Worldwide, an estimated 2–5% of the population experiences symptoms of attention deficit hyperactivity disorder (ADHD). However, with overtaxed mental health systems across the world, diagnosing ADHD can take months or even years.
By leveraging advancements in digital cognitive testing, providers can make ADHD assessments more accessible without compromising scientific validity or result accuracy. This may mean shorter wait times, less risk of misdiagnosis, and higher quality of care for patients.
In this post, we’ll explore the ways that pairing tried and true behavioral questionnaires with cognitive tasks can reduce barriers to diagnosis and improve clinical decision-making.
Why Does ADHD Diagnosis Take So Long?
Getting ADHD diagnosed is a multistep process that typically involves initial screening as well as conducting clinical interviews. Only after providers have sufficient data can a diagnosis be made and a treatment plan be made. While many individuals may show signs that resemble ADHD, these symptoms may be a manifestation of another related condition or may stem from a different reason entirely. An accurate diagnosis of ADHD must meet specific diagnostic criteria.
Initial ADHD Screening
ADHD symptoms can significantly impact a patient’s daily life; a quick assessment by a family doctor or mental health professional can offer clarity, but an official diagnosis can open the door for long-term assistance. Initially, a patient might brush off symptoms as being “a little spacey” or “a little restless,” but if these traits lead to real-world consequences, intervention is important.
For example, an adult struggling with overwhelming disorganization, poor task follow-through, and constant distractions at work may experience burnout. A screen can help to identify whether these issues stem from ADHD or other causes.
The Diagnostic and Statistical Manual (DSM-5) outlines three types of attention deficit hyperactivity disorder:
- Inattentive type: Patients often miss details, struggle with sustained mental effort, or are easily distracted.
- Hyperactive-impulsive type: Patients fidget, talk excessively, interrupt, or act without thinking.
- Combined type: Patients meet criteria for both inattentive and hyperactive-impulsive ADHD.
To meet the DSM-5 criteria for diagnosing ADHD, patients must:
- Experience six or more symptoms (or five for adults)
- Have persistent symptoms present for at least 6 months
- Have symptoms present before the age of 12
- Have symptoms appear in two or more settings (e.g., home and school)
- Have symptom-related challenges with social, academic, or occupational functioning
- Symptoms cannot be better explained by another mental disorder or medical condition
A quick initial screen, potentially billable through CPT Code 96127, is often the first step in getting the diagnostic process moving, and is meant to flag whether or not deeper evaluation is needed.
Standardized behavior rating scales offer useful structure, but they rely heavily on subjective interpretation of symptoms. Combining them with digital cognitive assessment tools, such as those offered by Creyos, helps providers also gather objective data regarding ADHD symptoms.
Diagnostic Interviews
If the initial screen flags symptoms consistent with ADHD, the next step in diagnosing ADHD is likely a structured interview. This may take place in primary care settings or through referrals to psychologists, psychiatrists, or other trained healthcare providers.
A diagnostic interview typically includes:
- Medical exam to identify or rule out other physical causes: Some ADHD symptoms can be linked to issues like sleep disturbances or seizure disorders like epilepsy. In fact, 20-50% of children with epilepsy have co-occurring ADHD, so a full medical evaluation can provide some necessary context.
- Screenings for other mental health conditions: Mood disorders, anxiety disorders, and trauma-related symptoms can exacerbate or mimic ADHD. Examining both the patient's and family members' medical history can also gather key data.
- Screen for ADHD comorbidities: Many individuals with ADHD also meet criteria for disorders like depression, anxiety disorders, or learning disabilities. Recognizing comorbidities can help providers create more personalized plans to effectively treat ADHD.
- Teacher rating scales for diagnosing children or adolescents: Performance history, academic difficulty, disciplinary actions, and feedback from teachers, guidance counselors, or school nurses are sometimes gathered to gain insight into a child’s symptom presentation in an academic setting.
- Involve family members: Especially in pediatric cases, immediate family members may be asked to provide information about behavior patterns in various environments.
Build a Treatment Plan
After reaching a proper diagnosis, treatment is often individualized based on symptom severity, age, and any comorbid conditions.
ADHD treatment typically involves a combination of:
- Medications: Both stimulant and non-stimulant ADHD medicines can help patients regulate their attention and impulse control. The specific medication recommended will depend on the patient's specific medical needs.
- Behavioral interventions: Coaching and skill training for both adult ADHD patients and parents of children with ADHD may improve functioning over time.
- Educational planning: For children and adolescents with ADHD, implementing an individualized education plan (IEP) can help patients succeed in school when used as part of a comprehensive support plan.
About 32% of children with ADHD receive a combination of medication and behavioral treatment for the condition, offering support from multiple angles.
Continuous Testing for Treatment Monitoring
Ongoing treatment requires more than a one-time ADHD test. Monitoring both subjective reports and objective data helps clinicians determine whether interventions are actually working.
This is especially important when medication is used to treat ADHD. Medication can improve cognitive function, but can also introduce side effects.
Readministering ADHD self-reports can gather snapshots of patients’ lived experiences with symptoms. However, online cognitive assessments can objectively track changes in attention, memory, and processing speed across multiple appointments. Combining these tools keeps treatment plans adaptive and responsive to each patient’s needs.
Behavioral Questionnaires for ADHD Assessment
Behavioral questionnaires remain a cornerstone of ADHD assessment, offering quick, low-cost insight into core symptoms and impairment. However, their reliance on subjective reporting can impact accuracy when diagnosing ADHD, especially when comorbid mental health disorders are involved.
Common ADHD questionnaires include:
- Vanderbilt ADHD Diagnostic Rating Scales (VADRS): For younger children aged 6–12, the VADRS assesses symptoms of ADHD and common comorbidities like ODD and anxiety. It includes parent and teacher forms and aligns with DSM criteria.
