investigations for ADHD?

The diagnosis of Attention Deficit Hyperactivity Disorder (ADHD) should only be made by a specialist psychiatrist, paediatrician, or another appropriately qualified healthcare professional with specific training and expertise in ADHD diagnosis ¹,². Primary care practitioners should not make the initial diagnosis or initiate medication for suspected ADHD in children or young people ¹.

The diagnostic process involves a comprehensive assessment, including:

• Full Clinical and Psychosocial Assessment: This includes a detailed discussion about the person's behaviour and symptoms across various aspects of their daily life and different settings ¹.
• Full Developmental and Psychiatric History: A thorough review of the individual's developmental milestones and past psychiatric conditions is essential ¹.
• Observer Reports and Mental State Assessment: Information from observers (e.g., parents, teachers) and an assessment of the person's current mental state are crucial components ¹.

It is important to note that a diagnosis of ADHD should not be based solely on rating scales or observational data ¹. However, rating scales such as the Conners' rating scales and the Strengths and Difficulties Questionnaire can be valuable adjuncts, and observations (e.g., at school) are useful when there is uncertainty about symptoms ¹,². Primary care practitioners may use these scales to augment their initial assessment when behavioural and/or attention problems are suggestive of ADHD ².

For a diagnosis to be made, symptoms of hyperactivity/impulsivity and/or inattention must meet the diagnostic criteria outlined in DSM-5 or ICD-11 ¹. These symptoms must also cause at least moderate psychological, social, and/or educational or occupational impairment, based on interviews and/or direct observation in multiple settings ¹. Furthermore, the symptoms must be pervasive, occurring in two or more important settings, including social, familial, educational, and/or occupational environments ¹.

As part of the diagnostic process, an assessment should also include the person's needs, coexisting conditions, social, familial, and educational or occupational circumstances, and physical health ¹. For children and young people, an assessment of their parents' or carers' mental health should also be included ¹. When assessing children and young people, their views on the clinical significance of impairment should be considered wherever possible ¹. For children and young people, the clinical assessment may also involve asking about foods or drinks that appear to influence hyperactive behaviour; if a clear link is identified, parents or carers may be advised to keep a diary, and referral to a dietitian may be considered ¹,².