In recent years, attention deficit hyperactivity disorder (ADHD) has become increasingly recognized, associated with a boom in demand for better assessments. In the United States alone, an estimated 7 million children between the ages of 3 and 17 have received an ADHD diagnosis as of 2022.
Additionally, ADHD affects individuals across the lifespan, with up to half of patients experiencing persistent ADHD symptoms into adulthood, which can impact their relationships, work performance, and mental health if left untreated.
Adults and children with ADHD can present differently, as symptoms may change with age. This makes age-appropriate tests and questionnaires essential for accurate ADHD assessment and effective symptom management.
While ADHD testing for children can help to ensure that they receive the support needed to succeed in school and social settings, many of these tools may be prone to risks like informant biases or differences in ratings from diverse sources. These risks can make an accurate diagnosis difficult. With objective cognitive testing and age-appropriate questionnaires, healthcare providers can more confidently assess for core ADHD symptoms across life stages.
Adult ADHD questionnaires usually avoid these issues by using self-report questions instead of informant reports, but this isn’t without issue. While Self-Report Methods have been shown to correctly classify non-ADHD individuals, they are prone to high false positive rates. As a result, providers can’t use these scales alone and must consider more rigorous evaluation before making any diagnostic decisions.
In this article, we’ll explore how core ADHD symptoms present at different ages, the importance of considering age when assessing patients, and we’ll compare the best tools for ADHD testing for adults and children.
While awareness of attention deficit hyperactivity disorder is on the rise, the way that ADHD may be portrayed in pop culture and how ADHD symptoms actually impact people’s lives can differ. ADHD can impact more areas of life than many people might realize.
Some common domains impacted by adult and childhood ADHD include:
Development is a critical area impacted by ADHD in children. Children with ADHD may display maturational delays compared to their neurotypical peers. For instance, one study found that on continuous performance tests, children with an ADHD diagnosis showed a delay of between 1 to 3 years compared to healthy peers.
Childhood developmental symptoms may relate to or affect other domains of cognition, like working memory and reaction time. These cognitive deficits may persist into adulthood, although their impact can look very different when looking at a child's behavior compared to the experiences of an adult.
The Neuropsychological function of people with ADHD may be different from peers of the same age. This means it’s important to test a variety of cognitive domains, including memory, executive function, impulsivity, and attention, and to compare the objective performance of patients to people in the same age cohort.
According to the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), attention deficit hyperactivity disorder can present with the following classes of symptoms:
ADHD symptoms can create significant barriers in school settings, where children are expected to focus, sit still, and quietly participate within a structure that might not suit their needs. Many of these children are accommodated with an individualized education plan (IEP). Challenges can transform as they pursue higher education, with research showing that symptoms of inattention can be particularly challenging for university students.
The environments in which ADHD impacts patients change as patients age and move through their lives. Evaluating how patients are impacted in a work environment is a critical distinction of adult ADHD assessment. Attention-deficit hyperactivity disorder can also contribute to chronic employment issues.
In one study, only 34% subjects with ADHD were employed full-time compared to a control group, where 59% had full-time employment. The same study showed that, with the exception of subjects 18-24 years of age, the average household incomes of those with ADHD were also significantly lower.
Socially, children may struggle to make friends with other children. This can also be linked to self-esteem issues and can impact adults with ADHD who have experienced chronic social challenges throughout their lives. ADHD stigma within the school system can also result in children being labeled as disruptive or inattentive rather than supported for their learning differences.
Unconscious racial bias can exacerbate social problems, particularly when it comes to impulsive symptoms. Compared to white children, African American and Hispanic youth are more likely to receive a disruptive behavior disorder diagnosis rather than ADHD, which can affect how they’re treated through school and beyond.
The experience of trying to diagnose ADHD can also vary depending on the child’s gender. On average, girls tend to receive an ADHD diagnosis later than boys, with the ratio of boys to girls diagnosed with ADHD shown to be 4:1 in childhood and closer to 2:1 in adulthood. This means women more frequently have to deal with the long-term repercussions of late diagnosis.
By using digital cognitive tests alongside age-appropriate questionnaires, healthcare providers can leverage objective patient data to get a clearer look at a patient’s specific symptoms and reduce the impact of gender bias when making an ADHD diagnosis.
Since ADHD can appear differently in the lives of children and adults, it’s important to use age-appropriate assessments when screening for ADHD. Questionnaires and self-reports provide valuable subjective insights. Digital cognitive tests from Creyos combine the critical insights gathered from age-appropriate questionnaires with the power of objective cognitive testing.
According to data from the 2022 National Survey of Children’s Health (NSCH), about 78% of children with ADHD have co-occurring developmental, behavioral, and mental disorders, including anxiety disorders and mood disorders.
As many as 77% of adults with ADHD have at least one coexisting psychiatric disorder, and are approximately twice as likely to experience substance abuse. These comorbid disorders can exacerbate symptoms of each other.
