ADHD symptoms in children and adolescents are routinely overlooked by general practitioners (GPs), who see these patients more often than they do their neurotypical peers in the two years preceding a diagnosis, according to the journal Archives of Disease in Childhood. With better training in ADHD, GPs could recognize these frequent visits — for everything from asthma and eczema to behavioral disorders — as possible indicators of ADHD and opportunities for early evaluation, say the researchers behind the study. ¹

The study found that children ultimately diagnosed with ADHD seek medical care, consult healthcare providers, undergo surgery, and get admitted to hospitals at double the rate of their neurotypical peers in the years preceding diagnosis. They also show increased rates of physical conditions, such as asthma and eczema; behavioral and mental health issues; learning differences, such as dyspraxia and dyslexia; autism; tics; and insomnia before receiving an ADHD diagnosis.

The research team from the University of Nottingham and King’s College London reported that reasons for delays in ADHD diagnosis referrals stemmed from GPs’ difficulty recognizing ADHD symptoms in children and a lack of specific recommendations for earlier ADHD detection in current guidelines from organizations such as the National Institute for Health and Care Excellence and the American Academy of Pediatrics. ²,³,⁴

William W. Dodson, M.D., LF-APA, clinician, writer, speaker, and consultant on ADHD medicine, says the lack of training hinders pediatricians and nurse practitioners as well as psychiatrists. “Around 93% of adult psychiatrists, when asked, report that they’ve never had any ADHD training, either in their residency or in their continuing medical education, whether in children, adolescents, or adults,” he says.

Inadequate training in early signs of ADHD may cause GPs to miss opportunities to identify and evaluate ADHD symptoms in children. “The peak age for diagnosis of ADHD is at 7 to 9 years,” the study’s authors wrote. “Yet, it is likely to have been present from an earlier age, with persistent symptoms.”

Untreated ADHD is associated with poor relationships and social functioning, low self-esteem, academic under-attainment, and injuries. In addition, children with ADHD may incur greater healthcare costs before their diagnosis.⁵

“The study underscores the importance of conducting additional research to identify children with ADHD at an earlier stage, thereby enabling them to receive more timely and effective treatments, including therapeutic interventions and medications,” the study’s authors wrote.

The clinical practice guidelines for ADHD, developed by the American Academy of Child and Adolescent Psychiatry (AACAP), recommend medication as the first-line treatment for ADHD in school-age children, citing a formal review of 78 studies on the treatment of ADHD, which “consistently supported the superiority of stimulant over the non-drug treatment.” (Footnote 5) According to the American Academy of Pediatrics (AAP), 80% of the children who use stimulant medications, either alone or combined with behavior therapy, increase focus and decrease impulsivity.⁶,⁷

“Treatment with ADHD stimulant medication prior to age 9 may actually decrease your child’s likelihood of abusing drugs and alcohol later in life, according to research,” says Timothy Wilens, M.D., an associate professor of psychiatry at Harvard Medical School. “Considerable evidence also suggests that children taking ADHD medication commonly experience improvements to academic and social functioning, which translates to improved self-esteem, lower rates of self-medication with drugs or alcohol, and decreased risk of substance abuse.”⁸

The population-based matched case-control study analyzed the medical records from 1998-2015 of 8,127 children and adolescents aged 4 to 17 years who were diagnosed with ADHD and 40,136 without ADHD from the Clinical Practice Research Datalink, a primary care database of 60 million patients in the U.K.

Sources

¹Prasad, V., Rezel-Potts, E., White, P., et al. (2024). Use of Healthcare Services Before Diagnosis of Attention-Deficit/Hyperactivity Disorder: A Population-Based Matched Case-Control Study. Archives of Disease in Childhood. https://adc.bmj.com/content/109/1/46
²Sayal, K., Prasad, V., Daley, D., et al . (2018). ADHD in Children and Young People: Prevalence, Care Pathways, and Service Provision. Lancet Psychiatry. doi:10.1016/S2215-0366(17)3016
³Tatlow-Golden, M., Prihodova, L., Gavin, B., et al. (2016) What Do General Practitioners Know About ADHD? Attitudes and Knowledge Among First-Contact Gatekeepers: Systematic Narrative Review. BMC Fam Pract. doi:10.1186/s12875-016-0516-x
⁴Sayal, K., Taylor, E., Beecham, J., et al. (2002). Pathways to Care in Children at Risk of Attention-Deficit Hyperactivity Disorder. Br J Psychiatry. doi:10.1192/bjp.181.1.43
⁵Holden, S.E., Jenkins-Jones, S., Poole, C.D., et al. (2013). The Prevalence and Incidence, Resource Use and Financial Costs of Treating People with Attention Deficit/Hyperactivity Disorder (ADHD) in the United Kingdom (1998 to 2010). Child Adolesc Psychiatry Ment Health. doi:10.1186/1753-2000-7-
⁶Pliszka, Steven. (2007). “Practice Parameter for the Assessment and Treatment of Children and Adolescents With Attention-Deficit/Hyperactivity Disorder.” Journal of the American Academy of Child & Adolescent Psychiatry. doi:10.1097/chi.0b013e318054e724
⁷Clinical Practice Guideline: Treatment of the School-Aged Child With Attention-Deficit/Hyperactivity Disorder. American Academy of Pediatrics. (Oct. 2001). https://pediatrics.aappublications.org/content/108/4/1033
⁸McCabe SE, et al. (2016). Age of Onset, Duration, and Type of Medication Therapy for Attention-Deficit/Hyperactivity Disorder (ADHD) and Substance Use During Adolescence: A Multi-Cohort National Study. J Am Acad Child Adolesc Psychiatry. 2016; 55(6):479-486: doi: 10.1016/j.jaac.2016.03.011

Approximately 25 years ago, when ADDitude published its first newsletter, the diagnosis of ADHD was based on criteria published in the Diagnostic and Statistical Manual of Mental Disorders, Version III-C. The DSM-IV diagnostic criteria adopted two years later were the most scientifically validated to date.

