A guide to ADHD tests and assessments

What is an ADHD test?

Attention Deficit Hyperactivity Disorder or ADHD is one of the mental disorders (or neurodevelopmental disorder) that affect both children and adults. People with ADHD have differences in brain activity and development. This can affect their ability to control their behavior, pay attention, and remain still. ADHD can affect a person at home, at school, at work and in friendships. Symptoms of ADHD can vary from person to person and may change with age, and not everyone with ADHD will have all the symptoms.

Scientific research suggests that diagnosis of ADHD isn’t that easy. Many people may feel restless, unfocused and scattered but not everyone has ADHD. Even chronic distractibility or hyperactivity doesn’t necessarily equal ADHD.

To find out if a child or adult has ADHD, a medical professional has to be involved. Healthcare practitioners may use several tools: a questionnaire, medical history of past and present problems, medical assessment or checklist of symptoms, to rule out other reasons for the symptoms.

There are online tools that parents and doctors can use to check for ADHD. These tools often have questions about a person's behaviors and habits. After answering the questions, the tool gives a score that shows if the person might have ADHD. Some popular tools are the Adult ADHD Self-Report Scale, the Conner's Adult ADHD Rating Scales, and the Wender Utah rating scale.

Getting a formal diagnosis and assessment is important because it is easy to confuse ADHD symptoms (such as concentration problems and hyperactivity) with other medical problems and psychiatric disorders, such as emotional issues, autism spectrum disorder, mood swings, sleep disorders, seizure disorders and learning disabilities (like dyslexia). These are treated differently.‍‍

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What to do if you think your child may have ADHD

If you think your child may have ADHD, the first step is to discuss it with their primary care provider. You can also talk to your child's teachers to see if they have any concerns about your child's behavior. The primary care provider or GP can refer you for a specialist assessment if needed. They may also suggest attending a parent training program or ADHD-focused parents education program to help you learn how to support your child and manage their symptoms.

A GP may ask questions about:

• When did the symptoms start?
• Where did the symptoms occur, for instance, in school or at home?
• How did the symptoms affect a person's or their child's everyday life?
• Are these symptoms making socialising difficult?
• Does the person have a family history of ADHD?
• Did the person face any recent significant incidents in life, such as a death or divorce in the family?‍

The GP may ask about any other symptoms or medical conditions, like anxiety disorder and depression, the affected person may have.

If the GP feels that a person may have ADHD, they usually first recommend a "watchful waiting" period, which lasts about 10 weeks. In this period, it is observed whether the medical issues and symptoms improve, become worse or stay the same.

Being offered an education programme or parent training does not indicate poor parenting or that someone has been a poor parent – it intends to teach people how to help themselves and their children.

If there is no improvement in the behaviour, and both family and the GP feel it's affecting their everyday life, the GP refers to a Paediatrician, Specialist or Mental Health Professional for the formal assessment.‍ This depends on the child's age and who is available in your area. 

For adults with the symptoms of ADHD, the GP may suggest an assessment if:

• The person was not diagnosed with ADHD in childhood, but the symptoms appeared during childhood and have been affecting his daily life since then;
• The symptoms cannot be elucidated by mental health conditions;
• The symptoms considerably affect everyday life—for instance, if the affected person finds intimate relationships difficult and has been underachieving at work;
• An adult may also be referred to a health care professional if he/ she had ADHD in childhood and its symptoms are now resulting in some degree of functional impairment.

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Which tests are used for diagnosing ADHD?

Behaviour assessments are not the same as screening tests or diagnoses that determine learning differences. There is no fixed right or wrong answer to the behaviour assessment. These are used to assess areas of strength and weakness and how children interact with their surrounding world. These assessments can specify behaviour patterns and causes for the behaviour.

It is usually families, teachers and others close to the person observe the children and respond to questions about them. Behaviour assessments usually include input from parents and teachers. Some behaviour assessment tools may monitor the impact of medications and other effective treatment options for those already diagnosed with ADHD.

Following are some of the most common psychological tests used for the behaviour assessment.

