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The American Academy of Pediatrics (2000) recommends that clinicians collect the following information when evaluating a child for AD/HD:

• A thorough medical and family history.
• A medical examination for general health and neurologic status.
• A comprehensive interview with the parents, teachers, and child.
• Standardized behavior rating scales, including AD/HD-specific ones completed by parents, teacher(s), and the child when appropriate. (Know that people with AD/HD typically are not great at accurately reporting symptoms of the disorder, because it causes them to have poor insight into their own behavior.)
• Observation of the child.
• A variety of psychological tests to measure IQ and social and emotional adjustment. These tests also help to determine the presence of specific learning disabilities, which can co-occur with AD/HD.

Once the practitioner completes the evaluation, he or she makes one of three determinations:

• The child does or does not have AD/HD.
• The child does not have AD/HD, but either has another disorder(s) or other factors that have created the difficulties.
• The child has AD/HD and another disorder (called a co-existing condition).

To make the first determination-that the child has or does not have AD/HD-the clinician considers his or her findings in relation to the criteria of the DSM-IV-TR mentioned earlier.

To make the second determination-that the child's difficulties are caused by another disorder or other factors-the professional first considers the disorders that have symptoms similar to AD/HD. You should be aware that some mental health disorders have their onset after puberty, but early warning signs, which are very similar to AD/HD symptoms, may be present. Thus, it is possible for a diagnosis to change as the child develops and other disorders become more apparent. It is also possible for a child or youth to have more than one disorder, or co-occuring disorders.

Generally, the DSM-IV-TR requires clinicians to rule out AD/HD if they see Pervasive Developmental Disorder (PDD), schizophrenia, other psychotic disorders, or if the symptoms are better explained by another disorder. For instance, although not very common, Bipolar Disorder (BPD) can be mistaken for AD/HD in early years.

It is also true that major stressful life events can result in temporary symptoms that look like AD/HD. Such events could include parental divorce, child abuse, death of a loved one, a move, or a sudden traumatic experience. Under these circumstances, AD/HD-like symptoms may arise suddenly and, therefore, would have no long-term history. Remember, AD/HD symptoms must exist for at least six months and cause some difficulty before the age of seven. Of course, a child can have AD/HD and a stressful event, so such events do not automatically rule out the existence of AD/HD.

To make the third determination-that the child has AD/HD and a co-existing condition-the assessor must first be aware that AD/HD can and often does co-occur with other difficulties, particularly learning disabilities, oppositional defiant disorder, and anxiety. A list of disorders that commonly co-occur with AD/HD is provided below.

The fact is: Other mental health conditions such as those listed in the box below can be the result of AD/HD, in addition to AD/HD, or mistaken for AD/HD. That is why evaluations need to be conducted by a professional who is trained in a wide variety of child and adolescent disorders. Thorough and correct diagnosis is an essential first step to better treatments.

Disorders That Commonly Co-Occur With AD/HD

For more information about the following disorders that frequently occur with AD/HD, see Section VI. Resources.

Oppositional Defiant Disorder (ODD)--A pattern of negative, hostile, and defiant behavior. Symptoms include frequent loss of temper, arguing (especially with adults), refusal to obey rules, intentionally annoying others, blaming others. The person is angry, resentful, possibly spiteful, and touchy. (Many of these symptoms disappear with AD/HD treatments.)

Conduct Disorder (CD)--A pattern of behavior that persistently violates the basic rights of others or society's rules. Behaviors may include aggression toward people and animals, destruction of property, deceitfulness or theft, or serious rule violations.

Anxiety--Excessive worry that occurs frequently and is difficult to control. Symptoms include feeling restless or on edge, easily fatigued, difficulty concentrating, irritability, muscle tension, and sleep disturbances.

Depression--A condition marked by trouble concentrating, sleeping, and feelings of dejection and guilt. There are many types of depression. With AD/HD you might commonly see dysthymia, which consists of a depressed mood for many days, over or under eating, sleeping too much or too little, low energy, low self-esteem, poor concentration, and feeling hopeless. Other forms of depression may also be present.

Learning Disabilities--Problems with reading, writing, or mathematics. When given standardized tests, the student's ability or intelligence is substantially higher than his or her achievement. Underachievement is generally considered age-inappropriate. [Note: Children with AD/HD frequently have problems with reading fluency and mathematical calculations. AD/HD learning problems have to do with attention, memory and executive function difficulties rather than dyslexia, dysgraphia, or dyscalculia, which are learning disabilities. The point here is not to overlook either. Depending on how learning disabilities are defined, between 10-90% of youth with AD/HD also have a learning disability (Robin, 1998).]