Its 18 symptoms were evenly divided into two lists: problems with inattention vs. problems with hyperactivity-impulsivity. To warrant a diagnosis, a patient had to exhibit at least six symptoms on either list, suffer impairment in one or more major life activities (home, school, community, peers), and begin experiencing symptoms by age seven. Furthermore, the symptoms could not be better explained as those of another condition.

Yet, problems remained. The committee handling ADHD criteria for the DSM-5 hoped to improve the DSM’s rigor and diagnostic accuracy. It proposed recommendations that reflected independent research findings. Sadly, many of those recommendations were rejected by higher-ranking committees, perhaps partly out of fear they would significantly increase the prevalence of ADHD diagnoses. Thus, the ADHD criteria in the DSM-5, released in 2013, represented only modest improvements.

The Problems with the DSM-5

The DSM-5 does not capture ADHD accurately because its criteria do not conceptualize ADHD as a disorder of executive functioning (EF) and self-regulation (SR). This limitation greatly narrows the concept of ADHD, trivializes its nature as just an attention deficit, and discourages diagnosing clinicians from focusing on the wider range of impairments inherent in ADHD. These impairments impact executive inhibition, self-awareness, working memory, emotional self-regulation, self-motivation, planning/problem-solving, and other functions not typically associated with ADHD. Ignoring them restricts diagnosis and, ultimately, treatment for many patients.

Why Qualifier Symptoms Should Go Unheeded

In the DSM-5, qualifier symptoms were added after each listing of a symptom to help clinicians understand the expression of that symptom beyond childhood. However, problems with these clarifiers include:

[Read: ADHD in Adults Looks Different. Most Diagnostic Criteria Ignores This Fact.]

• None of these clarifications arose out of prior research that tested them for their affiliation with ADHD, for their relationship to the root symptom they are supposed to clarify, for their accuracy in detecting ADHD, or for their relationship to impairment in major life activities. They were simply invented by committee members in a meeting.
• Adding such new and untested symptoms may have broadened eligibility for the disorder by up to 6 percent in older teens and adults.
• Some clarifications seemed to correlate with anxiety, which could lead to cross-contamination of the ADHD criteria.

These clarifications also were not informed by any theory of ADHD, such as EF-SR theory.

So, until the status of these parenthetical clarifiers is better researched, clinicians would do best to ignore them in making a diagnosis of ADHD in a teen or an adult.

A Better Way to Diagnose ADHD

Clinicians can ensure more accurate diagnoses and more appropriate care by following these five recommendations:

#1. Avoid placing undue emphasis on hyperactive symptoms.

Six of the nine hyperactive-impulsive symptoms on the DSM list reflect excessive activity, even though impulsivity has been viewed as a more prevalent ADHD symptom for the last 40 years. At best, hyperactivity is reflective of early childhood disinhibition of motor movement and, later, the inability to regulate such movement to the demands of the situation (e.g., teacher’s instructions to complete desk work). Those symptoms decline steeply over development and are of little diagnostic value by late adolescence. This is one reason why clinicians before the 1980s thought the disorder was outgrown before adulthood, which we now know is false for most people.

[Research: Only 1 in 10 Children with ADHD Will Outgrow Symptoms]

#2. Look for additional symptoms of impulsivity.

Poor inhibition may manifest not just in speech (currently, the DSM criteria include only three verbal symptoms) but in motor behavior, cognition, motivation, and emotion. Clinicians should screen for any of the following manifestations:

• often fails to consider the consequences of their actions
• has trouble motivating to persist toward goals
• has trouble deferring gratification or waiting for rewards
• lacks willpower, self-discipline, drive, and determination
• seems unusually impatient, easily emotionally aroused and frustrated, and quick to anger

Abundant research shows that these aspects of poor self-regulation are as common in people with ADHD as are the traditional DSM symptoms and, with age, more so than the symptoms of hyperactivity.

#3. Think of inattention as affecting a range of executive function deficits in daily life…

…particularly those involving impaired self-awareness, working memory, self-organization, emotional self-regulation, self-motivation, and time management. This will encourage clinicians to broaden their focus beyond the DSM symptoms when conducting open-ended interviews and selecting rating scales.

After the evaluation is completed, clinicians should explain to clients why their condition is so serious, impairing, and pervasive across major domains of life. This will also help clinicians and parents appreciate why teens (and young adults) may seem to be outgrowing ADHD, based on DSM criteria, when they are far less likely to outgrow their EF-SR deficits (and that these impairments may increase with age).

#4. Use rating scales broken down by sex and not just age.

Research suggests that females in the general population, at least in childhood and adolescence, do not show the same symptom severity as their male peers.¹ This makes it harder for a female to meet the DSM criteria. Another complicating factor: because males were overrepresented in field trials for earlier versions of the DSM, the symptom threshold was male-biased.

#5. Don’t adhere too rigidly to diagnostic thresholds when there are clear signs of impairment.

Empirical research demonstrates that ADHD falls along a continuum in the general population. So, clinicians will see clients who don’t meet all of the DSM criteria, yet who are experiencing enough impairment that they sought a diagnosis. This means clinicians should diagnose ADHD if:

• Clients or their caregivers state that a child or teen has a high number of ADHD (and EF) symptoms (place above the 20^th–16^th percentile in severity) and there is evidence of impairment in major life activities, even if the client fails to meet all DSM-5
• Symptoms became evident sometime during development, usually before age 21–24, and the patient meets all other criteria. DSM-5 raised the age of onset for ADHD from age 7 to age 12, but research repeatedly shows that few people are reliable or accurate in recalling the age of onset of their symptoms. It is a mistake, therefore, to consider age of onset in diagnosing ADHD, where all other criteria are met.

