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• AD/HD Guidelines

AD/HD Documentation Requirements

Evidence of Current Impairment on an Individual's Ability to Perform Academic Tasks Must Be Included

The diagnosis of ADHD is strongly dependent on a clinical interview in conjunction with a variety of formal and informal measures. Since there is no one test, or specified combination of tests, for determining ADHD, the diagnosis of an attention deficit/hyperactivity disorder (ADHD) requires a multifaceted approach. Any tests that are selected by the evaluator should be technically accurate, reliable, valid, and standardized on the appropriate norm group. The following list includes five broad domains that are frequently explored when arriving at an ADHD diagnosis. This listing is provided as a helpful resource but is not intended to be definitive or exhaustive.

1. Clinical interview - The evaluator should: 1) provide retrospective confirmation of ADHD; 2) establish relevant developmental and academic markers; 3) determine any other co-existing disorders; and 4) rule out other problems that may mimic ADHD.

   Specific areas to be addressed include:

   • history of presenting attentional symptoms, including evidence of ongoing impulsive/hyperactive or inattentive behavior that has significantly impaired functioning over time
   • developmental history
   • family history for presence of ADHD and other educational, learning, physical, or psychological difficulties deemed relevant by the examiner
   • relevant medical and medication history, including the absence of a medical basis for the symptoms being evaluated
   • relevant psychosocial history and any relevant interventions
   • a thorough academic history of elementary, secondary, and postsecondary education
   • a review of prior psycho educational test reports to determine whether a pattern of strengths or weaknesses is supportive of attention or learning problems
   • relevant employment history
   • description of current functional limitations pertaining to an educational setting that are presumably a direct result of problems with attention
   • relevant history of prior therapy
   • family history
   • results of a neuro-medical history
   • presence of ADHD symptoms since childhood
   • presence of ADHD symptoms in last 6 months
   • evidence that symptoms cause a "significant impairment" over time
   • results of clinical observation for hyperactive behavior, impulsive speech, distractibility
   • an accounting for periods in which the student was symptom-free
   • presence of other psychiatric conditions (mood or anxiety disorders, substance abuse, etc.)
   • indication that symptoms are not due to other conditions (e.g., depression, drug use, neuromedical problems)
   • relevant medication history
   • determination of which remediation approaches and/or compensating strategies are and are not currently effective.
   • determination of what accommodations, if any, have alleviated symptoms in the past or in the present setting.
2. Rating scales - Self-rater or interviewer-rated scales for categorizing and quantifying the nature of the impairment may be useful in conjunction with other data.

   Selected examples include:

   • Wender Utah Rating Scale
   • Brown Attention-Activation Disorder Scale
   • Beck Anxiety Inventory
   • Hamilton's Depression Rating Scale
   • Conners Teacher Rating Scale (age 3-17 years)
   • Conners Parent Rating Scale (age 3-17 years)
3. Neuro-psychological and psycho-educational testing - Cognitive and achievement profiles may suggest attention or information processing deficits. No single test or subtest should be used as the sole basis for a diagnostic decision.

   Acceptable instruments include, but are not limited to:

   Aptitude/Cognitive Ability

   • Wechsler Adult Intelligence Scale - III (WAIS-III)
   • Woodcock-Johnson Psychoeducational Battery - Revised: Tests of Cognitive Ability
   • Kaufman Adolescent and Adult Intelligence Test

   Academic Achievement

   • Scholastic Abilities Test for Adults (SATA)
   • Stanford Test of Academic Skills (TASK)
   • Woodcock-Johnson Psychoeducational Battery - Revised: Tests of Achievement
   • Wechsler Individual Achievement Test (WIAT)

   or specific achievement tests such as

   • Nelson-Denny Reading Skills Test
   • Stanford Diagnostic Mathematics Test
   • Test of Written Language - 3 (TOWL-3)
   • Woodcock Reading Mastery Tests - Revised

   Information Processing

   • Detroit Tests of Learning Aptitude - 3 (DTLA-3) or Detroit Tests of Learning Aptitude - Adult (DTLA-A).
   • Information from subtests on WAIS-R or Woodcock-Johnson Psychoeducational Battery - Revised: Tests of Cognitive Ability, as well as other relevant instruments, may be useful when interpreted within the context of other diagnostic information.
4. Medical evaluation - Medical disorders may cause symptoms resembling ADHD. Therefore, it may be important to rule out the following:
• Neuroendocrine disorders (e.g., thyroid dysfunction)
• Neurologic disorders
• Impact of medication on attention if tried, and under what circumstances
5. Collateral information - Include third party sources which can be helpful to determine the presence or absence of ADHD in childhood.
   • Description of current symptoms (e.g., by spouse, teachers, employer)
   • Description of childhood symptoms (e.g., parent)
   • Information from old school and report cards and transcripts