Making a Diagnosis of ADHD
During your visit, the clinician (1) completes a full medical & psychiatric assessment, (2) screens for the symptoms of ADHD and determines if there are sufficient symptoms to make the diagnosis, (3) determines if the symptoms are present in 2 or more settings (e.g. home, school, work; with friends or relatives; or in other situations), (4) finds out if the symptoms interfere with social, academic or occupational functioning, and (5) rules out other mental health disorders (e.g. depression, anxiety, substance abuse).
A clinician with excellent knowledge of all psychiatric disorders helps ensure diagnostic accuracy and appropriate treatment. Many disorders may mimic or complicate ADHD, so clarity is key.
ADHD Websites
Treatment of ADHD
Pharmacological treatments include stimulant and non-stimulant medications. Benefits, risks, dosing regimens and side-effects should be addressed with the prescriber. Benefits of medications are often enhanced by cognitive behavioral psychotherapy (CBT), which helps address the depression, anxiety, sense of failure and anger that may be associated with having ADHD.
The Canadian ADHD Resource Alliance (CADDRA) updated their treatment guidelines in May 2026.
Academic Accommodations
Students struggling with symptoms of ADHD often benefit from academic accommodation — arrangements that allow a student with a disability a fair opportunity to engage in academic activities and fulfill essential course requirements. Examples include assignment extensions, extra exam time, counselling support, a learning strategist, permission to record lectures, noise-cancelling headphones or ear-plugs, peer-provided lecture notes, reduced course load, fewer exams per day, and writing exams in a quiet location.
The ADHD Self-Report Scale (ASRS)
No rating scale can make a diagnosis of ADHD. However, scales are used to prompt a full psychiatric assessment. The Adult ADHD Self-Report Scale has 18 questions reflecting the 18 symptoms of ADHD. The first 6 questions can be used as a "screener," with 4 or more marks in the shaded areas being highly consistent with adult ADHD. Some clinicians use the ASRS to assess response to treatment.
Childhood Symptoms
To make a diagnosis of ADHD, several symptoms must be present prior to age 12. However, many adults forget they were diagnosed as children. The WURS scale helps adults recall childhood symptoms. A full psychiatric evaluation is always required, as many symptoms occur in other psychiatric disorders. Input from significant others and objective childhood measures (like school report cards) can support a more thorough adult evaluation.
Functional Impairment
Diagnosis of any psychiatric disorder, including ADHD, has 3 essential components: (1) a minimum number of symptoms, (2) symptoms persisting for a minimum period of time, and (3) symptoms causing impairment of functioning in one or more life areas. In ADHD, symptoms must be present in 2 or more settings and must clearly interfere with, or reduce the quality of, social, academic, or occupational functioning.
Comorbidity
Patients with Adult ADHD often suffer from other (comorbid) conditions including depression, anxiety disorders, substance use disorders, and personality disorders. One review (Sobanski 2006) reported that 65–89% of patients with ADHD suffered from one or more additional psychiatric disorders during their lifespan, complicating diagnostics, treatment, and outcomes. Assessment by an expert in both ADHD and the wider range of mimicking or complicating disorders is essential.
Cannabis Use & ADHD
Cannabis use may affect cognition, memory, and executive function, so screening for cannabis use and cannabis use disorder is important during an ADHD assessment. In patients with comorbid cannabis use and attention problems (diagnosed as ADHD), it may be best to decrease or stop cannabis use rather than take a stimulant — see Substance Use Disorders.
Medical Monitoring of Patients on ADHD Treatment
Before commencing stimulant or non-stimulant treatment, a personal and family cardiac history is taken. Baseline blood pressure and heart rate are measured and then monitored periodically during treatment. ECG screening and cardiologist referrals are only recommended if indicated (Hammerness et al. 2011). Studies suggest stimulants have a more profound effect on heart rate than on blood pressure (Mick E et al. 2013). A persistent heart rate above 80 bpm may warrant a change in treatment (Perret-Guillaume C et al. 2009).
The National Institute for Health and Care Excellence (NICE) in the UK has published monitoring guidelines.
Recommended Reading
1. Taking Charge of Adult ADHD by Russell Barkley PhD.
2. Mastering Your Adult ADHD: A Cognitive-Behavioral Treatment Program by Safren, Sprich, Perlman & Otto
Sleep Disturbance with ADHD
Insomnia, a side-effect observed with ADHD medications, may exist before treatment — sleep pattern should be assessed before starting medication. One study found that adults with ADHD (controlling for stimulant use) complained of both difficulty falling asleep and restless sleep (Surman 2009). Other studies found sleep disturbance was associated with the hyperactivity/impulsivity dimension rather than the inattentive dimension.
| Score | Interpretation |
|---|---|
| 0–7 | No clinically significant insomnia |
| 8–14 | Mild to moderate severity |
| 15–21 | Warrants further evaluation and possible treatment |
Comorbid depression or anxiety complicate the presentation.