DSM-5 ADHD Criteria Challenged: Next Steps

• Free 7-Part Series: The Clinicians’ Guide to Diagnosing ADHD
• Read: ADHD Is a Whole-Life Experience. The DSM Needs to Reflect That.
• Read: ADHD in Women and Girls — Why Female Symptoms Slip Through Diagnostic Cracks

Russell A. Barkley, Ph.D., is a retired clinical scientist, educator, and practitioner.

SUPPORT ADDITUDE
Thank you for reading ADDitude. To support our mission of providing ADHD education and support, please consider subscribing. Your readership and support help make our content and outreach possible. Thank you.

Sources

¹ Young, S., Adamo, N., Ásgeirsdóttir, B. B., Branney, P., Beckett, M., Colley, W., Cubbin, S., Deeley, Q., Farrag, E., Gudjonsson, G., Hill, P., Hollingdale, J., Kilic, O., Lloyd, T., Mason, P., Paliokosta, E., Perecherla, S., Sedgwick, J., Skirrow, C., Tierney, K., … Woodhouse, E. (2020). Females with ADHD: An expert consensus statement taking a lifespan approach providing guidance for the identification and treatment of attention-deficit/ hyperactivity disorder in girls and women. BMC psychiatry, 20(1), 404. https://doi.org/10.1186/s12888-020-02707-9

Hi FrustratedSeekerofUnderstanding:

It’s disheartening when your parents don’t take your concerns seriously. You’ve done your due diligence by researching and reaching out to your teachers for support. I’m here to help you navigate this challenging situation.

When broaching the topic of ADHD with your parents, try to approach the conversation with patience, a calm manner, and a well-prepared mindset. I’m hopeful they can match you “tone-for-tone” when discussing your concerns.

Here are a few suggestions for effectively communicating your concerns.

Educate Yourself…

…So, you can educate them. Continue to gather information about ADHD and learning differences from reputable sources. Consider making a “book” filled with articles and other resources (such as books, podcasts, websites, etc.) they can read, absorb, and process at their own pace. ADDitude magazine is a wonderful place to start as it strikes the perfect balance of research and real life, and its content is easily digestible. I would also include any documentation you have from your teachers or your school where they have expressed concern or documented the challenges you may have.

When you thoroughly understand ADHD, its symptoms, and its impact on your daily life, it will help you articulate your experiences to your parents. Make sure to explain that your goal is not to self-diagnose, but to explore the possibility that you may have ADHD and seek professional guidance.

[Self-Test: Surprising Signs of ADHD in Girls]

Get Organized

Create a list of ADHD symptoms you’ve observed in yourself and any learning or life challenges you face. Be specific, provide examples, and suggest what you may need to overcome them. This will help you present a clear and comprehensive picture of your struggles.

Choose the Right Time

Find a calm and appropriate moment to speak with your parents. Try to find a time when they’re relaxed and relatively open to listening. I recommend having the conversation outside your home. As a parent, my children will tell you I’m a much better listener when I’m not at home. So, suggest a walk, breakfast at the local coffee shop, or even time in the car when your parents are less distracted.

Share your Feelings

And I mean your true emotions and frustrations. I firmly believe it’s not always what you say but how you say it. Don’t be accusatory. Try to structure the conversation using “I” language. “I feel…” or “I need…,” and not, “You make me feel…” Let them know how much this issue affects your well-being and its impact on your mental health and day-to-day functioning.

Request a Professional Evaluation

Ask your parents to consider scheduling an appointment with a psychologist or psychiatrist who specializes in ADHD. Explain that a professional evaluation can provide clarity and insight into your struggles. Make sure to emphasize that an evaluation doesn’t necessarily mean you have ADHD, but it will help you understand your challenges better and provide you with a solutions-oriented roadmap.

[Get This Free Guide: How Is ADHD Diagnosed?]

If your parents remain skeptical or reluctant, please contact a trusted adult who can advocate for you. This could be a teacher, school counselor or psychologist, or another family member who can help facilitate a productive conversation.

Speaking to a psychologist without involving your parents depends on your age and the laws in your location. In some places, minors can seek confidential mental health services without parental consent. I would start with your school psychologist or counselor. They should be able to advise you and provide guidance on confidentiality.

Please know that advocating for your well-being can be challenging, but your experiences and concerns are real and valid. Keep seeking support, remind yourself daily that you are not lazy, and understand that just because you learn differently doesn’t mean it’s wrong or bad.

Wishing you strength and success in your journey for answers and understanding.

How to Talk to Your Doctor & Parents About ADHD: Next Steps

• Download: How to Prepare for Your ADHD Evaluation
• Read: How to Process and Accept Your Child’s Neurodiversity
• Learn: How to Find a Professional Who Specializes in ADHD

ADHD Family Coach Leslie Josel, of Order Out of Chaos, will answer questions from ADDitude readers about everything from paper clutter to disaster-zone bedrooms and from mastering to-do lists to arriving on time every time.

Submit your questions to the ADHD Family Coach here!

SUPPORT ADDITUDE
Thank you for reading ADDitude. To support our mission of providing ADHD education and support, please consider subscribing. Your readership and support help make our content and outreach possible. Thank you.

The Caregiver’s Guide to ADHD Diagnosis is a joint effort from WebMD and ADDitude designed to guide individuals through the difficult, important decisions they face when pursuing an evaluation for ADHD and its comorbid conditions in their children. This guided email course will cover the following topics:

DECISION 1: How can I better understand ADHD, its causes, and its manifestations?
DECISION 2: How can I understand the aspects of ADHD that might be new to the doctor?
DECISION 3: How can I improve the odds of an accurate ADHD evaluation for my child?
DECISION 4: How can I find the most appropriate professional to diagnose and treat my child’s ADHD?
DECISION 5: What should a thorough evaluation for pediatric ADHD include and exclude?
DECISION 6: How can I be sure my child’s evaluation screens for psychiatric comorbidities?
DECISION 7: How can I be sure my child’s evaluation considers look-alike comorbidities?
DECISION 8: Should my child be screened for the sleep, eating, and other disorders?

