Tests
1st tests to order
no formal laboratory or imaging studies
Test
Behavior rating scales can be used to aid with the diagnosis.[90] In the author's experience, a brief scale is the preferred choice, as it reduces the burden on parents and teachers. The same scale can be used to follow response to treatment. Commonly used scales include:
The ADHD Rating Scale: an 18-item scale based on the DSM criteria for ADHD. It is useful both for diagnosing ADHD in children and adolescents and for measuring improvements with treatment.
The Vanderbilt Scale: a scale that assesses ADHD, comorbid conditions (including oppositional defiant disorder, conduct disorder, anxiety, and depression), and performance. There are both parent and teacher forms as well as initial and follow-up forms. Vanderbilt ADHD diagnostic scales Opens in new window
SNAP-IV is included in many research trials, including the Multimodal Treatment Study of AD/HD (MTA). It is a 26-item scale that screens for hyperactive and inattentive types of ADHD and for oppositional defiant disorder (ODD). SNAP-IV 26 - teacher and parent rating scale Opens in new window
The Child Behavior Checklist (CBCL) can be used to evaluate a wide range of child behavioral problems, with the CBCL-Attention Problem (CBCL-AP) subscale used as a diagnostic tool for ADHD.[94] However, this scale does not include all the criteria to establish a diagnosis.
Conners rating scales: Includes a long and short version. There are three forms, to be completed by parents, teachers, and the child, respectively.
DuPaul ADHD Rating Scale: Includes both teacher and parent forms.
Result
diagnosis is clinical
Investigations to avoid
hair analysis
Recommendations
Do not order hair analysis for “environmental toxins” when testing children for a possible behavioral or developmental disorder.[97]
Rationale
There is no evidence for the analysis of chemicals in hair as a way to diagnose the cause of childhood diseases.[97] Hair sample collection and hair analysis methods may not be reliable: for example, chemicals in hair may not be distributed evenly throughout the hair shaft and contaminants, such as dust and hair washing and styling products, may be present. Test results reporting presence of metals in the hair may be a source of anxiety to the patient and their family, and potentially lead to further requests for diagnostic tests.[97]
Tests to consider
neuropsychological testing
Test
Because ADHD is considered a behavioral disorder and is diagnosed by clinical history, neuropsychological testing is neither necessary nor sufficient for the diagnosis.[90] However, testing should be considered by a neuropsychologist when it is important to differentiate between ADHD and learning disabilities. Failing to recognize a learning disability can result in inadequate response to medication, academic failures, and low self-esteem.
Result
normal cognitive ability and academic achievement but will often have deficits in executive functions (those required to plan, prioritize, attend to, and inhibit behaviors) including working memory and processing speed
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