Attention Deficit Hyperactivity Disorder (ADHD) Workup
- Author: Stephen Soreff, MD; Chief Editor: Glen L Xiong, MD more...
The diagnosis of attention deficit hyperactivity disorder (ADHD) is based on clinical evaluation. No laboratory-based medical tests are available to confirm the diagnosis.
Basic laboratory studies that may help confirm diagnosis and aid in treatment are as follows:
Serum CBC count with differential
Liver function tests (before beginning stimulant therapy)
Thyroid function tests
Brain imaging, such as functional MRI or single photon emission computed tomography (SPECT) scans have been useful for research, but no clinical indication exists for these procedures because the diagnosis is clinical.
The Conners Parent-Teacher Rating Scale is a questionnaire that can be given to both the parents and the child's teachers.
Barkley Home Situations Questionnaire may be useful.
The Wender Utah Rating Scale may be helpful in diagnosing ADHD in adults.
The Continuous Performance Tests (CPTs) are computer-based tasks that often are used to test attention and may be used in conjunction with clinical information to make a diagnosis. A currently popular example is the Test of Variable Attention (TOVA). While these tests can be supportive of the diagnosis in a full clinical evaluation, they have low sensitivity and specificity and should not be the sole basis for diagnosis.
Vision and hearing should be checked.
Moffitt TE, Houts R, Asherson P, Belsky DW, Corcoran DL, Hammerle M, et al. Is Adult ADHD a Childhood-Onset Neurodevelopmental Disorder? Evidence From a Four-Decade Longitudinal Cohort Study. Am J Psychiatry. 2015 May 22. appiajp201514101266. [Medline].
Rosack J. PET Scans Reveal Action of Methylphenidate in Brain. Psychiatric News. Sept 21, 2001. 36, 18:
Kooistra L, van der Meere JJ, Edwards JD, Kaplan BJ, Crawford S, Goodyear BG. Preliminary fMRI findings on the effects of event rate in adults with ADHD. J Neural Transm. 2010 Feb 16. [Medline].
Cherkasova MV, Hechtman L. Neuroimaging in attention-deficit hyperactivity disorder: beyond the frontostriatal circuitry. Can J Psychiatry. 2009 Oct. 54(10):651-64. [Medline].
Yang P, Wu MT, Dung SS, Ko CW. Short-TE proton magnetic resonance spectroscopy investigation in adolescents with attention-deficit hyperactivity disorder. Psychiatry Res. 2010 Feb 10. [Medline].
Sobel LJ, Bansal R, Maia TV, Sanchez J, Mazzone L, Durkin K, et al. Basal Ganglia surface morphology and the effects of stimulant medications in youth with attention deficit hyperactivity disorder. Am J Psychiatry. 2010 Aug. 167(8):977-86. [Medline].
Shaw P, Gilliam M, Liverpool M, et al. Cortical development in typically developing children with symptoms of hyperactivity and impulsivity: support for a dimensional view of attention deficit hyperactivity disorder. Am J Psychiatry. 2011 Feb. 168(2):143-51. [Medline].
Volkow ND, Wang GJ, Newcorn J, Telang F, Solanto MV, Fowler JS, et al. Depressed dopamine activity in caudate and preliminary evidence of limbic involvement in adults with attention-deficit/hyperactivity disorder. Arch Gen Psychiatry. 2007 Aug. 64(8):932-40. [Medline].
Morein-Zamir S, Hommersen P, Johnston C, Kingstone A. Novel Measures of Response Performance and Inhibition in Children with ADHD. J Abnorm Child Psychol. 2008 May 9. [Medline].
Akinbami LJ, Liu X, Pastor PN, Reuben CA. Attention deficit hyperactivity disorder among children aged 5-17 years in the United States, 1998-2009. NCHS Data Brief. 2011 Aug. 1-8. [Medline].
Goodman DW, Thase ME. Recognizing ADHD in adults with comorbid mood disorders: implications for identification and management. Postgrad Med. 2009 Sep. 121(5):20-30. [Medline].
Semiz UB, Basoglu C, Oner O, Munir KM, Ates A, Algul A, et al. Effects of diagnostic comorbidity and dimensional symptoms of attention-deficit-hyperactivity disorder in men with antisocial personality disorder. Aust N Z J Psychiatry. 2008 May. 42(5):405-13. [Medline].
Upadhyaya HP, Carpenter MJ. Is attention deficit hyperactivity disorder (ADHD) symptom severity associated with tobacco use?. Am J Addict. 2008 May-Jun. 17(3):195-8. [Medline].
