How Is ADHD Diagnosed in Children? The Process Step by Step

When a teacher or a relative says "this child is a bit too active, you should have them looked at," the first question that usually comes to mind is: where will we go and what will they do there?

Knowing the process reduces both unnecessary worry and the expectation that "a test will tell." This article explains how ADHD is diagnosed in children, what will be asked of you and how you can prepare for the meeting.

Who makes the diagnosis

In Turkey the ADHD diagnosis is made by a specialist in child and adolescent mental health and diseases. A family doctor or a pediatrician can listen to the situation at the first level and refer you, but for the diagnosis and the treatment plan you need to go to this specialist.

A psychologist and a pedagogue can provide assessment and support in the process. The medical diagnosis, however, is the doctor's responsibility. For the reporting and educational support side you can look at the article on the RAM (the Guidance and Research Center) report.

There is no single test

A blood test, imaging or an "attention test" for ADHD does not make the diagnosis on its own. The diagnosis is made by putting together information collected by an experienced doctor. The main pieces of this information are as follows.

Interview with the parents. The doctor asks about the child's developmental history: pregnancy and birth, speech and motor development, sleep, eating, illnesses they have had. Then they ask when the symptoms began, in which settings they appear and how they affect daily life.

Interview with the child and observation. The child's behavior during the interview gives information but is not decisive on its own. A child sitting calmly in the doctor's office does not mean they do not have ADHD; what happens in the classroom and at home is at least as important. In a new, interesting setting the symptoms may be seen less.

Information from school. The scales the teacher fills in, or written observations, show whether the symptoms are also seen in a second setting. Asking for this information is not the doctor questioning you; it is a requirement of the diagnostic criterion.

Rating scales. Standard forms filled in by the parent and the teacher are used. There are scales adapted for Turkey, and the doctor decides which will be used. A scale does not make the diagnosis on its own; it supports or puts a question mark over the impression from the interview.

Additional assessments. If it is thought necessary, tests such as intelligence and attention tests, hearing and vision examinations and blood tests are requested. Their purpose is not to prove ADHD but to separate out other conditions that look similar. For learning difficulty, the article on ADHD and learning difficulties may be a complement.

The criteria required for a diagnosis

According to DSM-5, the following need to be present together for a diagnosis:

• A sufficient number of inattention or hyperactivity and impulsivity symptoms. A threshold of six symptoms is used in children, five at age 17 and over.
• The symptoms having started before the age of 12.
• The symptoms being seen in at least two settings: for example home and school.
• The symptoms causing real impairment in school, relationships or daily functioning.
• The symptoms not being better explained by another mental or medical condition.

For the detailed list of symptoms you can look at the article on ADHD symptoms in children. What matters here is this: although the "six out of nine symptoms" criterion looks like a counting job, the doctor looks at loss of function more than at the number.

Conditions the doctor tries to rule out

A problem with attention and being active does not on its own mean ADHD. The doctor also considers pictures that look similar:

• sleep problems and snoring or sleep apnea
• hearing and vision problems
• anxiety disorders and depression
• learning difficulty, and education not matched to the level of intelligence
• a recent change of home or school, a crisis in the family, a loss
• the autism spectrum. The two can also exist together, which is why AuDHD is a separate heading.

This list is here not to cause worry but so that you understand why the doctor asks a few more questions.

Preparing for the meeting

A short preparation makes the meeting much more productive.

• Write down three or four behaviors you are worried about, with concrete examples. Instead of "they have no attention," "they get up every ten minutes during homework, and one page takes an hour."
• Think about when the symptoms began. If there is something you remember from preschool, note it down.
• Take school report cards, teacher notes and any previous reports.
• Roughly write down the child's sleep, appetite and screen time.
• Think about whether anyone in the family has ADHD, a learning difficulty or a similar diagnosis. The doctor asks about this because the hereditary influence in ADHD is strong.

Instead of listing the child's "problems" at length in front of them, giving part of it in writing or talking about it separately, if possible, also helps so that the child does not feel bad.

How long it takes

In some cases the diagnosis can be made in the first meeting. Most of the time it takes one to a few meetings, because the school information and the scales are collected. The doctor may ask for a period of observation. This is not indecision; it is the importance of the correct diagnosis.

After the diagnosis the treatment plan is made together. It varies by age: in preschool children the first step is parent training, and at school age medication and behavioral support can be considered together. For a frequently asked question about medication you can read the article on medication and growth in height.

The decision is yours and is reviewed over time

A diagnosis is not a label; it is a framework used to understand the child's needs. What is done after the diagnosis is planned with the child and their needs in mind, reassessed and, if needed, changed. When you do not understand what the doctor says, asking and getting a second opinion are your right.

This article is for information. For decisions about your child, the person to consult is the doctor who sees and assesses them.