The American Psychiatric Association's Diagnostic and Statistical Manual (4th Edition), known as DSM IV, offers the definitive diagnostic criteria. These criteria are reproduced in the gray box below 

No.

An x-ray is (usually) a definitive test of a bone's integrity. By contrast, ADHD and ADD can only be diagnosed on the basis of some combination of:

(1) professional observation across two or more settings [classroom, home and office, for example],

(2) standardized and valid reporting measures completed by spouse, parents, teachers [Connors' Rating Scales, for example], and

(3) reference to standardized and valid quantitative measures of attention and concentration, such as those available using the Wechsler intelligence tests [the WISC IV, for example].

Yes.

Any diagnosis can be offered under any circumstances. Will that diagnosis be valid and accurate? Particularly when attention difficulties are at issue, the more data available and the more independent sources considered the more accurate the diagnosis is likely to be.

Easily and often.

These diagnoses are offered too often and too quickly in contemporary society. Many other diagnoses and situations can and often are mistakenly called ADHD and ADD, including depression and anxiety, adjustment to trauma, learning disabilities and physical health problems including hearing and vision deficits.

Read about co-parental conflict and ADD/ADHD
Read about ADD/ADHD "Look-alikes"

Because other conditions and circumstances are so easily and often mikstaken for ADHD and ADD, the first step is to rule these out. This is not a quick process and is likely to require time, money and assertiveness, particularly if the concern is about a child. Try these steps:

1. Get a comprehensive physical examination from your primary care physician. Request thorough blood work (sorry kids: some needles are involved) including consideration of thyroid dysfunction, blood sugar (glucose) levels and iron.

2. Get a thorough vision and hearing exam. Schools and primary care physicians often offer brief screenings of both hearing and sight, but when any question persists, visit an audiologist and an opthamologist independently.

3. Beware of environmental contributors! Something as commonplace as a furnace leaking carbon monozide can cause symptoms resembling ADD/ADHD and/or depression. In sufficient quantities or accumulated exposure, carbon monozide can cause lasting impairment or death.

4. Complete a cognitive screening battery. This includes an intelligence (for example: WISC-IV) and an achievement (for example: Woodcock-Johnson) test. The school district may be able to do this for you at no cost upon your written request to the superintendant's office. Although absolute IQ numbers may be of interest, these tests in combination help to understand whether you are fulfilling your intellectual potential. When achievement is significantly different than IQ, questions about learning differences can be considered.

5. Complete an outpatient evaluation with a qualified, child-centered mental health professional. This will typically include interviews, observations, completion of  standardized report forms (the Connors forms, for example) and a synthesis of all of the data available to reach a preliminary diagnosis and recommendation for assistance.

Dr. Garber is very conservative in reaching the ADHD and ADD diagnoses. The typical diagnostic procedure for children requires the four steps above. In addition, Dr Garber typically requests:


1. An initial 90 minute history and background interview with all co-parents.

2. In some circumstances the opportunity to observe the child unannounced in the classroom is a very effective assessment tool.)

3. Two individual interviews in the office with the child.

4. A family observation in the office.

5. Collection of colateral data (grade reports, testing, Connors' report forms...).

6. Feedback to the parents regarding diagnostic formulation and recommendations for continuing treatment, changes at home and/or in school, and/or for medication consultation.

Dr. Garber takes a very conservative position in referring for medication consultation. Assuming that there is no concern for any person's immediate health or safety, you might consider the process of medication consultation in this way:

1. Get educated: Long before the need becomes critical, learn as much as you can about the medications that might be considered. Generally, the medications of choice are some formulation of methylphenidate. Search the internet. Sit down with the local pharmacist. Schedule a meeting with your physician.

2. Be practical: The science of medication (called psychopharmacology) is still young. There is no certainty that the first prescription will be the right medication or the right dosage. Expect to experiment at the prescribing physician's direction over time until you've got it right. That can take weeks. Also consider that getting in to see the pediatrician or psychiatrist of choice can take weeks. As a practical matter, this means that you should probably call to schedule that appointment at least eight to twelve weeks in advance. Don't wait for a crisis!

3. How do you know when to call? Consider two factors:

When either number is 7 or greater OR when the combination of the two is 10 or greater, its very likely time to act.

Remember: Prompt relief from the symptoms of ADHD and ADD (as can sometimes be achieved with medication) is important both in order to improve academic or occupational performance and in order to minimize the associated experiences of anxiety and depression (read on below....).