1. Conners Parent and Teacher Rating Scale: This may help medical professionals diagnose behavior disorder. Teachers and parents fill out a short multiple-choice questionnaire about a child's behaviour. Older children may also be asked to fill out the questionnaire. This type of behaviour assessment explores the presence and severity of different areas of mental health disorders such as social life skills disorders, sleep disorders, seizure disorder, learning problems and symptoms of inattention and hyperactivity. It may also help in monitoring the effectiveness of stimulant medication and other therapies for children who are already diagnosed. Its outcomes out where further assessment may be needed.

2. Vanderbilt Assessment Scales: This is used to assess the presence and severity of neuro-developmental condition such as ADHD symptoms. Health care team can also use this to determine other common behavioural concerns and how these might be affecting a child's education and behaviour. This test is used after a general assessment that shows a child displays signs of ADHD. Teachers and parents are asked about the frequency of the occurrence of the symptoms for attention deficit disorders and other behavioural difficulties. Some questions are about hyperactivity and focus issues. The provided options include “very often, ” often,” “occasionally,” and “never.” If most of the answers are “often” and “very often,” it may point to ADHD.‍

3. Achenbach Child Behavior Checklist: This is an ADHD test, which is used to measure social, behavioural and emotional abilities and child development. This test involves a list of 100 statements about children's behaviour. Then the teachers and parents are asked to rate how “untrue” or “true” each statement is for the kid being assessed. It includes a checklist for child behaviour for both preschoolers and older children. The outcomes of this test may indicate a variety of emotional and behavioural issues, mainly including ADHD, conduct disorders, oppositional defiant disorder (ODD), depression, and phobias.

4. Barkley Home and School Situations Questionnaires: These questionnaires are used as a diagnostic tool to measure a child's behaviour, both at school and at home. In these questionnaires, parents have to rate the behaviour of a child in 16 different home situations; whereas, teachers have to rate the behaviour in 12 different school situations. For officially diagnosing a child with ADHD, the child’ behaviour must be problematic in these two areas of life. Barkley Home and School Situations Questionnaires provide an effective way to show that.

It is better to learn as much as one can about the clinical assessment of ADHD. Some tests are used to evaluate social and academic skills. These test results are used to prescribe stimulant medication and create treatment plans, and Individualized Education Programs (IEPs) for the person diagnosed with ADHD‍.

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What about ADHD in adults?

Doctors may have a harder time figuring out if an adult has ADHD compared to a child. This is because some people think that the same ADHD behaviors that kids have do not happen in adults. To diagnose ADHD in an adult, a doctor looks for five or more symptoms of hyperactivity or five or more symptoms of impulsivity or not being able to pay attention. This is according to the Diagnostic and Statistical Manual of Mental Disorders (DSM) from the American Psychiatric Association.

The mental health providers may need to see an adult's old educational records or speak to the teachers or parents who knew the affected person very well in the affected person's childhood. An adult with ADHD also has moderate to high effect of these symptoms on various areas of life, like:

• Relationship issues with the partner
• Problems in making or keeping friendships
• Intimacy-related issues and parenting issues
• Driving carelessly
• Failure in education and career difficulties

If an adult's difficulties are current and did not occur in the past, he/she is not likely to be considered having ADHD. It is because scientific research indicates that adverse effects of ADHD do not develop for the first time in adulthood.

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ADHD in the Classroom

Allaa Gawish, working in Egypt British International School providing special education support offers us some words of wisdom.

Attention Deficit Hyperactivity Disorder (ADHD), a neurobiological condition that is a lifelong span that affects behaviour. ADHD may not be cured, but the quality of life can be improved by medication and support. Although treatment plan by medication is the most shared method in dealing with ADHD, also, therapy such as ‘Cognitive Behaviour Therapy (CBT)’ and lifestyle modifications are crucial strategies alongside medications (Verywell Mind, 2019).

1. Inattentive: People usually refer to it as ‘Attention Deficit Disorder (ADD).’ The person has a symptom of inattention (easily distracted) but is not hyperactive.
2. Hyperactive/ Impulsive: The person has hyperactivity and impulsivity symptoms but not inattention symptoms.
3. Combined: The person has symptoms of hyperactivity, impulsivity, and inattention.

