3. ADHD may present across the life span.

ADHD is the result of biological differences in the parts of the brain associated with paying attention, impulse control, and activity level. While ADHD is biologically-based and usually present from birth, symptoms may not become problematic until the individual begins to struggle trying to meet life's expectations. As a result, ADHD can present clinically anywhere along the life span and in any life domain.

Even though the symptoms of ADHD may not impair an individual until later in life, some of these symptoms must be present since childhood to make a positive diagnosis. Thus, an early history of ADHD symptoms is essential in making a diagnosis of ADHD in an adult. The evaluator should look for evidence of a childhood onset of ADHD symptoms through third party interviews, transcripts, report cards, teacher comments, medical records, past psycho educational testing, and other archival data.

ADHD often negatively affects a person's educational achievements. Lack of school success can contribute to a myriad of economic, social and life adjustment problems throughout a person's life. Educational functioning should be reviewed carefully. In children, adolescents, or adult students, a review of educational functioning should include administration of intelligence and achievement tests. However, it should be noted that success in the educational arena is not by itself a reason to rule out the diagnosis of ADHD.

4. A comprehensive assessment is necessary for an accurate diagnosis.

ADHD is complex and impacts all aspects of a person's life. It can co-exist and/or mimic a variety of health, emotional, learning, cognitive, and language problems. An appropriate, comprehensive evaluation for ADHD includes a medical, educational, and behavioral history, evidence of normal vision and hearing, recognition of systemic illness and a developmental survey.

The diagnosis of ADHD should never be made based exclusively on rating scales, questionnaires, or tests. The evaluation should be designed to answer three basic questions: (1) Are a sufficient number of ADHD symptoms occurring, pervasively and causing impairment, at the present time in the person's life; (2) Have these symptoms been present since childhood; (3) Is there any alternative explanation for the presence of these ADHD symptoms?

5. The evaluation and treatment of ADHD should be conducted by a qualified professional.

A qualified professional may be from any one of the following disciplines and would have the appropriate license to practice this discipline: psychiatrist, pediatrician, internist, family physician, other qualified physician, psychologist, social worker, professional counselor, and psychiatric nurse. A qualified professional not only has a license to practice but has training and experience in the differential diagnosis and treatment of ADHD and the full range of psychiatric disorders.

6. Response to medication should not be used as the basis to diagnose ADHD.

There are a number of reasons why an individual's response to a stimulant or other medication is not a valid indication of the presence of ADHD. First, stimulant medications doesn't just work for people with ADHD; individuals with other disorders and without any disorders may respond positively to them. Second, failure to respond to medication may be because the dose was incorrect or the person's body is not responsive to that drug, rather than because the person does not have the diagnosis of ADHD. Third, a positive response to medication may the result of a placebo effect rather than a true indication of the presence of ADHD. Fourth, the use of medication as a diagnostic tool may lead the physician to prematurely conclude the diagnostic process without considering disorders that coexist with ADHD and jointly interfere with the individual's functioning.

7. Diagnosis should be based primarily upon the DSM-IV ADHD criteria.

In order to promote standardization, the diagnosis of ADHD should be based upon the prevailing professional criteria for the diagnosis of mental conditions. At the present time, the prevailing criteria are the Diagnostic and Statistical Manual of the American Psychiatric Association, Fourth Edition, known as DSM-IV. A number of professionals have justifiably criticized the DSM-IV ADHD criteria, noting several problems. In particular, they are not adjusted for age, making them too stringent in their published form for diagnosis of adults, e.g. adults will be under diagnosed. Minor adjustments have been suggested in the professional literature, but nonetheless, it is strongly recommended that diagnosis be based primarily upon these criteria.

8. Diagnosis and treatment of ADHD should involve others familiar with the person undergoing the evaluation.

Proper diagnosis and treatment of ADHD should involve others such as parents, spouses, teachers, and when appropriate, employers. These individuals can corroborate and provide information and can be enormously helpful in the diagnostic and treatment process. When guided to better understand and accept ADHD, they can also become positive supports for the person with ADHD.

9. Treatment should often involve more than one discipline working cooperatively.

Since there is currently no way to cure ADHD, the goal of treatment is to enhance the individual's ability to cope with it. Coping successfully with ADHD often requires a combination of treatments provided by specialists from different disciplines. The physician prescribes stimulant or other types of medication. The mental health professional and/or the coach provides supportive counseling for the individual with ADHD and the family, teaches the individual compensatory strategies for home and school/workplace, and provides training in behavior management. The educator helps to remediate school-based problems, and often provides feedback to the parents and the physician about the effectiveness of medication. Members of different disciplines should communicate with each other to coordinate their efforts to help the individual cope with ADHD.

Generally, medication should not be started until a comprehensive evaluation has been completed and the need for other forms of treatment has been evaluated. Coordinated treatment by physicians, mental health professionals, educators, coaches, and other health care professionals will maximize the individual's opportunities for treatment success.

10. Practitioners should become familiar with current research and diagnostic tools.

It is the responsibility of each professional involved in the evaluation and management of ADHD to continually integrate the most up to date understanding of ADHD into his/her repertoire of clinical skills. The improved understanding of the cause, diagnosis, and treatment of ADHD which comes from a review of the current literature will improve the quality of care.

National ADDA urges all professionals to become familiar with updated diagnostic tools and treatment methods, as well as standards for a comprehensive assessment. National ADDA is committed to facilitating the process of keeping professionals abreast of the latest developments in the field of ADHD through its conferences and publications.