How do psychiatrists diagnose ADHD in adults?

Children are most commonly diagnosed with attention deficit/hyperactivity disorder (ADHD). But did you know that many people with the disorder don’t receive a diagnosis until adulthood? If you live with undiagnosed ADHD, you may struggle with symptoms like forgetfulness and disorganization — receiving a diagnosis as an adult can be a relief.

In this article, we discuss how psychiatrists diagnose ADHD in adults, including the most common tests used and the types of ADHD you may be diagnosed with.  

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How does a psychiatrist diagnose ADHD?

ADHD must be diagnosed by a board-certified, licensed healthcare professional, such as an ADHD psychiatrist or psychiatric nurse practitioner (NP). Be aware there isn’t a single test for ADHD. And, it may take 2 or more visits to your provider to get a diagnosis. Learn more about ADHD treatment and diagnosis.

The majority of mental health providers in the U.S. use the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) as a reference handbook. It provides criteria that can be used by professionals to evaluate a patient and come to a diagnosis if 1 is applicable. For ADHD, people older than 17 need to show 5 or more criteria for at least 6 months. 

To determine if you meet the criteria for an ADHD diagnosis, your provider will conduct a comprehensive evaluation that involves:

• An interview about your physical and mental health history and current symptoms
• Using any of several standardized behavior rating scales, known as quality of life assessments or ADHD screeners
• Performance-based psychological tests to assess your memory, executive function, and visual, spatial, and reasoning skills.
• Interviews with people close to you to see how your symptoms impact you (if necessary and with your permission)

Tests for an ADHD diagnosis

ADHD screeners

ADHD screeners are typically questionnaires or surveys that help your provider determine whether you have ADHD. The Adult ADHD Self-Report Scale Symptom Checklist is 1 such screener. It asks questions about your ADHD symptoms and how often they impact your life. Your provider will compare your answers to criteria listed in the DSM for an ADHD diagnosis. It also helps your provider determine which treatment or medication, if any, is best for your symptoms.

If you search “do I have ADHD?” online, you’ll find a lot of self-assessments that tell you how likely it is that you have ADHD. But, these tests aren’t a diagnosis nor are they used by mental health professionals to diagnose ADHD. If you take an online assessment that says you likely have the disorder, print your questions and answers and bring them when you talk to your doctor about ADHD.

Performance-based tests

Performance-based tests evaluate your cognitive abilities, such as executive functioning, memory, and reasoning skills. These tests can show whether you have impaired executive function, lack of focus, forgetfulness, and impulsivity related to ADHD. 

The continuous performance test (CPT) is a popular machine-based prediction model commonly used to help diagnose ADHD. It typically involves rapid presentation of sounds or symbols on a screen. Your provider will give you simple directions, such as clicking a mouse when a pattern is repeated. By tracking the number of correct responses, times you failed to respond, and your response time, this test measures your attention span and impulsivity. 

3 types of ADHD

There are 3 types of ADHD: attentive, hyperactive/impulsive, and combined. 

Inattentive type diagnosis criteria

Inattentive type ADHD is identified in people who have trouble with the following:

• Following detailed instructions
• Organization
• Memory
• Listening
• Following through with tasks
• Paying attention 
• Keeping track of things 

Hyperactive/impulsive type diagnosis criteria

Hyperactive/impulsive type ADHD is characterized by an inability to sit still and/or focus on tasks. People who have this type of ADHD are more likely to show the following symptoms:

• A need to constantly be moving
• Fidgeting often
• Excessive talking
• Interrupting others
• Blurting out thoughts or answers
• Struggle with impulse control

Combined type diagnosis criteria

The third type of ADHD is a combination of the inattentive and hyperactive/impulsive types. People with combined ADHD have at least 5 symptoms of inattentive type and 5 or more symptoms of hyperactive/impulsive type for 6 months.

Who can diagnose ADHD in adults?

If you think you have ADHD as an adult, you should be evaluated by a licensed mental health professional who can diagnose ADHD. This can be a clinical psychologist, psychiatrist, neurologist, family doctor, clinical social worker, or other licensed healthcare provider. 

Untreated ADHD in adults can be difficult to recognize. And, it often occurs with, or looks like, other mental health conditions. It’s important to find a provider who has experience with ADHD, so you get the correct diagnosis and treatment plan for you. 

Comorbid illnesses and ADHD

Many mental health conditions can occur at the same time, or share symptoms that make it look like you have 1 or the other. When diseases occur simultaneously, it’s referred to as a comorbid illness. Recognizing the likeliness of mental conditions to occur together (comorbidity) is important for determining treatment options.  

ADHD has a high rate of comorbidity with other disorders — many people with ADHD also have another mental condition or learning disability. If you’re diagnosed with more than just ADHD, it’s important to treat the condition with the larger problem first, and not always both conditions at the same time. 

Depression or ADHD?

You can have ADHD and depression at the same time. About a quarter of adults who have ADHD also have symptoms of depression. If you have ADHD, you’re about 3 times more likely to have depression too. 

Sometimes ADHD is mistaken for depression because many of the symptoms overlap. For example, restlessness and boredom can be symptoms of both. And some side effects of ADHD medication can cause symptoms of depression, such as loss of appetite, mood swings, and fatigue. 

Anxiety or ADHD?

Individuals with ADHD may also have anxiety. Anxiety is a natural response to situations that are difficult, scary, or uncomfortable, but it becomes an issue when it’s excessive or persistent. Both ADHD and anxiety can cause you to avoid tasks and have trouble focusing. 

