The short answer
A DSM-5-TR ADHD diagnosis needs enough symptoms for the client's age (six or more in a domain through age 16, five or more from 17), present for at least six months, several before age 12, in two or more settings, with clear impairment, and not better explained by another condition. A solid evaluation documents each of these with sources.
The criteria to document
- Symptom count: inattention and hyperactivity-impulsivity are counted separately. Six or more in a domain for children through age 16; five or more for adolescents 17 and older and adults.
- Duration: symptoms have lasted at least six months and are inconsistent with developmental level.
- Onset: several symptoms were present before age 12.
- Settings: several symptoms show up in two or more settings, such as home, school, work or with friends.
- Impairment: clear evidence the symptoms interfere with or reduce the quality of social, school or work functioning.
- Exclusion: symptoms are not better explained by another mental disorder and don't occur only during psychosis.
- Presentation and severity: combined, predominantly inattentive or predominantly hyperactive-impulsive, and mild, moderate or severe.
Gather information from more than one source
- Clinical interview with the client and, for children, caregivers.
- Rating scales: for example, parent and teacher Vanderbilt forms for children, and the ASRS for adults.
- School records, report cards or work feedback.
- For adults, someone who knew them in childhood can help confirm onset before 12.
Rule-outs and co-occurring conditions
Screen for conditions that can mimic or co-occur with ADHD: anxiety, depression, bipolar disorder, trauma, learning disorders, autism, sleep problems, substance use, and medical causes such as thyroid problems or hearing and vision issues. Document what you considered and why it does or doesn't explain the symptoms.
Before prescribing
- Cardiac history and family history of sudden cardiac death; blood pressure and heart rate.
- Substance use and diversion risk, especially for stimulants.
- Height and weight for children, to track growth.
- Suicide risk screening and a safety plan when indicated.
What the report should include
- Reason for referral and sources of information.
- History: developmental, school or work, medical, psychiatric, family and social.
- Symptom review against each criterion, with who reported each symptom and where.
- Rating scale results and interpretation.
- Differential diagnosis and rule-outs.
- Diagnostic impression with presentation and severity.
- Recommendations and a treatment plan: education, behavioral strategies, school or work accommodations, and medication if appropriate.
Frequently asked questions
How many symptoms are needed for an adult ADHD diagnosis?
Under DSM-5-TR, adolescents 17 and older and adults need at least five symptoms in the inattentive or hyperactive-impulsive domain, compared with six for younger children, along with the other criteria.
What rating scales are used in ADHD evaluations?
Common choices include the Vanderbilt parent and teacher scales for children and the Adult ADHD Self-Report Scale (ASRS) for adults. Rating scales support the clinical interview; they don't diagnose on their own.
Can ADHD be diagnosed in one visit?
Sometimes, if enough information is available, but many clinicians gather rating scales and records from other settings first. The diagnosis needs evidence from more than one setting.
Related resources
From JV Clinical Technologies, founded by Jaime Varney, PMHNP-BC. General professional education only, not legal, billing or clinical advice for a specific case. Check current payer, state and professional rules before relying on any requirement described here.