about your health and look for possible ADHD symptoms. For instance, a psychiatrist might notice frequent fidgeting, which could be a sign of hyperactivity. They may also observe your level of attention and ability to follow instructions during the exam. 

A clinical interview is another common diagnostic tool. During the interview, the psychiatrist usually gathers information about your symptoms, developmental history, lifestyle, and relationships. They may also ask about your daily functioning in different settings, such as at home and at work. 

Examples of questions you might be asked during a comprehensive ADHD evaluation include: 

• Do you frequently make careless mistakes at work or when completing projects around the house? 
• Do you often get distracted during activities, such as watching a movie? 
• Are you regularly preoccupied or inattentive when someone speaks to you? 
• How often do you fail to complete projects or meet your responsibilities at work? 
• When you need to finish a task, do you frequently struggle to get started or organized? 
• Is there anyone else in your immediate family who you think may have ADHD, even if they haven't been diagnosed? 
• Do you often misplace items, such as paperwork or your wallet? 
• How often do you forget things during your daily routine? 

Talking about your challenges and symptoms may feel scary, but a psychiatrist isn't there to judge you. They're simply trying to understand your experiences and make a proper diagnosis. 

Your psychiatrist may also ask you to complete a questionnaire, such as the Adult ADHD Self-Report Scale. These forms often have a standardized rating scale to help your provider understand the frequency and severity of your symptoms. For instance, you might rate how often you feel restless or fidgety on a scale from 1 to 4. 

In some cases, the psychiatrist may also ask family members and, if you're in school, teachers to complete questionnaires. This process may help them better understand how your symptoms impact your daily life and relationships. 

Some ADHD assessments involve a symptom timeline. To receive an ADHD diagnosis, several symptoms must have been present before age 12. In addition, several current symptoms must be present in two or more settings, such as at home, school, work, or in social situations.

What diagnostic criteria do psychiatrists use?

Once a psychiatrist has learned about your symptoms, they compare them to specific ADHD diagnostic criteria from the DSM-5. According to the manual, adult ADHD may present in three ways: 

• Predominantly Inattentive Presentation: Symptoms of inattention are present, while criteria for hyperactivity and impulsivity are not met.
• Predominantly Hyperactive-Impulsive Presentation: Symptoms of hyperactivity and impulsivity are present, while criteria for inattention are not met.
• Combined Presentation: Criteria for both inattention and hyperactivity-impulsivity are met. 

To get diagnosed with ADHD, adults and adolescents age 17 and older must experience at least five symptoms in a symptom domain, while children age 16 and younger must experience at least six.

These symptoms must also have a negative impact on your daily life and activities. For example, someone who occasionally loses their keys or daydreams at work may not meet the diagnostic criteria. ADHD is diagnosed based on a pattern of significant and persistent symptoms, not one-off mistakes. 

What other conditions do psychiatrists consider during an ADHD evaluation?

Psychiatrists may also consider bipolar disorder and anxiety disorders during an assessment. These conditions may mimic ADHD symptoms. For example, bipolar disorder and ADHD may both involve irritability and hyperactivity. 

A psychiatrist needs to distinguish ADHD from other mental disorders with similar symptoms to make an accurate diagnosis. 

Of course, it's also possible for ADHD to occur alongside another mental health condition. According to BetterHelp research, over 75% of Americans say they've experienced some form of anxiety or depression in the last two weeks. 

If you're unsure about what your symptoms might mean or how to address them, consider working with a licensed therapist. Alongside therapy, BetterHelp offers psychiatry services through the BetterHelp psychiatry platform, so you can connect with a licensed psychiatric provider for evaluations or medication management, all from wherever you feel comfortable, through video sessions.

*Based on finalized paid psychiatry visits with a copay. Insurance availability, coverage, and costs vary by state, plan, provider network, and provider availability.

What happens after an ADHD diagnosis?

If a psychiatrist diagnoses you with ADHD, they'll recommend a treatment plan. This may include medications, behavioral therapy, or a combination, depending on your needs. 

In addition to any medical ADHD treatment, online therapy may help you learn how to regulate your emotions. It may also teach daily coping strategies. For example, you might try using the Pomodoro method to work in short, focused bursts instead of spending hours trying to complete a task. Decluttering your workspace and minimizing distractions are other methods you may find helpful. 

If you experience impulsivity, your therapist may also teach you mindfulness techniques and strategies for making more intentional decisions. 

This article is for informational and educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Medication decisions should be made with a licensed healthcare professional who may consider your individual symptoms, health history, current medications, and treatment goals. 

Do not start, stop, or change any medication without guidance from a qualified healthcare professional. If you are experiencing a medical emergency or symptoms that feel urgent or life-threatening, call emergency services or seek immediate medical care.