(Healthline, 2017) and (Verywell Mind, 2020)

From my experience, we often see a variety and mix of different symptoms in the classroom including:

● Easily distracted

● Short attention Span (Loses focus)

● Seems unable to listen

● Poor working- memory

● Lack of organization (e.g: losing things)

● Difficulty in following instructions

● Fidgeting

● Excessive physical activity and talking

● Interrupting Conversations

● Careless mistakes (e,g: acting without thinking, forgetting items)

● Little sense of danger (Risk taker)

● Difficulty with social interaction (e.g: taking turns)

● Symptoms of both types

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Practical support for a child with ADHD

1. Be Consistent:

• Give information in short chunks.
• Give explicit instructions.
• Rules should be posted and be updated when necessary.
• Allow the child to repeat the instructions to ensure that he/she understood the instructions; take into consideration that the child may hear the word but misunderstand the meaning.
• Create a daily routine to follow with his/her daily activities.
• Provide a schedule that would help during transitions (visual or written schedule).
• Provide a checklist for the child to tick off tasks that were achieved.‍

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2. Limit Distractions:

• Make sure that the pupil is sitting in a place where you can have eye contact with the child.
• Place the child away from doors, windows, noise, any distracting objects and place them beside a good role.

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3. Provide Frequent Feedback:

• Act quickly to negative behaviours and choose related consequences actions.
• Focus on positive reinforcement by rewarding good behaviours (e.g: use behaviour chart rewards).
• Use signals to attract the child’s attention rather than using their name, so it will not be embarrassing.
• Do not lose temper and remember that an ADHD child may not tend to misbehave but is struggling to control their actions.

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4. Use Tools and Flexible Rules:

• Use different learning channels (Differentiation techniques in tasks, instructions, explanations, timings, and grouping).
• If the child is working in a group or in pairs, clarify the role for each one in the group clearly.
• Increase the levels of activity, for example, allowing the child to move during the lesson.
• Allow breaks.
• Always provide the child with extra time to finish the task or answer a question and always use a timescale to show an indicator for the time (e.g: sand timer, alarm).

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5. Do Not Overload the child:

• Reduce the workload (e.g: breaking down the tasks and instructions into short activities).
• Regarding the homework, give the instructions clearly using verbal or written instructions.
• Try to reduce the amount of homework, and remember that an ADHD child is getting distracted by the environment; that means the homework that would take 5 minutes may take a longer time. Always give different homework styles (word search, a game related to the learning context).

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6. Encourage Support:

• Allocate at least one person care, that the child can develop with them a positive relationship to act as a mentor and address their academic skills and social skills training.
• Allow the child to work with other peers to enhance their social skills and relationships with peers.

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7. Tips for Parents:

• Keep track of what your child eats if the child is getting hyperactive after certain types of food and provides your child with healthy foods.
• Make sure that your child is sleeping and waking up at the same time every day. Children with ADHD may have problems in sleeping as a result try to provide them with a sleep-friendly routine.
• Avoid using smartphones.
• Take a warm bath before going to bed.
• Doing relaxation exercises (such as listening to relaxation music).
• Writing a to-do list for the next day would help the child organize their thoughts and clear their mind of distractions.

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FAQs

I have an ADHD assessment soon. What can I expect?

If you are scheduled for an ADHD assessment, you can expect to be asked a variety of questions about your symptoms, lifestyle and medical history. Your doctor or mental health practitioner will also likely perform some cognitive tests and assessments to help better understand the symptoms. After gathering all the necessary information, your doctor will be able to diagnose whether you have ADHD and provide treatment options. You should also be aware that many insurance plans may not cover the cost of an ADHD assessment. Be sure to check with your insurance provider before scheduling an appointment.

I failed an ADHD assessment, what do I do now?

It means that the specialist or mental health professional who conducted the assessment did not find sufficient evidence to diagnose you with the condition. This does not necessarily mean that you do not have ADHD or that you do not have any symptoms that are impacting your daily life. It may be helpful to discuss the results of the assessment with the specialist or another mental health professional to better understand why you did not meet the criteria for a diagnosis. They may be able to provide additional information or suggest alternative explanations for your symptoms.

Will my ADHD affect my IQ test score?

