What happens in an ADHD assessment?

Attention Deficit Hyperactivity Disorder (ADHD) is one of the most commonly diagnosed neurodevelopmental conditions – yet the path to diagnosis is often fraught with challenges. In the UK, an estimated 5% of children1 and 4% of adults2 live with ADHD, though many go undiagnosed or are misdiagnosed. For healthcare professionals, understanding and navigating the ADHD assessment process can be an important part of supporting individuals and their families.

Diagnosing ADHD is complicated by its symptoms that overlap3 with other conditions such as anxiety, depression, and learning disorders. Additionally, societal stigmas4 or limited awareness5 can lead to delays in seeking an evaluation. Healthcare professionals play a pivotal role in guiding clients through the process, equipping them with accurate knowledge about ADHD assessments to foster a smoother treatment journey.

An ADHD assessment is more than just a diagnostic tool; for those individuals who may be living with the condition, it’s a gateway to tailored interventions and improved quality of life. By understanding the process, medical practitioners can better prepare their clients for what lies ahead and optimise treatment outcomes.

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An overview of ADHD

ADHD is a complex neurodevelopmental condition characterised by persistent patterns of inattention, hyperactivity, and/or impulsivity that interfere with daily functioning. It stems from imbalances in neurochemical pathways, particularly those involving dopamine and norepinephrine6. These neurotransmitters play vital roles in regulating attention, motivation, and executive functioning7.

From a neurobiological perspective, ADHD often involves structural and functional differences in brain regions such as the prefrontal cortex, which governs decision-making and self-regulation8. Reduced activity in these areas can lead to difficulty maintaining focus and managing impulses.

ADHD manifests in three primary subtypes:

• Predominantly inattentive type: marked by difficulties in maintaining attention, organisation, and follow-through on tasks.
• Predominantly hyperactive-impulsive type: characterised by excessive energy, restlessness, and impulsive decision-making.
• Combined type: a mixture of both inattentive and hyperactive-impulsive symptoms.

The purpose of an ADHD assessment

The primary goal of an ADHD assessment is to identify the condition accurately, and distinguish it from other disorders with similar symptoms. Most individuals seek an ADHD evaluation to address ongoing challenges in school, work, or personal life9. In turn, the insights gained from the assessment can help clinicians design targeted treatment plans that address both core symptoms and comorbidities.

However, recently some clinicians have  expressed concerns about potential overdiagnosis10. With increasing public awareness, some medical professionals fear individuals may pursue an ADHD diagnosis to access stimulant medications for non-therapeutic reasons, such as cognitive enhancement or recreational use11,12. 

Nonetheless, for healthcare professionals, an accurate ADHD diagnosis remains a critical step toward empowering individuals to manage their condition effectively. Rigorous assessments, guided by clinical expertise and validated tools, are essential to ensure diagnostic integrity.

ADHD assessment components

An ADHD assessment is a multifaceted process involving clinical interviews, behavioural questionnaires, and psychological testing. Each component provides unique insights into the person’s cognitive, emotional, and behavioral patterns.

Clinical interviews

The clinical interview is the cornerstone of an ADHD evaluation. It involves a detailed exploration of the individual’s developmental, medical, educational, and psychosocial history. The interviewer assesses symptom onset, duration, and impact across different settings: home, school, or work.

Clinicians often employ semi-structured interviews to ensure comprehensive data collection13 while maintaining flexibility for individualised inquiry. For example, the Diagnostic Interview for ADHD in Adults (DIVA 2.0) is a widely used tool for adult assessments14. These interviews may also explore comorbid conditions like anxiety, depression, or learning disabilities, which can complicate the diagnostic picture.

Behavioural questionnaires

Standardised behavioural questionnaires provide quantitative data to complement qualitative findings from interviews. Tools like the Conners’ Rating Scales15 or the ADHD Rating Scale (ADHD-RS)16 evaluate symptom severity and frequency based on input from the individual, parents, or teachers.

These scales are particularly useful in identifying symptom patterns across multiple environments. For example, a child’s teacher may report inattentiveness in the classroom, while parents observe hyperactivity at home. This multi-informant approach ensures a well-rounded understanding of the presenting challenges.

Psychological testing

Meanwhile, psychological testing evaluates various cognitive functions such as attention, working memory, and processing speed. Tests like the Continuous Performance Test (CPT17) assess sustained attention and impulsivity through tasks requiring rapid responses to visual or auditory stimuli.

Neuropsychological assessments can also identify coexisting conditions like dyslexia or executive function deficits, which can often accompany ADHD. These findings help clinicians design interventions that address the full spectrum of the individuals’ needs.

What to expect in an ADHD assessment

Healthcare professionals can play a vital role in preparing people for ADHD assessments – helping to reduce anxiety, and laying the groundwork for a smoother diagnostic process.

Preparation

Encourage clients to gather relevant documents, such as school records, performance reviews, or past medical reports. They should also try to calmly reflect on their symptoms ahead of time, noting specific examples of how ADHD may have impacted their daily life. Where appropriate, family members or close contacts can also contribute valuable observations, providing a broader perspective.