NOTE: This resource is for personal use only.

SLEEP: What sleep disorders commonly co-occur with ADHD in children?

A: In one study, about half the parents said their child with ADHD had difficulty sleeping. They said their child felt tired when they woke up, had nightmares, or had… | Keep reading on WebMD »

SPD: What distinguishes ADHD from sensory processing disorder?

A: Both disorders will make you restless and unable to concentrate. You could also find it hard to control your emotions. Children might have frequent meltdowns… | Keep reading on WebMD »

EATING DISORDERS: What distinguishes eating disorders from ADHD?

A: For individuals with bulimia nervosa, food is self-medication for anxiety, stress, anger, and boredom. Eating is stimulating, and food fills the gap. People with ADHD who… | Keep reading on ADDitude »

PTSD:  Does trauma increase the likelihood for ADHD in children, and vice versa?

A: ADHD is a largely genetic condition that impacts specific areas of the brain. Because trauma affects those same areas of… | Keep reading on ADDitude »

BFRB: What body-focused repetitive behaviors common co-occur with ADHD in children?

A: Recent studies suggest that 20 to 38 percent of children with trichotillomania also meet the criteria for ADHD. Available prevalence rates are few, but they suggest that… | Keep reading on ADDitude »

TRAUMA: What should I know about the impact of trauma and stress on developing brains?

A: Under stress and exposure to trauma, the brain effectively enters survival mode. It funnels more fuel and resources into the limbic system and diverts them away from the prefrontal cortex… | Keep reading on ADDitude »

FIRST-PERSON: “Sometimes, Raising My Sensitive Child Was Hell”

“Baths, sounds, clothing textures, food textures, naptime, bedtime — almost every daily routine set off meltdowns that made our daily life hell. I called them tantrums, but looking back, they were much more than that. My thought every day was ‘just get through it.'” | Keep reading on ADDitude »

RELATED RESOURCES

SYMPTOM TEST: Sensory Processing Disorder in Children

SPD interferes with the body’s ability to interpret sensory messages from the brain, and may manifest as meltdowns or anxiety. | Take the self-test on ADDitude »

SYMPTOM TEST: Eating Disorders in Children and Teens

Does your child express concerns about their body size? Feel guilty after eating? | Take the self-test on ADDitude »

8-Part Guide to ADHD Diagnosis in Children, from WebMD x ADDitude:

DECISION 1: How can I better understand ADHD, its causes, and its manifestations?
DECISION 2: How can I understand the aspects of ADHD that might be new to the doctor?
DECISION 3: How can I improve the odds of an accurate ADHD evaluation for my child?
DECISION 4: How can I find a professional to diagnose and treat my child’s ADHD?
DECISION 5: What should a thorough evaluation for pediatric ADHD include and exclude?
DECISION 6: How can I be sure my child’s evaluation screens for psychiatric comorbidities?
DECISION 7: How can I be sure my child’s evaluation considers look-alike comorbidities?
> DECISION 8: Should my child be screened for the sleep, eating, and other disorders?

LDs: What distinguishes ADHD from learning differences?

A: Between 30–50% of those with ADHD also have a learning disability — and if an LD is not recognized early, a child might exhibit ADHD-like symptoms… | Keep reading on ADDitude »

ODD: What distinguishes ADHD from oppositional defiant disorder?

A: ADHD is a type of brain disorder that often lasts well into adulthood. ODD is a type of behavior disorder that’s mostly diagnosed in childhood. If your child has ODD, they tend to be… | Keep reading on WebMD »

AUTISM: What distinguishes ADHD from autism in children?

A: Autism spectrum disorders are a series of related developmental disorders that can affect language skills, behavior, socializing, and… | Keep reading on WebMD »

CD: What distinguishes ADHD from conduct disorder?

A: While kids with ADHD might be disruptive, they aren’t typically aggressive. When kids show a pattern of more aggressive, violent, or antisocial behaviors… | Keep reading on WebMD »

TIC DISORDERS: What distinguishes ADHD from Tourette’s Syndrome?

A: The main symptom of Tourette’s syndrome is repeated movements or sounds, called tics, that a person can’t control. They can be simple, like constant eye blinking, sniffing… | Keep reading on WebMD »

FIRST-PERSON: “How My Son’s ADHD Masked His Dyslexia”

“Some of the signs were obvious, in retrospect. He was a late reader. He had significant struggles with spelling. But here’s where I went off track: I wrongly assumed that these issues were due to his ADHD distractibility. So many other things had landed in that bucket, why not this?” | Keep reading on ADDitude »

RELATED RESOURCES

SYMPTOM TEST: ODD in Children

Is your child touchy, prickly, or easily offended? Test limits by ignoring rules or arguing? | Take the self-test on ADDitude »

SYMPTOM TEST: Learning Disabilities in Children

Could your child’s reading, math, spelling, or coordination challenges be signs of a learning difference? | Take the self-test on ADDitude »

8-Part Guide to ADHD Diagnosis in Children, from WebMD x ADDitude:

DECISION 1: How can I better understand ADHD, its causes, and its manifestations?
DECISION 2: How can I understand the aspects of ADHD that might be new to the doctor?
DECISION 3: How can I improve the odds of an accurate ADHD evaluation for my child?
DECISION 4: How can I find a professional to diagnose and treat my child’s ADHD?
DECISION 5: What should a thorough evaluation for pediatric ADHD include and exclude?
DECISION 6: How can I be sure my child’s evaluation screens for psychiatric comorbidities?
> DECISION 7: How can I be sure my child’s evaluation considers look-alike comorbidities?
DECISION 8: Should my child be screened for the sleep, eating, and other disorders?

COMORBIDITIES: What co-existing conditions should my child’s doctor consider when evaluating for ADHD?