This is why early diagnosis can be so beneficial. Early diagnosis means that patients can be given an ADHD treatment plan sooner, leading to better outcomes. Studies show that beginning stimulant treatment early can reduce the risk of substance use disorder (SUD) by 50%.
Not only can fast, objective ADHD assessment provide information about patient symptoms as early as possible, but it can also help to differentiate between comorbid conditions like autism, where symptoms may overlap. Incorporating objective digital cognitive assessments is one way for mental health professionals to better assess ADHD early, distinguish it from comorbid disorders, and possibly prevent downstream effects of ADHD like substance abuse.
Age-appropriate ADHD assessment is critical for ensuring that screening is as accurate as possible. Not only does greater accuracy contribute to earlier diagnosis and earlier intervention, but it can also allow providers to consider additional screening questionnaires to better address potential comorbid conditions like SUD.
While there are many different tools available to support ADHD assessment, the right childhood ADHD test should look for signs of ADHD that are specifically relevant to their age. Rating scales provide subjective data through self, parent, and/or teacher reporting to facilitate informed diagnoses and treatment plans. These are critical tools for helping healthcare providers understand how ADHD symptoms interfere with the lives of patients across various settings.
Strengths and Weaknesses of the ADHD Symptoms and Normal Behavior Scale (SWAN) |
For kids below the age of 18, the SWAN reframes ADHD traits on a spectrum of behavior, measuring both strengths and weaknesses. It’s useful for detecting subtle variations and is less biased toward identifying deficits. |
Vanderbilt ADHD Diagnostic Rating Scale (VADRS) |
Designed for children age 6–11, the VADRS screens for ADHD and common comorbidities (e.g., ODD, anxiety). It includes both parent and teacher versions and aligns closely with DSM-5 criteria. |
Conners Rating Scale |
Used for ages 6–18, the Conners Rating Scale offers in-depth behavioral insight across home and school settings. It includes teacher, parent, and self-report versions and screens for comorbid concerns like mood or conduct issues. |
ADHD Rating Scale—5 |
Closely aligned with DSM-5, this tool provides a symptom checklist for children 5–17, with both home and school versions. It’s straightforward, widely validated, and commonly used in clinical and school settings. |
Adult ADHD Self-Report Scale (ASRS v1.1) |
The ASRS is a brief self-assessment tool based on DSM criteria. It includes a 6-question screener and a full 18-item version, making it quick and accessible. |
Conners' Adult ADHD Rating Scales (CAARS) |
As the adult version of the Conners Rating Scale, the CAARS also includes self-report and observer versions. It evaluates core ADHD symptoms along with related issues like emotional dysregulation and self-concept. |
Brown Executive Function/Attention Scales (Brown EF/A Scales) |
The Brown EF/A Scales include context-specific measurements of patients’ executive function and attention span, focusing on severity rather than frequency, situational variability, and context-specific items. For example, it would identify the difference between memory challenges with assigned versus self-selected reading. Notably, this scale has different variations for different age groups. |
Wender Utah Rating Scale (WURS) |
This retrospective questionnaire assesses ADHD symptoms that began in childhood and how they have persisted into adulthood. |
While all of these behavioral health questionnaires are useful for learning more about a patient’s subjective experience of ADHD symptoms, they can fail to capture objective cognitive data and are best paired with cognitive testing.
The Creyos ADHD Cognitive Assessment is a digital, performance-based cognitive testing tool that uses gamified cognitive tasks and behavioral questionnaires to assess several aspects of cognitive ability, including attention, working memory, and impulse control. These tasks can be completed in a matter of minutes, either remotely or in-clinic.
This tool is scalable across age groups—including children, adolescents, and adults—making it ideal for gathering longitudinal data as patients age.
The Creyos ADHD Cognitive Assessment offers a scientifically validated, digital approach to assessing ADHD symptoms in children and adults. It combines traditional behavioral screeners with performance-based cognitive tasks that gather objective data for a more well-rounded picture of a patient’s symptoms and abilities.
This protocol includes trusted questionnaires such as the VADRS and SWAN assessments for children. For adult patients exhibiting ADHD symptoms, the Creyos ADHD Assessment automatically includes the Adult ADHD Self-Report Scale (ASRS), allowing you to support ADHD patients of all ages.
These tools also help differentiate ADHD from conditions with overlapping symptoms by identifying unique cognitive patterns. If you suspect a child has a different mental health condition or developmental disorder, Creyos offers many other behavioral health assessments to gather more information.
Assessing ADHD isn’t always straightforward, but gathering both subjective and objective data boosts clinical confidence, reduces misdiagnosis, and supports more personalized care.
As ADHD awareness grows, early assessment gives children the support and treatment they need from the start. With the right care in place, they’re better equipped to grow into confident, capable, and happy adults.
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.