The day of the assessment

On assessment day, clients can expect to follow a structured process. The clinician will conduct interviews, administer questionnaires, and possibly perform cognitive tests. As far as possible, depending on location and individual circumstances, the environment is designed to be supportive, ensuring individuals feel comfortable discussing their experiences openly.

Understanding the results

Interpreting the findings of an ADHD assessment is a collaborative effort between clinicians and clients.

Interpreting the findings

Assessment results are analysed against established diagnostic criteria, such as those outlined in the DSM-518. Clinicians evaluate symptom severity, functional impairment, and any coexisting conditions to formulate a comprehensive diagnosis.

Diagnosis and next steps

A confirmed ADHD diagnosis paves the way for tailored interventions. Clinicians will discuss treatment options with the individual. At this stage, it’s important for medical professionals to underscore the importance of a multidisciplinary approach. This will ensure treatment addresses both symptoms and underlying challenges, and has been proven to be significantly more effective than ‘single-stream’ treatment19, such as medication alone.

Treatment options following diagnosis

The most effective ADHD management involves an integrated combination of medication, therapy, and lifestyle adjustments. 

Medication

Stimulant medications like methylphenidate or amphetamines20 are the most commonly prescribed treatments21 for ADHD. They work by enhancing dopamine and norepinephrine activity, improving focus and self-regulation. 

Non-stimulant options, such as atomoxetine or guanfacine, may be recommended for those with contraindications to stimulants22.

Therapy and behavioural interventions

Cognitive Behavioural Therapy (CBT) is a highly effective modality for addressing ADHD-related challenges23, such as time management or emotional regulation. Equally, behavioural interventions (such as training programs) can empower friends, families and colleagues to support individuals with ADHD, while social skills training and executive function coaching can also enhance daily functioning.

Curated, confidential, complete-person care

At Harbor London, we adopt a whole-person approach to ADHD treatment. Our tranquil, luxurious properties throughout central London offer a private, calm, and nurturing environment for recovery. From personalised therapy plans to dietary and lifestyle guidance, our multidisciplinary services are designed to address the unique needs of each individual.

Make a referral now

Healthcare professionals play a crucial role in connecting individuals with the care they need. If you have a client who may be presenting the symptoms of ADHD, make a referral today – our multidisciplinary team is committed to delivering clinically guided, compassionate care that helps individuals manage the effects of ADHD and build towards a balanced, fulfilling life.

References

1. https://www.sciencedirect.com/science/article/abs/pii/S2215036617301670
2. https://www.england.nhs.uk/long-read/attention-deficit-hyperactivity-disorder-adhd-programme-update/#:~:text=The%20National%20Institute%20for%20Health,terms%20of%20completeness%20and%20coverage.
3. https://www.medicalnewstoday.com/articles/325595
4. https://pmc.ncbi.nlm.nih.gov/articles/PMC3430836/#:~:text=Variables%20identified%20to%20contribute%20to,of%20the%20respondent%20or%20the
5. https://www.medicalnewstoday.com/articles/adhd-awareness
6. https://www.medscape.org/viewarticle/523887#:~:text=Both%20agents%20contribute%20to%20maintaining,NE%20synthesis%20in%20the%20brain.
7. https://www.frontiersin.org/journals/molecular-neuroscience/articles/10.3389/fnmol.2019.00334/full
8. https://www.nature.com/articles/pr9201196
9. https://chadd.org/for-adults/diagnosis-of-adhd-in-adults/#:~:text=Most%20adults%20who%20seek%20an,academic%20and%2For%20career%20underachievement
10. https://add.org/adhd-overdiagnosis/#:~:text=ADHD%20can%20be%20overdiagnosed%20or,and%20treated%20for%20their%20symptoms.
11. https://www.cnn.com/2023/04/18/health/teen-misuse-adhd-meds-wellness/index.html
12. https://www.urmc.rochester.edu/encyclopedia/content.aspx?ContentTypeID=1&ContentID=23617#:~:text=People%20who%20abuse%20stimulants%20may,increase%20the%20ability%20to%20focus.
13. https://chadd.org/for-professionals/the-adhd-diagnostic-process/ 
14. https://www.divacenter.eu/
15. https://www.healthline.com/health/adhd/conners-scale
16. https://www.hmpgloballearningnetwork.com/site/pcn/saundras-corner/scales-screeners/adhd/adhd-rating-scale-iv-adhd-rs
17. https://www.qbtech.com/blog/exploring-the-evolution-of-cpt-and-adhd-tests/
18. https://www.cdc.gov/adhd/diagnosis/index.html
19. https://pmc.ncbi.nlm.nih.gov/articles/PMC10336987/#:~:text=in%204%20cases.-,Multimodal%20integrated%20intervention%20resulted%20in%20a%20significantly%20higher%20treatment%20efficacy,0.05)%20(Table%202).
20. https://www.webmd.com/add-adhd/adhd-stimulant-therapy
21. https://www.medicalnewstoday.com/articles/325201 
22. https://pmc.ncbi.nlm.nih.gov/articles/PMC3824845/
23. https://www.additudemag.com/cognitive-behavioral-therapy-for-adhd/