Reiersen AM, Todd RD. Co-occurrence of ADHD and autism spectrum disorders: phenomenology and treatment. Expert Rev Neurother. 2008 Apr. 8(4):657-69. [Medline].
Halmoy A, Halleland H, Dramsdahl M, Bergsholm P, Fasmer OB, Haavik J. Bipolar symptoms in adult attention-deficit/hyperactivity disorder: a cross-sectional study of 510 clinically diagnosed patients and 417 population-based controls. J Clin Psychiatry. 2010 Jan. 71(1):48-57. [Medline].
Arcos-Burgos M, Jain M, Acosta MT, Shively S, Stanescu H, Wallis D, et al. A common variant of the latrophilin 3 gene, LPHN3, confers susceptibility to ADHD and predicts effectiveness of stimulant medication. Mol Psychiatry. 2010 Feb 16. [Medline].
Kopecková M, Paclt I, Petrásek J, Pacltová D, Malíková M, Zagatová V. Some ADHD polymorphisms (in genes DAT1, DRD2, DRD3, DBH, 5-HTT) in case-control study of 100 subjects 6-10 age. Neuro Endocrinol Lett. 2008 Apr. 29(2):246-51. [Medline].
Faraone SV, Mick E. Molecular Genetics of Attention Deficit Hyperactivity Disorder. Psychiatr Clin North Am. 2010 Mar. 33(1):159-180. [Medline]. [Full Text].
Bellgrove MA, O'Connell RG, Vance A. Genetics of cognitive deficits in ADHD: clues for novel treatment methods. Expert Rev Neurother. 2008 Apr. 8(4):553-61. [Medline].
Padrón A, Galán I, García-Esquinas E, Fernández E, Ballbè M, Rodríguez-Artalejo F. Exposure to secondhand smoke in the home and mental health in children: a population-based study. Tob Control. 2015 Mar 25. [Medline].
Martel MM, Nikolas M, Jernigan K, Friderici K, Nigg JT. Personality Mediation of Genetic Effects on Attention-Deficit/Hyperactivity Disorder. J Abnorm Child Psychol. 2010 Feb 10. [Medline].
Tcheremissine OV, Salazar JO. Pharmacotherapy of adult attention deficit/hyperactivity disorder: review of evidence-based practices and future directions. Expert Opin Pharmacother. 2008 May. 9(8):1299-310. [Medline].
Volkow ND, Swanson JM. Does childhood treatment of ADHD with stimulant medication affect substance abuse in adulthood?. Am J Psychiatry. 2008 May. 165(5):553-5. [Medline].
Mannuzza S, Klein RG, Truong NL, Moulton JL 3rd, Roizen ER, Howell KH, et al. Age of methylphenidate treatment initiation in children with ADHD and later substance abuse: prospective follow-up into adulthood. Am J Psychiatry. 2008 May. 165(5):604-9. [Medline].
Semrud-Clikeman M, Pliszka S, Liotti M. Executive functioning in children with attention-deficit/hyperactivity disorder: Combined type with and without a stimulant medication history. Neuropsychology. 2008 May. 22(3):329-40. [Medline].
Blader JC, Schooler NR, Jensen PS, Pliszka SR, Kafantaris V. Adjunctive divalproex versus placebo for children with ADHD and aggression refractory to stimulant monotherapy. Am J Psychiatry. 2009 Dec. 166(12):1392-401. [Medline].
Solanto MV, Marks DJ, Wasserstein J, Mitchell K, Abikoff H, Alvir JM, et al. Efficacy of Meta-Cognitive Therapy for Adult ADHD. Am J Psychiatry. 2010 Aug. 167(8):958-968. [Medline].
Pelham WE Jr, Fabiano GA. Evidence-based psychosocial treatments for attention-deficit/hyperactivity disorder. J Clin Child Adolesc Psychol. 2008 Jan. 37(1):184-214. [Medline].
Young S, Myanthi Amarasinghe J. Practitioner Review: Non-pharmacological treatments for ADHD: A lifespan approach. J Child Psychol Psychiatry. 2009 Nov 4. [Medline].
Sonuga-Barke EJ, Brandeis D, Cortese S, et al. Nonpharmacological Interventions for ADHD: Systematic Review and Meta-Analyses of Randomized Controlled Trials of Dietary and Psychological Treatments. Am J Psychiatry. 2013 Mar 1. 170(3):275-89. [Medline].
Adler LD, Nierenberg AA. Review of medication adherence in children and adults with ADHD. Postgrad Med. 2010 Jan. 122(1):184-91. [Medline].
