How Is ADHD Severity Measured?

Attention deficit hyperactivity disorder, also commonly referred to as ADHD, is a neurotype marked by specific traits such as forgetfulness, difficulty concentrating, a sense of restlessness, and procrastination, among others.

Despite what the numbers show, this does not mean that adults don't struggle with ADHD as much as children do. There are fewer struggles because adults are able to better accommodate their ADHD traits.

With awareness and diagnosis of ADHD increasing, it can be helpful to understand what goes into an assessment and how the severity of ADHD is clinically determined.

Who Can Conduct an ADHD Assessment?

It is important to find a trusted provider who is knowledgeable about ADHD. This can include mental health providers such as:

• Psychiatrists
• Clinical psychologists
• Behavioral psychologists
• Clinical social workers
• Licensed mental health therapists
• Nurse practitioners
• Neurologists

If you are curious about a formal diagnosis and looking for a professional to help determine if you meet the criteria for ADHD, it is good to remember that not all providers will be specialized in this area.

Taking time to research qualified professionals will help you find someone who is knowledgeable of ADHD and has experience conducting formal diagnostic assessments. If you have difficulty knowing where to begin your search, it can be helpful to reach out to your primary care doctor or child's pediatrician for trusted referrals in your area.

What Is Involved in an ADHD Assessment?

There is not a singular test used to clinically diagnose someone with ADHD. To gain an understanding of the severity of symptoms and come to a formal diagnosis, there are a variety of elements to the ADHD assessment process.

By using multiple tools, the mental health provider can better determine what symptoms are due to ADHD and what might be due to other physical or mental health conditions.

A thorough ADHD assessment will include such things as a physical examination, a diagnostic interview with the client, and supporting interviews from people like parents, family members, or spouses. The client's family history of ADHD and any other situational factors that may be contributing to the experience of ADHD symptoms will also be assessed.

Medical Exam

A medical provider will typically conduct a full medical examination, including vision, speech, and hearing assessment, to gain an understanding of the client's overall physical health. It is important during this time to note any medical or physical conditions that could be contributing to the client's behavioral symptoms.

For children, the exam can also include an assessment of the child's developmental markers appropriate for their age, as well as a possible assessment from an educational psychologist to determine any learning disabilities that could be impacting or influencing ADHD characteristics.

The medical provider may refer to vision, hearing, speech, and neurology specialists to conduct their own assessments in these areas.

Diagnostic Interview

For a child or adult to be clinically diagnosed with ADHD, the provider must gather detailed information about the person's symptoms based on criteria outlined in the DSM-5-TR.

Much of the time this information is through the process of a diagnostic interview between the mental health professional and the client. This is often done in the form of a structured conversation, where the psychologist or other qualified professional asks the client specific questions that offer insight into their characteristics. They'll ask how long they have been experiencing challenges and how their behaviors are impacting their life at work, school, and at home.

As the client responds to these questions, the mental health professional will be looking to see if what the person describes meets or exceeds the clinical criteria for ADHD. The time of the interview can vary by provider, although it would be common to expect the interview portion of the assessment to last an hour or more.

Feedback From Others

In addition to a detailed interview with the client, a provider assessing the severity of ADHD symptoms may wish to speak with other people in the client's life.

• Children: For children, this could include parents or other caregivers as well as teachers. Hearing from others close to the client can help the assessor gain an understanding of the level at which these symptoms are presenting at school and home.
• Adults: For an adult assessment, the mental health provider may wish to speak with the client's parents, spouse or partner, and any other close support people. Again, the information shared by loved ones can help offer the provider a fuller picture of the level to which the client is experiencing symptoms of ADHD and how this is impacting their daily functioning and relationships.

When assessing adults and children, talking with parents and caregivers can provide important information about any family history of diagnosed ADHD or symptoms of ADHD in the family that may have gone undiagnosed. Support people can also, sometimes, provide information about potential stressors or situational factors that could be contributing to the client's experience of symptoms.

ADHD Scales

Although there is not one specific test used to diagnose ADHD, there are a variety of scales that have been designed to help mental health providers assess the number and severity of symptoms a client is experiencing.

The use of assessments can be very helpful, in addition to the diagnostic interview, to gather more information regarding the onset, severity, frequency, and duration of ADHD symptoms.

Narrowband scales are assessments designed to gather information specific to symptoms of ADHD. Core symptoms of ADHD as outlined in the DSM-5-TR can be assessed, and help clinicians get a better understanding of the type of ADHD (e.g., hyperactive, inattentive, or mixed) the client has. This information can then be used to help personalize an effective treatment plan for the client.

An example of narrowband scales often used with children include:

• Vanderbilt ADHD Rating Scales
• Conner's Rating Scales
• ADHD Rating Scales
• SNAP Scales

Other available assessments can help providers gather information about the severity of ADHD symptoms, while also gaining an understanding of any co-occurring issues the child may be experiencing, such as:

• Child Behavior Checklist
• Behavioral Assessment Scale for Children
• Brown Attention Deficit Disorder Scales

For adults, some common scales often used in a clinical ADHD assessment might include:

• Adult ADHD Self-Report Scale
• ADHD Rating Scale with Adult Prompts
• Adult ADHD Clinical Diagnostic Scale
• Brown Attention Deficit Disorder Symptom Assessment Scale for Adults

Why Is Knowing the Severity of ADHD symptoms Important?

There are mild-, moderate-, and severe-level specifiers to be noted when clinically diagnosing someone with ADHD. Conducting a thorough assessment, including a medical examination, structured diagnostic interview, and ADHD scales can offer a qualified mental health provider much-needed information to determine symptom severity.

To Develop a Tailored and Effective Treatment Plan

Information regarding the severity of ADHD symptoms is a key part of developing an effective plan for the client.

Solutions might include behavioral interventions at school, counseling for the client, medication management services, accommodations at work and more.

The more severe the symptoms, the more a person's ADHD will be impacting their life at school, at work, at home, and within their most important relationships.