When determining whether you have ADHD vs anxiety, it’s important to note what’s causing your symptoms. Anxiety may cause you to avoid something because you’re afraid of doing it or what may come after. ADHD can cause you to avoid tasks or have trouble completing them because you struggle to maintain focus. 

Bipolar disorder or ADHD?

Bipolar disorder (BD) is a mental illness that causes extreme mood changes and shifts in energy levels. And it often occurs with ADHD. Research shows that around 1 in every 13 patients has ADHD and BD. 

Individuals with BD experience periods of extreme depression followed by mania. This cycle repeats itself continuously — many individuals with undiagnosed BD mistake manic episodes as a sign that their depression is improving. 

ADHD shares symptoms of both the manic and depressive sides of BD, such as increased energy, being easily distracted, talking a lot, impulsivity, and inattention. Both ADHD and BD can significantly impact your life, but they’re treated differently, so distinguishing between the 2 during diagnosis is very important. 

Thyroid disorder or ADHD?

The thyroid is a gland that has several important functions in the body. It regulates heart rate, breathing, metabolism, and body temperature. Thyroid hormones are also incredibly vital for brain development and cognitive function. 

Disruptions in brain function due to thyroid issues can cause symptoms similar to those of ADHD. The brain fog associated with hypothyroidism (low thyroid function) can look like the lack of focus, forgetfulness, and distractability related to inattentive type ADHD. 

Likewise, if you have hyperthyroidism (excessive thyroid function), you may have symptoms like difficulty focusing, hyperactivity, irritability, insomnia, and anxiety — all symptoms of ADHD as well.

Treatment for ADHD diagnosis

If you’ve been diagnosed with ADHD, treatment often includes medication and/or behavioral therapy. If you need therapy, your provider can refer you to an ADHD therapist. And if you need ADHD medication, there are several available, including stimulants and non-stimulants. 

Central nervous system (CNS) stimulants calm ADHD symptoms by increasing the amount of brain chemicals dopamine and norepinephrine. The result is improved attention span and focus. Common stimulants for ADHD include Adderall and Adderall XR (amphetamine/dextroamphetamine), Dexedrine (dextroamphetamine), Focalin (dexmethylphenidate), and Ritalin (methylphenidate).

Your provider may prescribe non-stimulant ADHD medication if you can’t, or don’t want to, take stimulants. Non-stimulants increase your levels of the brain chemical norepinephrine to help with ADHD symptoms, like poor memory and focus. Medications include Strattera (atomoxetine), Qelbree (viloxazine), and Intuniv (guanfacine).

Key takeaway

Living with undiagnosed ADHD as an adult can disrupt everyday life, and make certain tasks and responsibilities more challenging. Receiving a professional diagnosis can help alleviate these challenges by providing access to treatment options to manage your symptoms, improve your focus, and make daily tasks easier. 

Get an ADHD diagnosis and treatment plan with help from Klarity Health

If you think you have ADHD, a licensed healthcare provider can evaluate your symptoms and provide a diagnosis and treatment plan, if appropriate. Start the process today when you find an ADHD provider on Klarity Health and have an appointment in as little as 24 hours. *

Sources

Attention Deficit Disorder Association, Adult ADHD Self-Report Scale (ASRS-v1.1) Symptom Checklist Instructions, https://add.org/wp-content/uploads/2015/03/adhd-questionnaire-ASRS111.pdf

Attention Deficit Disorder Association, ADHD Combined Type: A common and treatable diagnosis, Dec. 2022, https://add.org/adhd-combined-type/

Brain and Behavior, Validity and accuracy of the Adult Attention‐Deficit/Hyperactivity Disorder (ADHD) Self‐Report Scale (ASRS) and the Wender Utah Rating Scale (WURS) symptom checklists in discriminating between adults with and without ADHD, Erlend Joramo Brevik et al., Apr. 2020,

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7303368

CHADD, Diagnosis of ADHD in Adults, https://chadd.org/for-adults/diagnosis-of-adhd-in-adults/

Center for Disease Control and Prevention, Symptoms and Diagnosis of ADHD, https://www.cdc.gov/ncbddd/adhd/diagnosis.html

Frontiers in Human Neuroscience, A Machine-Based Prediction Model of ADHD Using CPT Data, Ortal Slobodin et al., Sept. 2020, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7528635/

PsychCentral, What Is the DSM-5? Resource Guide, https://psychcentral.com/lib/dsm-5

The information provided in this article is for educational purposes only and should not be construed as medical advice. Always seek the guidance of a qualified healthcare professional with any questions or concerns you have regarding your health. Providers on Klarity Health are independent practitioners with full medical authority. No diagnosis result or treatment option is guaranteed for the services rendered through the Klarity Health platform.

If you’re having a mental health crisis or experiencing a psychiatric emergency, it’s crucial to seek immediate help from a mental healthcare professional, such as a psychiatrist, psychologist, or therapist. You can also call your local emergency services, visit your nearest emergency room, or contact a crisis hotline, such as the National Suicide Prevention Lifeline, by calling or texting 988 or dialing the Lifeline’s previous phone number, 1-800-273-TALK (1-800-273-8255) in the U.S.

How we reviewed this article: This article goes through rigorous fact-checking by a team of medical reviewers. Reviewers are trained medical professionals who ensure each article contains the most up-to-date information, and that medical details have been correctly interpreted by the author.