Hosenbocus S, Chahal R. A review of long-acting medications for ADHD in Canada. J Can Acad Child Adolesc Psychiatry. 2009 Nov. 18(4):331-9. [Medline]. [Full Text].
Buitelaar J, Medori R. Treating attention-deficit/hyperactivity disorder beyond symptom control alone in children and adolescents: a review of the potential benefits of long-acting stimulants. Eur Child Adolesc Psychiatry. 2009 Oct 13. [Medline]. [Full Text].
Cassels, C. FDA Okays Once-Daily Dyanavel XR for ADHD in Children. Medscape Medical News. Available at http://www.medscape.com/viewarticle/852988. October 21, 2015; Accessed: October 27, 2015.
Pfizer. Pfizer Receives U.S. FDA Approval of New QuilliChew ER™ (methylphenidate hydrochloride) extended-release chewable tablets CII. December 7, 2015. Available at http://www.pfizer.com/news/press-release/press-release-detail/pfizer_receives_u_s_fda_approval_of_new_quillichew_er_methylphenidate_hydrochloride_extended_release_chewable_tablets_cii?linkId=19384409.
Chang Z, Lichtenstein P, D'Onofrio BM, Sjölander A, Larsson H. Serious Transport Accidents in Adults With Attention-Deficit/Hyperactivity Disorder and the Effect of Medication: A Population-Based Study. JAMA Psychiatry. 2014 Jan 29. [Medline].
Habel LA, Cooper WO, Sox CM, et al. ADHD medications and risk of serious cardiovascular events in young and middle-aged adults. JAMA. 2011 Dec 28. 306(24):2673-83. [Medline].
FDA. FDA warns of rare risk of long-lasting erections in males taking methylphenidate ADHD medications and has approved label changes. US Food and Drug Administration. Available at http://www.fda.gov/Drugs/DrugSafety/ucm375796.htm. Accessed: January 16, 2014.
Webb JR, Valasek MA, North CS. Prevalence of stimulant use in a sample of US medical students. Ann Clin Psychiatry. 2013 Feb. 25(1):27-32. [Medline].
Lichtenstein P, Halldner L, Zetterqvist J, et al. Medication for attention deficit-hyperactivity disorder and criminality. N Engl J Med. 2012 Nov 22. 367(21):2006-14. [Medline]. [Full Text].
Klein RG, Mannuzza S, Olazagasti MA, et al. Clinical and Functional Outcome of Childhood Attention-Deficit/Hyperactivity Disorder 33 Years Later. Arch Gen Psychiatry. 2012 Oct 15. 1-9. [Medline].
Chronis-Tuscano A, Molina BS, Pelham WE, Applegate B, Dahlke A, Overmyer M, et al. Very early predictors of adolescent depression and suicide attempts in children with attention-deficit/hyperactivity disorder. Arch Gen Psychiatry. 2010 Oct. 67(10):1044-51. [Medline].
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR). 4th ed. Washington, DC: American Psychiatric Association; 2000. 78-85.
Faraone SV, Perlis RH, Doyle AE, et al. Molecular genetics of attention-deficit/hyperactivity disorder. Biol Psychiatry. 2005 Jun 1. 57(11):1313-23. [Medline].
Faraone SV, Sergeant J, Gillberg C, Biederman J. The worldwide prevalence of ADHD: is it an American condition?. World Psychiatry. 2003 Jun. 2(2):104-113. [Medline].
Kaplan HI, Sadock BJ, Grebb JA. Kaplan and Sadock's Synposis of Psychiatry. 7th ed. Baltimore, Md: Williams & Wilkins; 1994. 1063-8.
Rugino TA, Samsock TC. Modafinil in children with attention-deficit hyperactivity disorder. Pediatr Neurol. 2003 Aug. 29(2):136-42. [Medline].
Shillington AM, Reed MB, Lange JE, Clapp JD, Henry S. College undergraduate Ritalin abusers in Southwestern California: Protective and Risk Factors. J Drug Iss. 2006. 36:4:999-1014.
Spencer T, Biederman J, Wilens T. Nonstimulant treatment of adult attention-deficit/hyperactivity disorder. Psychiatr Clin North Am. 2004 Jun. 27(2):373-83. [Medline].
White BP, Becker-Blease KA, Grace-Bishop K. Stimulant medication use, misuse, and abuse in an undergraduate and graduate student sample. J Am Coll Health. 2006 Mar-Apr. 54(5):261-8. [Medline].