A: ADHD rarely exists in isolation. Clinicians must properly screen for and address ADHD and its comorbidities… | Keep reading on ADDitude »

DEPRESSION: What distinguishes ADHD from depression in children?

A: Clinical depression is more than just the blues. It’s a serious illness, and it affects more young people than parents realize… | Keep reading on ADDitude »

ANXIETY: What distinguishes ADHD from anxiety in children?

A: Some anxiety disorders can be hard to spot in children because symptoms include internal thoughts and feelings that don’t always… | Keep reading on WebMD »

OCD: What distinguishes ADHD from OCD in children?

A: Obsessive-compulsive disorder is marked by repetitive thoughts or fears (obsessions) that may turn into repetitive behaviors… | Keep reading on WebMD »

BIPOLAR: What distinguishes ADHD from bipolar disorder in children?

A: Medical science is learning more about bipolar disorder in children and teens. But the condition is still difficult to diagnose. That’s especially true for teenagers in whom irritability and moodiness… | Keep reading on WebMD »

DMDD: What are the symptoms of disruptive mood dysregulation disorder in children?

A: DMDD causes children to experience unstable emotions they cannot regulate, including extreme outbursts of anger, leading to temper tantrums. These outbursts often occur in response to… | Keep reading on WebMD »

FIRST-PERSON: “How I Calmed My Daughter’s Anxiety Attack”

“It’s critical that you accept the attack as real. The dizziness, sweating, chest pain, racing heart — all of it is real. Don’t tell her that it’s just in her head or that she’s OK. So what can you do? Start by holding her close.” | Keep reading on ADDitude »

RELATED RESOURCES

SYMPTOM TEST: Generalized Anxiety Disorder in Children

Every child worries sometimes — about monsters or tests or new experiences. A child with anxiety feels anxious about nearly everything. | Take the self-test on ADDitude »

SYMPTOM TEST: Depression in Children

Does your child say they’re ‘too tired’ to do activities they used to love? Have trouble making even simple decisions? | Take the self-test on ADDitude »

8-Part Guide to ADHD Diagnosis in Children, from WebMD x ADDitude:

DECISION 1: How can I better understand ADHD, its causes, and its manifestations?
DECISION 2: How can I understand the aspects of ADHD that might be new to the doctor?
DECISION 3: How can I improve the odds of an accurate ADHD evaluation for my child?
DECISION 4: How can I find a professional to diagnose and treat my child’s ADHD?
DECISION 5: What should a thorough evaluation for pediatric ADHD include and exclude?
> DECISION 6: How can I be sure my child’s evaluation screens for psychiatric comorbidities?
DECISION 7: How can I be sure my child’s evaluation considers look-alike comorbidities?
DECISION 8: Should my child be screened for the sleep, eating, and other disorders?

EVALUATIONS: What is the step-by-step ADHD evaluation process for children?

A: Diagnosing ADHD is a process that takes several steps and involves gathering information from multiple sources. You, your child… | Keep reading on WebMD »

EARLY DIAGNOSIS: Can my child be evaluated for ADHD as early as preschool?

A: Most children aren’t checked for ADHD until they’re school age, but kids as young as 4 can be diagnosed, according to guidelines… | Keep reading on WebMD »

TESTS: What tests are used to diagnose ADHD in children?

A: There’s no single test to diagnose ADHD. Instead, doctors rely on several things, including interviews with the parents, relatives, teachers, or other adults, questionnaires or rating scales… | Keep reading on WebMD »

ONLINE CARE: Can my child get diagnosed with ADHD via a telehealth appointment?

A: While much of the process can be done online, medication fulfillment, physical exams, and cognitive or educational testing may… | Keep reading on ADDitude »

DIFFERENTIAL DIAGNOSIS: How can I be sure my child’s symptoms don’t point to another condition?

A: Many other disorders have the same, or similar, symptoms as ADHD, so it’s important for your doctor to look for all possibilities before coming to a conclusion… | Keep reading on WebMD »

TIMELINE: How long will it take to get my child evaluated for and diagnosed with ADHD?

A: An initial consultation with the patient (and parents) could range from 45 minutes to two hours or more. You should also expect to fill out questionnaires, checklists… | Keep reading on ADDitude »

FIRST-PERSON: “How a Diagnosis Unlocked My Son’s Best Self”

“Gone was my happy, carefree boy who would sing in his room and laugh at our cats. In his place was a struggling child who could not focus on schoolwork, who had trouble getting along with other kids, and whose mishaps were bleeding him dry.” | Keep reading on ADDitude »

RELATED RESOURCES

FREE DOWNLOAD: ADHD Diagnosis Guide

There is no definitive way to check for ADHD. No blood test or X-ray. There is, however, a logical set of steps that medical professionals should take. | Download now on ADDitude »

FREE DOWNLOAD: Common ADHD Diagnosis Mistakes

Doctors sometimes diagnose ADHD too quickly. Here’s what you need to know to avoid common mistakes. | Download now on ADDitude »

8-Part Guide to ADHD Diagnosis in Children, from WebMD x ADDitude:

DECISION 1: How can I better understand ADHD, its causes, and its manifestations?
DECISION 2: How can I understand the aspects of ADHD that might be new to the doctor?
DECISION 3: How can I improve the odds of an accurate ADHD evaluation for my child?
DECISION 4: How can I find a professional to diagnose and treat my child’s ADHD?
> DECISION 5: What should a thorough evaluation for pediatric ADHD include and exclude?
DECISION 6: How can I be sure my child’s evaluation screens for psychiatric comorbidities?
DECISION 7: How can I be sure my child’s evaluation considers look-alike comorbidities?
DECISION 8: Should my child be screened for the sleep, eating, and other disorders?

HEALTH CARE TEAM: What types of providers should be on my child’s ADHD health care team?

