Here's the messy truth.
There is no test for ADHD.
Medical science hasn't yet devised a physical, medical, or genetic test to help your healthcare providers conclude that you have ADHD (or that you don't).
But fear not. Diagnosing ADHD in lawyers is, oddly, quite straightforward.
How to Get Diagnosed with ADHD as an Adult
Your healthcare provider will gather information from several sources—primarily, though not exclusively, you—and take you through a diagnostic assessment. That's it.
If you meet the criteria, your doctor should be able to make the diagnosis. If you do not, she won't.
Information Sources Your Doctor Will Use to Diagnose Your ADHD
Every practitioner does their ADHD assessment a bit differently. But the goal remains constant: to gather enough information from reliable sources to determine whether you meet the diagnostic criteria for adult ADD.
Some common sources include ADHD symptom checklists, asking you specific questions about your current day-to-day challenges and the ones you recall from your past, and gathering information from people who know you well now and knew you well as a child.
For even more context, some practitioners will ask about your academic record and may even request your report cards dating back as far as they'll go. Some diagnosticians use a battery of cognitive ability tests to understand more about your IQ, working memory, attention to detail, and visual and auditory processing.
Your doctor may even prefer to use a brain scan to gather as much data as possible.
To be clear, your healthcare provider may not be able to offer an accurate diagnosis just by interviewing you or using simple observations. ADHD can be a sneaky foe and may not always reveal itself during your first visit.
Making things more difficult, adults with ADHD often have other characteristics that can complicate a diagnosis (like sleep disorders, anxiety, depression, learning disabilities, autism spectrum disorders, and personality disorders).
In this case, the more data about your life your doctor can gather, the more helpful it will be for making—or ruling out—an ADHD diagnosis.
The 18 Diagnostic Criteria for Adult ADHD
Diagnostic Guidelines for Adult ADHD
The American Psychiatric Association publishes a manual so that healthcare providers can use standardized criteria to diagnose mental health conditions.
Your doctor will consult the guidelines described in the AMA's Diagnostic and Statistical Manual, Fifth edition (DSM-5) to diagnose ADD.
Doctors and researchers use DSM-5 guidelines widely, both in clinical practice and research. During your assessment, your doctor will try to uncover the level of ADHD symptoms you have and whether they've been present since childhood.
For better or worse, the DSM-5 is the bible of ADHD diagnosis.
Bear with me here. The venerable authors of the DSM-5 may understand the human mind, but they can't write for shit. I have edited this list gently for readability, but I've also tried to leave the critical bits unvarnished.
The DSM-5 Adult ADHD Diagnostic Criteria
Here's what the DSM-5 says about adult ADHD.
First, to meet the criteria for a diagnosis of adult ADHD, you will first meet all five of the following basic criteria:
- You have 5 or more inattention symptoms and/or 5 or more hyperactivity/impulsivity symptoms, and those symptoms have persisted for more than 6 months. What's more, the symptoms will be to a degree that is inconsistent with your developmental level and negatively impact your social, academic, or occupational activities.
- You've had several symptoms since before you turned 12 years old.
- You show several symptoms in more than two settings (at home, school, or work; with friends, relatives, or coworkers; in other activities, etc.).
- “Clear evidence” shows that your symptoms interfere with—or reduce the quality of—your social, academic, or occupational functioning.
- Your symptoms do not occur exclusively during the course of schizophrenia or another psychotic disorder, and are not better explained by another mental disorder (like mood disorder, anxiety disorder, dissociative disorder, personality disorder, substance intoxication, or withdrawal).
The DSM-5 then groups ADHD into three different categories:
- Predominantly Inattentive Presentation
- Predominantly Hyperactive-Impulsive Presentation
- Combined Presentation
Let's take a closer look at those three categories.
ADHD—Predominantly Inattentive Presentation
If an adult has inattentive-type ADHD, she will describe having at least five of these persistent, impactful symptoms:
- Often fails to give close attention to details or makes careless mistakes in schoolwork, at work, or with other activities.
- Often has trouble holding attention on tasks or play activities.
- Often does not seem to listen when spoken to directly.
- Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (e.g., loses focus, side-tracked).
- Often has trouble organizing tasks and activities.
- Often avoids, dislikes, or is reluctant to do tasks that require mental effort over a long period of time (such as schoolwork or homework).
- Often loses things necessary for tasks and activities (e.g. school materials, pencils, books, tools, wallets, keys, paperwork, eyeglasses, mobile telephones).
- Is often easily distracted.
- Is often forgetful in daily activities.
ADHD—Predominantly Hyperactive-Impulsive Presentation
An adult with hyperactive-impulsive ADHD will describe having at least five of these persistent, impactful symptoms:
- Often fidgets with or taps hands or feet, or squirms in seat.
- Often leaves seat in situations when remaining seated is expected.
- Often runs about or climbs in situations where it is not appropriate (adolescents or adults may be limited to feeling restless).
- Often unable to play or take part in leisure activities quietly.
- Is often “on the go” acting as if “driven by a motor.”
- Often talks excessively.
- Often blurts out an answer before a question has been completed.
- Often has trouble waiting their turn.
- Often interrupts or intrudes on others (e.g., butts into conversations or games).
An adult with combined-type ADHD will have at least five persistent, impactful symptoms meeting the criteria for both inattention and hyperactivity-impulsivity.
Your Doctor's Role in Diagnosing ADHD
Your doctor will decide whether you have adult ADHD after making some judgments about your history. For example, the number, severity, duration, impact, and reach of your symptoms can help clarify the diagnosis.
If enough symptoms impair your life, you can meet the criteria.
So, what does it mean for a symptom to “impair” your life? Here is a non-exhaustive list for you:
- Trouble completing projects
- Difficulty following instructions
- Making careless mistakes at work or at home
- Poor time management
- Planning difficulty
- Motor vehicle accidents
- Drug or alcohol use or abuse
- Insomnia or other sleep difficulties
- Struggles with mood and temper control
- Losing your job as a result of ADHD symptoms
- Distress and conflict in your marriage
- Financial difficulties brought by impulsive spending
- Overdue bill payments
Notably, this means that you can meet the diagnostic criteria for “ADHD” even if you are not impulsive or hyperactive in the slightest. That's why some people use the word “ADD” to describe inattentive-type ADHD, since it is missing the “hyperactive” component.
To learn whether any of your symptoms appeared before you turned 12, most healthcare providers will try to gather information and confirmation from a parent or other adult who knew you well as a child.
If you have several ADHD symptoms but they don't cause any major impairments, you may not qualify for an ADHD diagnosis as a clinical disorder.
What About Internet Self-Rating Scales?
The internet is awash in ADHD self-rating scales.
Truth be told, I hope to publish one here in the near future. I like them. They're useful to understand what ADHD looks like and feels like. They give you context. They help you understand the scope and scale of ADHD's impact on our lives.
Here's the thing, though: they're mostly hogwash.
A quick Google search returns loads of ADHD symptoms lists, questionnaires, and “tests.” Even those built by the most well-intentioned authors are flawed. The questionnaires aren't standardized, scientifically validated, or peer reviewed. And, as we've said elsewhere, there is no test that can diagnose ADHD.
Don't use internet ADHD self-rating scales to diagnose yourself or anyone else with adult ADHD. As we've said elsewhere, only a qualified and licensed health care expert can diagnose you with ADHD.
Who is Qualified to Provide an ADHD Diagnosis?
If the ADHD symptoms we've described here resonate with you and you're curious about whether you might have ADHD, only a licensed physician or mental health expert can evaluate and diagnose you.
Three main categories of healthcare professionals can make an ADHD diagnosis: 1.) clinical social workers and advanced-practice nurses; 2.) clinical psychologists; and 3.) physicians (primarily family doctors, internists, general practitioners, neurologists, and psychiatrists).
No matter the professional you choose, it's critical that you ask about their experience and training in dealing with people with ADHD.
Often, the particular professional degree doesn't matter. The single most important credential is their expertise and knowledge base about adult ADHD.
If your professional is qualified, she'll be more than willing to show her training and experience when it comes to handling adult ADHD. If they're reluctant, move on.