- Conners Rating Scales (3rd Edition): For ages 6–18, the Conners-3 offers detailed behavioral assessments across settings. It includes input from parents, teachers, and the child, and screens for mood and conduct issues.
- Strengths and Weaknesses of ADHD-symptoms and Normal-behavior (SWAN): For children under 18, the SWAN rates both strengths and weaknesses in ADHD-related behaviors. It captures subtle traits and offers a more balanced view of ADHD.
- Adult ADHD Self-Report Scale (ASRS-v1.1): Developed with the WHO, the ASRS-v1.1 screens for adult ADHD using 18 items. It’s quick, accessible, and useful for identifying symptoms, though not diagnostic on its own.
While these tools help clinicians gather input from multiple observers, they are prone to bias, overreporting, and underreporting. Pairing them with objective cognitive assessments adds critical context to support a diagnosis of ADHD.
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Barriers to Getting ADHD Diagnosed
Despite growing awareness, getting an ADHD diagnosis comes with a few hurdles:
Long wait times
In many regions, patients face months-long referral delays before they can see a specialist for an ADHD assessment. With rising demand for diagnosing ADHD, primary care providers are often overburdened, and patients may bounce between professionals before receiving a proper diagnosis.
Digital screening tools can provide accurate data early, streamlining triage and reducing unnecessary referrals. For SohoMD, working with Creyos helps them diagnose and stabilize ADHD symptoms in as few as four visits.
Stigma
In one study, 25% of parents said they would not want their child to make friends with a child with ADHD. For children, ADHD stigma often stems from school settings, where kids are expected to sit still, focus, and follow routines. Their ADHD symptoms can affect feedback from teachers and peers, who may be more likely to reject children with ADHD as friends.
Stigma also leads to low self-esteem for adults with ADHD, who may internalize symptoms as personal failures. This stigma delays help-seeking.
Masking
Many individuals, and especially women and girls with ADHD, develop coping strategies that mask ADHD symptoms. While masking can make it easier to “fit in,” it also often leads to late or missed diagnoses.
Chronic masking is also linked to ADHD burnout, where executive dysfunction is related to breakdowns in work, relationships, and mental health.
Social factors
ADHD diagnosis is shaped by social factors like gender and race. For example, girls with ADHD are more often overlooked because of how symptoms typically present, and as a result, are diagnosed an average of five years later than boys. Studies show that 6% of girls between the ages of 3 and 17 are diagnosed with ADHD, while 13% of boys in the same cohort receive a diagnosis.
When it comes to racial bias, African American and Hispanic youth are more likely to receive a disruptive behavior disorder diagnosis rather than ADHD compared to their White peers.
Cognitive Impact of Childhood and Adult ADHD
Along with behavioral challenges, ADHD is linked with cognitive performance across patients’ lifespans. Both adults and children with ADHD commonly experience impairments in executive function, working memory, processing speed, and sustained attention.
In children, these deficits often show up as:
- Difficulty completing tasks that require sustained mental effort
- Trouble following multi-step instructions
- Frequent careless mistakes in schoolwork
- Emotional dysregulation and impulsivity
As children mature, these symptoms may evolve rather than disappear.
Adults with ADHD often report:
- Chronic disorganization
- Differences in time perception
- Difficulty switching between tasks
- Forgetfulness in daily responsibilities
- Reduced tolerance for frustration
While symptoms may present differently with age, they are linked with the same underlying cognitive challenges. This is where objective cognitive assessments add value to ADHD screening. By tracking performance on key domains like attention, memory, and executive function, providers can observe how symptoms objectively affect functioning—not just how patients describe them.
Confidently Diagnosing ADHD With Digital Cognitive Testing
The Creyos Health ADHD Protocol and Report offers a scientifically validated digital approach to diagnosing ADHD and guiding treatment. It combines standardized questionnaires with five cognitive tasks measuring 14 key ADHD markers, helping providers quickly and confidently assess both subjective and objective symptoms.
The Creyos ADHD protocol and automated report offers:
- Age and gender-matched normative comparisons to support patients across different demographics.
- Virtual or in-person administration, allowing patients to perform screening from home.
- Ongoing monitoring capabilities that gather longitudinal data, allowing providers to track the effectiveness of medication and behavioral interventions.
- Additional behavioral health assessments, like the Mood Disorder Questionnaire (MDQ) and Drug Abuse Screening Test (DAST-10), are used to identify comorbidities.
- Instantly generated patient- and provider-friendly reports for fast and transparent decision making.
- Automatic electronic health record (EHR) integration that allows data to be shared between primary care providers, psychologists, psychiatrists, neurologists, and more.
By combining subjective patient reporting with objective cognitive data, providers can improve the diagnostic timeframe, as well as reduce misdiagnosis. With the help of Creyos cognitive assessments, Telapsychiatry reduced ADHD overdiagnosis by over 30% and helped their ADHD patients quickly access the documentation they needed to receive essential accommodations.
Supporting Patients With an ADHD Diagnosis
When ADHD is identified early, individuals have a better chance of building confidence, receiving treatment, and avoiding childhood feelings of failure. By combining self-reports with cutting-edge cognitive assessments, providers can diagnose ADHD faster and more accurately.
With the right guidance, people with ADHD can better understand how their minds work—and build on their strengths from the start.
Reviewed by Mike Battista, Director of Science & Research at Creyos
Mike Battista specializes in brain health, cognition, and neuropsychological testing. He received his PhD in personality and measurement psychology at Western University in 2010 and has been doing fun and useful stuff in the intersection between science and technology ever since.