A: If your child has ADHD symptoms, contact their doctor or pediatrician as a first step. They should already have a strong relationship with your family… | Keep reading on WebMD »

FINDING A DOC: How can I choose the best health care professional(s) to manage my child’s ADHD?

A: When you find out your child has ADHD, you can turn to a team of pros who can get them the right treatment. Each one plays a different role… | Keep reading on WebMD »

ASSESSING PROFESSIONALS:  What questions should I ask in evaluating health care providers to diagnose my child’s ADHD?

A: How many of your pediatric patients have ADHD? How do you evaluate the symptoms of ADHD in children?… | Keep reading on ADDitude »

SPECIALISTS: What steps should I follow to find an ADHD specialist for my child?

A: If your pediatrician dismisses your worries, you should request a referral to a specialist in child behavior and development… | Keep reading on ADDitude »

THE RIGHT FIT: How can I tell if a doctor is a good fit for our family?

A: What qualities in a health care provider are important to you? The following is a list of traits that people most often mention when asked what they want from a health care professional… | Keep reading on ADDitude »

FIRST QUESTIONS: How can I best prepare for my child’s ADHD evaluation?

A: Strong, engaged advocacy will help ensure the best outcomes for your child. Knowing the right questions to ask yourself and other professionals before your child’s ADHD evaluation will… | Keep reading on ADDitude »

FIRST-PERSON: “7 Therapists — and Counting”

“And then there were seven. Later this week, we’ll be meeting Dr. P, a cognitive behavioral therapist recommended by ‘the team.’ And I’ll do my best to stop judging who we are, who we’ve become, and how we got here.” | Keep reading on ADDitude »

RELATED RESOURCES

FREE DOWNLOAD: Choosing the Right Professional to Treat ADHD

Use this comparison chart to help you understand the benefits and drawbacks of each option. | Download now on ADDitude »

EXPERT WEBINAR: Forming a Cross-Functional Care Team

Expert webinar with Leslie F. Graham, MSW, Douglas Russell, M.D., and Sheryl Morelli, M.D. | Listen now on ADDitude »

8-Part Guide to ADHD Diagnosis in Children, from WebMD x ADDitude:

DECISION 1: How can I better understand ADHD, its causes, and its manifestations?
DECISION 2: How can I understand the aspects of ADHD that might be new to the doctor?
DECISION 3: How can I improve the odds of an accurate ADHD evaluation for my child?
> DECISION 4: How can I find a professional to diagnose and treat my child’s ADHD?
DECISION 5: What should a thorough evaluation for pediatric ADHD include and exclude?
DECISION 6: How can I be sure my child’s evaluation screens for psychiatric comorbidities?
DECISION 7: How can I be sure my child’s evaluation considers look-alike comorbidities?
DECISION 8: Should my child be screened for the sleep, eating, and other disorders?

GENDER: Why is ADHD so often missed or misdiagnosed in girls?

A: Hyperactivity and impulsivity are two of the most well-known symptoms of ADHD. But they aren’t as common with girls… | Keep reading on WebMD »

DIAGNOSING GIRLS: How can parents and doctors better recognize signs of ADHD in girls?

A: Girls with inattention can compensate in the early school years, especially if they’re bright. But the strategies often fail when they get to middle school, which demands more planning… | Keep reading on WebMD »

AGE-BY-AGE: How might my child’s ADHD symptoms change as they age?

A: In the teen years, hyperactivity tends to improve. But your child may feel restless and be uncomfortable sitting for long periods. And an impulsive teen with ADHD might do risky things… | Keep reading on WebMD »

TEENS: What do I need to understand about ADHD in adolescence?

A: Teens with ADHD face an extra set of challenges: puberty aggravates their symptoms, academics tax their EFs, and… | Keep reading on ADDitude »

ADHD & RACE: How can I combat disparities in ADHD diagnosis and treatment for children of color?

A: After hundreds of years of racialized history, trust won’t come overnight, but it can be improved by diversifying educational and medical communities… | Keep reading on ADDitude »

BEYOND TANTRUMS: Can early signs of emotional dysregulation suggest ADHD in my child?

A: The babies who may be at risk for ADHD are the ones who cry constantly and have trouble self-soothing; who are angry, fussy, and difficult to control; who have… | Keep reading on ADDitude »
FIRST-PERSON: “The Model Minority Myth Left No Room for My ADHD”
“Neurological differences are not talked about in my culture. They are taboo. This meant I was to tell nobody about my diagnosis, because even with that validation, I would face judgement and isolation.” | Keep reading on ADDitude »

RELATED RESOURCES

SYMPTOM TEST: Symptoms in Teen Girls

Typical symptoms of ADHD in girls — daydreaming, non-stop talking, tardiness — are too often shrugged off. | Take the self-test on ADDitude »

EXPERT WEBINAR: The Teen Years with ADHD

Expert webinar with Thomas E. Brown, Ph.D. | Listen now on ADDitude »

8-Part Guide to ADHD Diagnosis in Children, from WebMD x ADDitude:

DECISION 1: How can I better understand ADHD, its causes, and its manifestations?
DECISION 2: How can I understand the aspects of ADHD that might be new to the doctor?
> DECISION 3: How can I improve the odds of an accurate ADHD evaluation for my child?
DECISION 4: How can I find a professional to diagnose and treat my child’s ADHD?
DECISION 5: What should a thorough evaluation for pediatric ADHD include and exclude?
DECISION 6: How can I be sure my child’s evaluation screens for psychiatric comorbidities?
DECISION 7: How can I be sure my child’s evaluation considers look-alike comorbidities?
DECISION 8: Should my child be screened for the sleep, eating, and other disorders?

RSD: Is rejection sensitive dysphoria a symptom of ADHD?

A: Rejection sensitive dysphoria (RSD) is not a medical diagnosis, but a way of describing certain symptoms associated with ADHD… | Keep reading on WebMD »

EMOTIONS: Is emotional dysregulation a symptom of ADHD?