Attention Deficit Hyperactivity Disorder (ADHD) may affect your score on an IQ test. However, the impact will vary depending on the specific test and your individual symptoms. Some people with ADHD may have difficulty with tasks that require sustained attention and focus, which can impact their performance on IQ tests. However, many people with ADHD have above-average intelligence and may perform well on IQ tests. It is important to talk to the test administrator about your ADHD and any accommodations you may need.

Does ADHD evaluation require a blood test?

A blood test is not typically required for an evaluation for Attention Deficit Hyperactivity Disorder (ADHD).

I have ADHD. Are there any tips for me to pass my tests?

If you have ADHD, there are several strategies you can use to help you pass your tests. Some tips that may be helpful include:

• Create a study schedule and stick to it: Plan out when and where you will study and make a commitment to follow your schedule.
• Use study aids: Consider using tools such as flashcards, study guides, or online resources to help you learn and retain information.
• Take breaks: Make sure to take regular breaks while studying to give your mind a rest and prevent burnout.
• Find a quiet, distraction-free study space: Choose a location where you can focus and avoid distractions, such as loud noises or interruptions.
• Use active study techniques: Engage with the material in a hands-on way, such as by discussing it with others or teaching it to someone else.
• Get plenty of sleep: Make sure you are well-rested before taking a test. This can help improve your concentration and focus.
• Talk to your teacher: If you have concerns about taking a test, talk to your teacher about accommodations or other support that may be available to you.

It is also important to remember that having ADHD does not mean you cannot pass your tests. Many individuals with ADHD are successful in school and go on to achieve their goals. With the right support and strategies, you can overcome any challenges and succeed in your studies.

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Further Reading on ADHD Tests

Here are five key research papers focusing on ADHD tests and their efficacy. These papers provide insights into various ADHD tests and treatments, highlighting their efficacy in diagnosing and managing symptoms, with implications for clinical psychologists and treatment options.

1. Clinical and cognitive response to extended-release methylphenidate in attention deficit/hyperactivity disorder: Efficacy evaluation by A. Fernández-Jaén, D. Fernández‐Mayoralas, A. Pardos, B. Calleja‐Pérez, N. Muñoz Jareño (2009)

Summary: This study evaluates the efficacy of extended-release methylphenidate in improving attention and self-control in children with ADHD, indicating its role as an effective treatment option and screening tool for impulsive behaviors.

2. Efficacy of a Continuous Performance Test Based on Virtual Reality in the Diagnosis of ADHD and Its Clinical Presentations by D. Areces, C. Rodríguez, T. García, M. Cueli, P. González-Castro (2018)

Summary: The study highlights the AULA Nesplora test's effectiveness in differentiating between various ADHD presentations, emphasizing its role as a diagnostic assessment tool in identifying impulsive and hyperactive behaviors.

3. Neurofeedback in children with attention-deficit/hyperactivity disorder (ADHD) – a controlled multicenter study of a non-pharmacological treatment approach by M. Holtmann, Benjamin Pniewski, D. Wachtlin, S. Wörz, U. Strehl (2014)

Summary: This paper discusses the effectiveness of Slow Cortical Potentials (SCP)-neurofeedback training as a non-pharmacological treatment for children with ADHD, demonstrating improvements in behavior, attention, and IQ.

4. A Randomized Controlled Trial to Examine the Posttreatment Efficacy of Neurofeedback, Behavior Therapy, and Pharmacology on ADHD Measures by I. Moreno-García, S. Meneres-Sancho, Carlos Camacho-Vara de Rey, M. Servera (2019)

Summary: The study compares the efficacy of neurofeedback, behavior therapy, and pharmacological treatments on ADHD symptoms, with behaviour therapy showing extensive results in managing impulsive behaviors.

5. Effect of Osteopathic Manipulative Therapy in the Attentive Performance of Children With Attention-Deficit/Hyperactivity Disorder by A. Accorsi, C. Lucci, Lorenzo Di Mattia, C. Granchelli, G. Barlafante, Federica Fini, G. Pizzolorusso, F. Cerritelli, Maurizio Pincherle (2014)

Summary: This research evaluates the impact of Osteopathic Manipulative Therapy (OMTh) on improving selective and sustained attention in children with ADHD, suggesting a potential treatment option beyond conventional clinical approaches.