How Can You Identify ADHD in Children?

Using the Vanderbilt Screening Tool

Parents commonly wonder if their child has ADHD but this disorder is only one reason why your child may seem to be inattentive or hyperactive. Though the diagnosis of ADHD can only be made after observing and quantifying different aspects of the child's behavior in at least two settings, the first step always starts with obtaining the parents' impressions of their child.

Validated test using standardize questions

Probably the most widely used initial screening tool for ADHD is the National Institute for Children's Health Quality's (NICHQ) Vanderbilt Assessment Scale. The parent-informant version of this scale can be found below and can be used to help start the process of evaluation a child for this disorder. It is fully automated and scored instantly.

This scale uses questions to help identify potential behaviors which are required to meet the formal criteria for diagnosis of ADHD. This is not a definitive test; in fact, by definition, observations must also be made by informants who are in a different setting other than home (typically school)

However, this tool is extremely useful and clinicians will often ask to have this questionnaire completed even before the first visit in order to focus the initial evaluation on relevant aspects of the patient's history.

Positive, negative, and alternative diagnoses

As you would expect, this screening tools attempts to identify behaviors / qualities in children which suggest ADHD, but there are numerous reasons why a patient may appear distractible and restless.

For instance children (or anyone for that matter) suffering from depression may experience cognitive difficulties which can look like ADHD. Actually, the diagnosis of ADHD cannot be made in the context of active clinically significant mood conditions such as Major Depression (MDD). Similarly, anxiety and the consequences of severe anxiety can also manifest in a manner similar to ADHD. For this reason, you will notice that there are questions pertaining to non-ADHD factors which can exclude this diagnosis.

Other behavioral disorders

There are some common conditions such as Oppositional Defiant Disorder (ODD) and more uncommon ones such as Conduct Disorder (CD) which also may initially appear to be ADHD. Indeed, these disorders are highly comorbid with ADHD but are not always associated.

For this reason, the Vanderbilt screening tool includes some questions that will be useful for clinicians in helping them understand behavioral traits in the child which could dictate how treatment is approached.

In certain circumstances, conditions such as ODD and CD are actually the primary diagnosis for patients who originally present with concerns about ADHD and treatment of these other conditions should be the priority.

Appropriate Usage

Again, keep in mind the screening tool below cannot make the diagnosis of ADHD but it can be extremely useful to complete before a child's evaluation as well as a tool to guide parents decision about seeking help for their child.

NICHQ Vanderbilt Assessment Scales -- PARENT Informant

Today's Date: Child's Name: Date of Birth:

Parent's Name: Parent Contact Info:

Direction: Each rating should be considered in the context of what is appropriate for the age of your child. When completing this form, please think about your child's behaviors in the past 6 months.

Is this evaluation based on a time when the child: was on medication was not on medication not sure?

Symptoms	Never	Occasionally	Often	Very Often
1. Does not pay attention to details or makes careless mistakes with, for example, homework	0	1	2	3
2. Has difficulty keeping attention to what needs to be done	0	1	2	3
3. Does not seem to listen when spoken to directly	0	1	2	3
4. Does not follow through when given directions and fails to finish activities (not due to refusal or failure to understand)	0	1	2	3
5. Has difficulty organizing tasks and activities	0	1	2	3
6. Avoids, dislikes, or does not want to start tasks that require ongoing mental effort	0	1	2	3
7. Loses things necessary for tasks or activities (toys, assignments, pencils, or books)	0	1	2	3
8. Is easily distracted by noises or other stimuli	0	1	2	3
9. Is forgetful in daily activities	0	1	2	3
10. Fidgets with hands or feet or squirms in seat	0	1	2	3
11. Leaves seat when remaining seated is expected	0	1	2	3
12. Runs about or climbs too much when remaining seated is expected	0	1	2	3
13. Has difficulty playing or beginning quiet play activities	0	1	2	3
14. Is “on the go” or often acts as if “driven by a motor”	0	1	2	3
15. Talks too much	0	1	2	3
16. Blurts out answers before questions have been completed	0	1	2	3
17. Has difficulty waiting his or her turn	0	1	2	3
18. Interrupts or intrudes in on others’ conversations and/or activities	0	1	2	3
19. Argues with adults	0	1	2	3
20. Loses temper	0	1	2	3
21. Actively defies or refuses to go along with adults’ requests or rules	0	1	2	3
22. Deliberately annoys people	0	1	2	3
23. Blames others for his or her mistakes or misbehaviors	0	1	2	3
24. Is touchy or easily annoyed by others	0	1	2	3
25. Is angry or resentful	0	1	2	3
26. Is spiteful and wants to get even	0	1	2	3
27. Bullies, threatens, or intimidates others	0	1	2	3
28. Starts physical fights	0	1	2	3
29. Lies to get out of trouble or to avoid obligations (ie,“cons” others)	0	1	2	3
30. Is truant from school (skips school) without permission	0	1	2	3
31. Is physically cruel to people	0	1	2	3
32. Has stolen things that have value	0	1	2	3
33. Deliberately destroys others’ property	0	1	2	3
34. Has used a weapon that can cause serious harm (bat, knife, brick, gun)	0	1	2	3
35. Is physically cruel to animals	0	1	2	3
36. Has deliberately set fires to cause damage	0	1	2	3
37. Has broken into someone else’s home, business, or car	0	1	2	3
38. Has stayed out at night without permission	0	1	2	3
39. Has run away from home overnight	0	1	2	3
40. Has forced someone into sexual activity	0	1	2	3
41. Is fearful, anxious, or worried	0	1	2	3
42. Is afraid to try new things for fear of making mistakes	0	1	2	3
43. Feels worthless or inferior	0	1	2	3
44. Blames self for problems, feels guilty	0	1	2	3
45. Feels lonely, unwanted, or unloved; complains that “no one loves him or her”	0	1	2	3
46. Is sad, unhappy, or depressed	0	1	2	3
47. Is self-conscious or easily embarrassed	0	1	2	3

Performance	Excellent	Above Average	Average	Somewhat of a Problem	Problematic
48. Overall school performance	1	2	3	4	5
49. Reading	1	2	3	4	5
50. Writing	1	2	3	4	5
51. Mathematics	1	2	3	4	5
52. Relationship with parents	1	2	3	4	5
53. Relationship with siblings	1	2	3	4	4
54. Relationship with peers	1	2	3	4	5
55. Participation in organized activities (eg: teams)	1	2	3	4	5

Sources

M Wolraich, W Lambert, M Doffing, L Bickman, T Simmons, K Worley. Psychometric Properties of the Vanderbilt ADHD Diagnostic Parent Rating Scale in a Referred Population. Journal of Pediatric Psychology. 28(8): 559-568 (2003).