A: Emotional dysregulation is a term used to describe an emotional response that is poorly regulated and does not fall within… | Keep reading on WebMD »

SUBTLE SYMPTOMS: What symptoms of ADHD are often missed by educators, professionals, and even parents?

A: It’s not easy to know if your child has ADHD. As a parent, it may be less about the symptoms shouting ADHD, and more about feeling something’s not right. Your kid is struggling, but you don’t know why… | Keep reading on ADDitude »

EARLY YEARS: How does ADHD manifest in toddlers?

A: Emotional dysregulation often looks like excess emotion. Neurotypical toddlers typically experience up to three tantrums a week. Toddlers with ADHD, on the other hand… | Keep reading on ADDitude »

SOCIAL SKILLS: What social executive function deficits may suggest ADHD in my child?

A: Children and teens with ADHD tend to have a hard time with skills that underlie social interactions, such as perspective-taking, situational awareness… | Keep reading on ADDitude »

MISDIAGNOSIS: What symptoms of ADHD are my child’s doctor most likely to miss or misread?

A: Some children resort to defiant behavior to cover up anxiety, and other children who appear “defiant” are actually just impulsive. This is another case where it’s important for doctors to tease out the root cause… | Keep reading on ADDitude »

FIRST-PERSON: “When the First Signs of My Child’s ADHD Were Revealed”

“I asked our son why he didn’t like to wash his hair. ‘It takes too long and it’s boring,’ he told me. ‘Yeah, it is kind of boring,’ I replied. That’s when we decided to have him evaluated for ADHD. (I have ADHD myself, and told him he might have inherited mommy’s ‘silly brain.’)” | Keep reading on ADDitude »

RELATED RESOURCES

SYMPTOM TEST: Working Memory Deficits

A working memory deficit could explain a child’s difficulty with reading retention or mental math. | Take the self-test on ADDitude »

SYMPTOM TEST: Executive Function Deficit

Does your child have trouble getting started or struggle with problem-solving? | Take the self-test on ADDitude »

8-Part Guide to ADHD Diagnosis in Children, from WebMD x ADDitude:

DECISION 1: How can I better understand ADHD, its causes, and its manifestations?
> DECISION 2: How can I understand the aspects of ADHD that might be new to the doctor?
DECISION 3: How can I improve the odds of an accurate ADHD evaluation for my child?
DECISION 4: How can I find a professional to diagnose and treat my child’s ADHD?
DECISION 5: What should a thorough evaluation for pediatric ADHD include and exclude?
DECISION 6: How can I be sure my child’s evaluation screens for psychiatric comorbidities?
DECISION 7: How can I be sure my child’s evaluation considers look-alike comorbidities?
DECISION 8: Should my child be screened for the sleep, eating, and other disorders?

DEFINITION: What is today’s medical understanding of ADHD?

A: ADHD (attention deficit hyperactivity disorder) is a brain disorder that affects how you pay attention and control your behavior. It happens in children and teens and can continue into adulthood… | Keep reading on WebMD »

SYMPTOMS: How can I tell if my child is showing signs and symptoms of ADHD?

A: The symptoms of attention deficit hyperactivity disorder — or ADHD — vary from person to person, but consist of some combination of inattention, hyperactivity, and impulsivity… | Keep reading on WebMD »

SUBTYPES: What are the key differences between inattentive, hyperactive, and combined-type ADHD in children?

A: Signs of hyperactivity include squirming, fidgeting, tapping, talking, and constant movement, especially in situations where it’s not appropriate. Signs of… | Keep reading on WebMD »

INATTENTIVE: Why do doctors and patients often misunderstand inattentive ADHD?

A: Formerly called ADD, inattentive ADHD is characterized by disorganization, a lack of focus, poor time management… | Keep reading on ADDitude »

ADHD IN TODDLERS: How young is too young for ADHD?

A: Though no clinical guidelines exist for diagnosing ADHD in children under the age of 4, a growing number of studies suggest that ADHD symptoms first show up during these early years… | Keep reading on ADDitude »

FIRST-PERSON: “Our Long and Winding Trek to the Summit”

“I am thankful that we got a fairly early and accurate diagnosis for our kid. It turned around his poor self-esteem and helped him understand that he’s not damaged; he’s just neurodevelopmentally unique.” | Keep reading on ADDitude »

“Dear Parent of a Newly Diagnosed Kid”

“It’s OK to feel mad. It’s OK to feel it’s not fair that the universe handed this diagnosis to your kid. Your kid is hard. You can love your kid to the moon and back and still look at him and think, you are hard.” | Keep reading on ADDitude »

RELATED RESOURCES

SYMPTOM TEST: ADHD in Children

Could your child’s distractibility, blurting, and difficulty remaining seated be due to ADHD? | Take the self-test on ADDitude »

SYMPTOM TEST: Inattentive ADHD in Children

Symptoms can show up as missing instructions, forgetfulness, and difficulty sustaining attention. | Take the self-test on ADDitude »

8-Part Guide to ADHD Diagnosis in Children, from WebMD x ADDitude:

> DECISION 1: How can I better understand ADHD, its causes, and its manifestations?
DECISION 2: How can I understand the aspects of ADHD that might be new to the doctor?
DECISION 3: How can I improve the odds of an accurate ADHD evaluation for my child?
DECISION 4: How can I find a professional to diagnose and treat my child’s ADHD?
DECISION 5: What should a thorough evaluation for pediatric ADHD include and exclude?
DECISION 6: How can I be sure my child’s evaluation screens for psychiatric comorbidities?
DECISION 7: How can I be sure my child’s evaluation considers look-alike comorbidities?
DECISION 8: Should my child be screened for the sleep, eating, and other disorders?