This I know from personal experience. Even a psychologist claiming deep expertise in ADHD can miss the diagnosis, and may even succumb to common ADHD myths in doing so. My particular charlatan, Roberta, did just that. 😡
“You graduated from law school, passed the bar, and practiced law in a big law firm? Well, you don't have ADHD. I'll give you the test anyway, but you don't have ADHD.”
Please learn from my mistakes. Be discerning in who you trust with your brain, would you?
Finding a Qualified Professional for a Proper ADHD Diagnosis
One way you can find these experts is by asking your personal doctor.
Because they interact with other professionals in their field, they are often able to refer you to a qualified clinician who can give you an adequate ADHD assessment.
If that approach doesn't work, seek out recommendations from a graduate-level psychology program, medical school, or a local university-based health care center.
Third, do your due diligence. There are countless resources available online, and your community may have an adult ADHD support group available. Ask group members for their recommendations.
You can also check with your medical insurance provider. Most insurance companies list professionals according to their specialties and might be useful in helping you the right ADHD clinician for you.
Finally, you can consult healthcare professional listing websites, which list professionals that offer ADHD diagnosis and assistance.
Do You Need an ADHD Evaluation?
Many adults looking for an ADHD evaluation have experienced major problems in one or several aspects of their life.
Here is a small sampling of some of them:
- Inconsistent job performance. Adults with ADHD might lose or leave jobs often out of boredom or performance issues.
- Under-achievement in their academic life or career.
- Poor life management. Completing household chores is hard, they're disorganized, and they are struggling to pay bills on time (despite having ample money).
- Relationship issues with colleagues and loved ones.
- Getting upset over small things and forgetting crucial things.
- Failing to meet goals and commitments leading to chronic stress, anxiety, worry, depression, or alcohol and substance abuse.
- Blaming himself, feeling guilty and frustrated and inadequate.
When you visit a qualified professional, they'll help decide whether your struggles have ADHD at their root.
And even though some symptoms may have shown in childhood, some adults may not describe significant problems until later. For instance, talented and bright people may compensate for their symptoms and may not experience overwhelming challenges until they reach high school, college, law school, or their young careers.
In other cases, parents may have offered a supportive and protective home, reducing the impacts of ADHD and its symptoms until you move out and start living independently.
How Do You Prepare for an Initial ADD Appointment and ADHD Evaluation?
If you're feeling a bit anxious about the idea of seeing a healthcare provider to talk about ADHD, you're not alone.
A bit of preparation will go a long way in helping soothe your nerves.
Other than being prepared mentally and psychologically, how else should you prepare?
Many professionals find it useful to analyze old report cards and other school records, going back to preschool and kindergarten. If you have them—or can convince your folks to dig them out of your baby book—bring them along to your appointment. If you have done any psychological testing or had any therapy in the past, order copies of your records (or at least bring detailed contact information for those appointments.
If you have access to them, job evaluations can also come in quite handy.
During your first appointment, your doctor may offer you questionnaires, quizzes, assessments, or other tools. They'll also ask you to send some questionnaires to loved ones who may be able to provide some insight into your patterns and proclivities. The more the better.
What is a Comprehensive ADHD Evaluation?
Every clinician will have slightly different testing materials and procedures she uses to diagnose adults with ADHD.
Still, the DSM-5 provides several protocols critical for a comprehensive examination:
- An in-depth diagnostic interview.
- The DSM-5 symptom checklist.
- ADHD standardized behavior rating scales.
- Information from other sources, like parents and other loved ones.
- Other psychometric testing tools as necessary .
The Diagnostic Interview: Evaluating Adult ADHD Symptoms
This is the most crucial part of the evaluation, and it provides your particular professional with your educational, social, family, and medical background.
Your doctor will dig into your health history, your life development dating back to childhood (and even birth, in some cases), academic experience, work experience, driving history, marital and family life, substance abuse, and social history.
She'll look for patterns seen in people living with ADHD, and try to decipher whether other non-ADHD factors could be playing a role.
