What should an ADHD assessment include?
A credible assessment is a clinical process, not a score. It brings together symptoms, developmental history, function, mental health, physical health and information from more than one setting.
What NICE expects
- A full clinical and psychosocial assessment.
- A full developmental and psychiatric history.
- Discussion of symptoms and behaviour in different domains and settings.
- Observer reports where appropriate and assessment of mental state.
- Consideration of diagnostic criteria and functional impairment.
Why developmental history matters
ADHD is neurodevelopmental, so the clinician looks for a pattern that began during development rather than symptoms that appeared only recently. Old school reports, family recollections and other historical information can be helpful, but the exact evidence available differs from person to person.
Why differential diagnosis matters
Concentration, restlessness and impulsivity are not unique to ADHD. Sleep disturbance, anxiety, mood disorders, substance use, trauma, thyroid disease, medication effects and other neurodevelopmental conditions may contribute. Good assessment asks what best explains the whole pattern, not merely whether an ADHD checklist is positive.
What happens after assessment?
The clinician should explain the conclusion, uncertainty where relevant, coexisting needs and sensible next steps. If ADHD is diagnosed, support may include education, environmental adjustments, psychological strategies and — where appropriate — medication assessed and managed by a suitably qualified prescriber.
Questions worth asking a provider
- Who will actually conduct and sign off my assessment?
- What is their regulated profession and registration number?
- What ADHD-specific training and experience do they have?
- How do you obtain developmental and collateral information?
- How do you assess differential diagnoses and comorbidities?
- If medication is recommended, who prescribes and monitors it?