The Clinicians’ Guide to Differential Diagnosis of ADHD is a clinical compendium from Medscape, MDEdge, and ADDitude designed to guide health care providers through the difficult, important decisions they face when evaluating pediatric and adult patients for ADHD and its comorbid conditions. This guided email course will cover the following topics:

• DECISION 1: How can I better understand ADHD, its causes, and its manifestations?
• DECISION 2: What do I need to understand about ADHD that is not represented in the DSM?
• DECISION 3: How can I avoid the barriers and biases that impair ADHD diagnosis for underserved populations?
• DECISION 4: How can I best consider psychiatric comorbidities when evaluating for ADHD?
• DECISION 5: How can I differentiate ADHD from the comorbidities most likely to present at school and/or work?
• DECISION 6: How can I best consider trauma and personality disorders through the lens of ADHD?
• DECISION 7: What diagnostic criteria and tests should I perform as part of a differential diagnosis for ADHD?

NOTE: This resource is for personal use only.

Virtual reality (VR) games may be used to accurately and objectively diagnose ADHD symptoms in children, according to a team of Finland-based researchers. Their newly developed VR game, Executive Performance in Everyday LIving (EPELI), performed better than standard behavioral tests in distinguishing children with ADHD from those without ADHD in a small study of 76 subjects. According to the study, “EPELI showed predictive validity as the ADHD group exhibited higher percentage of irrelevant actions reflecting lower attentional-executive efficacy and more controller movements and total game actions, both indicative of hyperactivity-impulsivity.”¹

Unlike the questionnaires, interviews, and clinical observations commonly used to assess ADHD, EPELI simulates tasks that occur in everyday life. Players are asked to remember to engage in simple tasks like brushing their teeth or eating a banana despite distractions in the environment.

“The game measures everything: how much the child clicks on the controls and how efficiently they perform the tasks,” says Topi Siro, the developer of EPELI. “Efficiency correlates with everyday functioning, where children with ADHD often have challenges.²

How EPELI Gauges ADHD

EPELI presents 13 task scenarios to players over 25 to 35 minutes. Each scenario includes one general topic (e.g. morning routines) and 4 to 6 subtasks (e.g. wash hands). Participants engage in an instruction phase and execution phase for each scenario. The execution phase must be completed within 90 seconds.

A previous study of EPELI successfully distinguished children with ADHD from a neurotypical control group.¹  That research was recently replicated in a study published by Nature, but with an added behavioral marker: visual attention.³ Children played EPELI followed by a second VR game called Shoot the Target. The latter tracked eye movement by asking participants to “shoot” virtual objects with their gaze.

Liya Merzon, a doctoral researcher at Aalto University, said this proved to be “an effective way of detecting ADHD symptoms.”

“The ADHD children’s gaze paused longer on different objects in the environment, and their gaze jumped faster and more often from one spot to another. This might indicate a delay in visual system development and poorer information processing than other children.”²

Practical Applications of VR for ADHD

In a recent ADHD Experts webinar on this topic, Randy Kulman, founder of LearningWorks for Kids, explained why VR games may offer a more comprehensive and useful way to measure ADHD behaviors.

“As somebody who does assessments on a regular basis, I know that the tools I use — like the Continuous Performance Test, tests from the NEPSY, the Auditory Attention and Response Subtest — are only capturing certain kinds of things from the kids. And some of it involves observation and hand-scoring,” Kulman said. “Whereas when you are using VR to assess kids with ADHD, you’re picking up on everything. You’re picking up on their eye movement. You’re seeing how quickly they actually respond. You’re seeing what they do when there are transitions. You’re seeing how much they’re actually looking or paying attention to distractors.”

Erik Seesjärvi, a doctoral researcher at the University of Helsinki and clinical neuropsychologist at Helsinki University Hospital, said EPELI is available for professionals to use in their clinical work and that “the experience has been very positive.”

“All of the neuropsychologists who answered a feedback survey after the first pilot said they had benefited from using virtual reality methods as a complementary tool in their work.”²

Its creators say EPELI could be used to understand and assess other conditions including age-related diseases, autism, language problems, brain trauma, adult ADHD, and cerebral palsy.

VR is being used more commonly today in ADHD treatment. Companies like XRHealth and Amelia Virtual Care are using VR in their mental health treatment practices, and several research centers are now investigating the efficacy of VR treatments in improving ADHD symptoms such as working memory, executive function, and cognitive processes. Though further research is needed, initial analyses conclude that “this technology, by simulating and providing a virtual environment for diagnosis, training, monitoring, assessment and treatment, is effective in providing optimal rehabilitation of children with ADHD.”⁴

Virtual Reality Games for ADHD: Next Steps

• Download: Free Guide to Brain-Boosting Video Games
• Download: Expert Overview of Common ADHD Diagnosis Mistakes
• Read: FDA Approves First-Ever Game-Based Therapy for Attention
• Read: Akili Expands Prescription Digital Therapeutics Portfolio with TALi Partnership

Sources

¹Seesjärvi, E. et al. (2021). Quantifying ADHD symptoms in open-ended everyday life contexts with a new virtual reality task. J. Atten. Disord. https://doi.org/10.1177/10870547211044214

²Salmitaival, J. P. S., Merzon, L., & Seesjärvi, E. (2022, December 20). Virtual reality game to objectively detect ADHD. Aalto University. https://www.aalto.fi/en/news/virtual-reality-game-to-objectively-detect-adhd

³Merzon, L., Pettersson, K., Aronen, E.T. et al. (2022). Eye movement behavior in a real-world virtual reality task reveals ADHD in children. Sci Rep 12, 20308. https://doi.org/10.1038/s41598-022-24552-4

⁴Bashiri, A., Ghazisaeedi, M., & Shahmoradi, L. (2017). The opportunities of virtual reality in the rehabilitation of children with attention deficit hyperactivity disorder: a literature review. Korean journal of pediatrics, 60(11), 337–343. https://doi.org/10.3345/kjp.2017.60.11.337