Pediatric Attention Deficit Hyperactivity Disorder (ADHD) Workup

Updated: Mar 31, 2022
  • Author: Maggie A Wilkes, MD; Chief Editor: Caroly Pataki, MD  more...
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Laboratory Studies

Workup in attention deficit hyperactivity disorder (ADHD), previously termed attention deficit disorder (ADD), includes the following:

Liver function tests

Liver function tests (LFTs) may be indicated if the patient has a history of hepatic dysfunction.

Amphetamines, methylphenidate, atomoxetine, and tricyclic antidepressants are metabolized hepatically and excreted mainly in the urine.

A cause-and-effect relationship has been established between the use of atomoxetine and reversible hepatic failure. However, no evidence suggests that baseline LFT results assist care with atomoxetine in any way.

Consider checking LFTs if a patient who is taking atomoxetine presents with signs of hepatitis including early signs, such as nausea, vomiting, diarrhea, and muscle aches lasting longer than 5 days.

Determination of CBC counts

A coincident relationship has been reported, but no cause-and-effect relationship has been established between use of methylphenidate and blood dyscrasias.

A few clinical authorities recommend periodic determination of the CBC counts, but their necessity is not generally endorsed, even for patients receiving long-term treatment.

Drug screening

Consider periodic random drug screening by means of urine testing (witnessed) or serum testing (if witnessing of urine testing is not possible) in all patients with a history of chemical abuse or suspected chemical abuse.

Any suspected substances should be investigated.


Imaging Studies

Evidence suggests that MRI and positron emission tomography (PET) may be useful as future diagnostic methods. Current use is appropriate for research purposes only.

At present, no laboratory studies, imaging studies, or procedures help with the diagnosis of ADHD (ADD), unless the patient's history suggests that other pathology must be ruled out.


Other Tests

Psychometric and educational testing is often important for the diagnosis of ADHD (ADD). The patient's initial history may indicate a need for additional tests, as follows:

  • Examine children by using the Conners' Parent and Teacher Rating Scale and examine adolescents according to the Brown Attention Deficit Disorder Scale (BADDS) for Adolescents and Adults. [2]

  • Assess impulsivity and inattention using timed computer tests such as the Conners Continuous Performance Test (CPT), the Integrated Visual and Auditory (IVA) CPT, or both.

  • Assess girls using the Nadeau/Quinn/Littman ADHD Self-Rating Scale for Girls.

  • Assess the patient's executive function by using various neuropsychologic tests.

  • Perform a learning disability evaluation (intelligence quotient [IQ] vs achievement).

  • Several well-validated IQ tests are available. The Wechsler tests are the standards. Many believe that untimed tests are most appropriate for persons with ADHD (ADD). A large discrepancy between the patient's IQ and other measures, such as visual or auditory abilities or an ability to work with numbers, is not uncommon, particularly in older children and adolescents

  • Baseline ECG to access the QT interval may be indicated before a tricyclic antidepressant is prescribed.

In 2013, the Neuropsychiatric EEG-Based Assessment Aid (NEBA) System became the first FDA-approved, brain function–based medical device for use in the diagnosis of ADHD in children and adolescents aged 6-17 years. Although it is not meant to be used alone as a means of confirming the presence of ADHD, it can be employed in combination with a complete medical and psychological assessment to help confirm the diagnosis or to indicate the direction that further testing should take. Using electroencephalographic technology, the NEBA system calculates the ratio of theta and beta brain waves, which is comparatively high in children and adolescents with ADHD. [7, 8]