You'll answer a set of pre-determined and standardized questions, then your doctor will cover a wide range of topics and ask you about all the issues that might be relevant to a diagnosis. Expect to have several follow up questions and other areas of interest.
Your doctor will review your whole profile, compare it with the diagnostic criteria, and decide whether the criteria apply (and if so, the severity, frequency, and onset), and follow up with more questions to see how ADHD has interfered with your daily life.
The Diagnostic Interview: Screening for Other Psychiatric Disorders and “Co-Morbid” Conditions
Your doctor will, hopefully, be diligent in exploring whether you may be showing symptoms of any psychiatric disorders that can resemble ADHD or coexist with it.
ADHD rarely comes alone, and research shows that more than two-thirds of people with ADHD have one or more coexisting conditions.
Conditions that often cohabitate in people with ADHD are substance abuse disorders, learning disorders, anxiety disorders, depression, and personality disorders.
Many of these so-called “comorbidities” have symptoms that can resemble ADHD's symptoms. A mistake here can have hefty consequences.
If your assessment reveals one or more coexisting conditions, you'll need to treat them. Failing to treat coexisting conditions can doom your ADHD treatment.
It is also important to note that if your ADHD symptoms are a function of your anxiety, depression, or other psychiatric disorder, the failure to find and treat the underlying condition can lead to misguided—and potentially harmful—ADHD treatment.
In other cases—as with me—diagnosing and treating your underlying ADHD can eliminate or dramatically reduce the impacts from the other disorder,.
Participation of Loved Ones
During the arc of your ADHD evaluation, your clinician will need to interview one or more people related to you. Your spouse, parent, relative, or partner are likely suspects, because they will know you well and be able to provide valuable context about your life.
These interviews aren't to “check your work” or prove you wrong. They're simply meant to gather as much information and context as possible to make the most accurate diagnosis.
Many adults with ADHD are what the medical establishment call “poor historians.” That is, they can struggle to remember their past, particularly when they were young. Parents are a powerful link to your younger days and the behavior you showed in it.
Adults with ADHD can also struggle to see how their ADHD-related behaviors can complicate their lives and the lives of people around them.
That's why your clinician may interview your spouse or partner while analyzing your ADHD symptoms. If your spouse doesn't have ADHD (or even if she does), she may be able to describe how your symptoms have impacted your relationships.
Having her involved at this early stage of the process can also create a strong foundation for improving your relationship after your diagnosis is complete and your treatment begins to take root.
If interviewing loved ones isn't possible, your doctor may have them fill out symptoms checklists.
ADHD can cause a host of problems for the adults it afflicts, and that, in turn, can cause them deep shame, embarrassment, and frustration.
Talk about your struggles as honestly and openly as you can, without fear of criticism or shame. Your ADHD assessment's accuracy and quality will depend on the amount and accuracy of the data your doctor is able to evaluate. Don't be stingy.
Standardized Behavior Rating Scales
During your ADHD assessment, your doctor will likely walk you through one or more standardized behavior rating scales.
These assessment tools attempt to compare how adults with ADHD compare with those who don't. Your scores aren't diagnostic, per se, but they can provide valuable information about your ADHD's symptoms and impacts on your life.
Your doctor more choose to use other tests.
Much of the process depends on your symptoms, your doctor, and the solutions you're trying to find.
You may complete learning, neuropsychological, or psychological disability testing. These tools aren't diagnostic of ADHD itself, but they can offer information about how ADHD impacts you personally.
These tests can also help clarify whether any coexisting conditions might exist and how they may be playing a role in your symptoms and impairments. For example, ADHD and dyslexia often appear together, and knowledge about whether you have a coexisting learning disability can come from intellectual ability and academic achievement tests.
If you haven't had a medical examination in the last year or so, your doctor may encourage one. It is possible that a separate medical condition could be causing or contributing to your symptoms.
A medical exam may unearth a seizure disorder or thyroid issue, for example.
Finishing Your ADHD Testing and Evaluation
As your doctor finishes the evaluation, she will likely integrate all the information she collected, write a report or summary, and give you an opinion about ADHD and any other issues that she may have identified during the process. She will then review the treatment options available and help you start to build a treatment plan.