Yes.

For reasons that are not well understood, ADD and ADHD are often accompanied by:

(1) learning disabilities or
(2) sensory defensiveness  and/or
(3) social awkwardness sometimes associated with Asperger's Syndrome or Non-Verbal Learning Disabilities

There is no necessary relationship between ADD or ADHD and intelligence.

Undiagnosed and untreated, ADD and ADHD often cause an individual to commonly experience rejection, criticism and failure, experiences that can result in secondary anxiety and depression.

Stimulant medications (for example Ritalin^®, Concerta^®, Adderol^®, Focalin^®, each of which is a brand name formulation of a compound called methylphenidate) are among the most commonly prescribed medications for ADD and ADHD. Physicians usually describe these substances as relatively benign and short-lived in a person's body. Still, these are medications and therefore have some risk of at least psychological addiction, abuse and overdose. They are more and more often being abused by teens in the schools. See your prescribing physician and/or your pharmacist about these concerns.

In theory, imagine that everybody seeks to maintain an optimal level of total stimulation (like filling a cup to the top). Total stimulation is a combination of two substances (like oil and water combining to fill the cup). One part is arousal, the stimulation that we experience from within (including anxiety and physical discomfort). The other part is the sensory input that we receive from the world around us (sight, sound, texture, smell....). The theory is that ADD and ADHD individuals have just a drip of arousal in the bottom of their cups, therefore needing a constant and large dose of sensory input to reach optimal arousal. This "sensory starvation" causes distractibility and overactivity. Stimulants serve to increase arousal, filling the cup more and decreasing the need for stimulation from the world, thus decreasing activity level and distractibility.

[Its interesting in this theory to imagine that autism may be the opposite: Individuals with too much arousal who cannot tolerate even a drop of stimulation from the world around them.]

Specific strategies to assist with education are offered HERE

In order to institute these kinds of interventions, you may need to learn more about the federal Individuals with Disabilities in Education Act (IDEA 97), about Individual Education Plans (IEPs) and 504 plans. The single best readable reference to these matters can be found  In New Hampshire, contact the Parent Information Center 603.224.7005.

Essential features:
A. Persistent pattern of inattention and/or hyperactivity-impulsivity that is more frequently displayed and is more severe than is typically observed in individuals at comparable level of development.
B. Some hyperactive-impulsive or inattentive symptoms must have been present before seven years of age.
C. Some impairment from the symptoms must be present in at least two settings.
D. There must be clear evidence of interference with developmentally appropriate social, academic or occupational functioning.
E. The disturbance does not occur exclusively during the course of a Pervasive Developmental Disorder, Schizophrenia, or other Psychotic Disorders and is not better accounted for by another mental disorder.

Three Subtypes:
Attention-Deficit/Hyperactivity Disorder Predominantly Inattentive Type: This subtype is used if six (or more) symptoms of inattention (but fewer than six symptoms of hyperactivity-impulsivity) have persisted for at least six months.

Attention-Deficit/Hyperactivity Disorder Predominantly Hyperactive-Impulsive Type: This subtype should be used if six (or more) symptoms of hyperactivity-impulsivity (but fewer than six of inattention) have persisted for at least six months.

Attention-Deficit/Hyperactivity Disorder Combined Type: This subtype should be used if six (or more) symptoms of inattention and six (or more) symptoms of hyperactivity-impulsivity have persisted for at least six months.

Diagnostic Criteria for the three subtypes of Attention-Deficit/Hyperactivity Disorder according to DSM-IV:

A. “Persistent pattern of inattention and/or hyperactivity-impulsivity that is more frequently displayed and is more severe than is typically observed in individuals at comparable level of development.” Individual must meet criteria for either (1) or (2):

(1) Six (or more) of the following symptoms of inattention have persisted for at least six months to a degree that is maladaptive and inconsistent with developmental level:

Inattention
(a) often fails to give close attention to details or makes careless mistakes in schoolwork, work or other activities
(b) often has difficulty sustaining attention in tasks or play activity
(c) often does not seem to listen when spoken to directly
(d) often does not follow through on instructions and fails to finish schoolwork, chores or duties in the workplace (not due to oppositional behavior or failure to understand instructions)
(e) often has difficulty organizing tasks and activities
(f) often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (such as schoolwork or homework)
(g) often looses things necessary for tasks or activities (e.g., toys, school assignments, pencils, books or tools)
(h) is often easily distracted by extraneous stimuli
(i) is often forgetful in daily activities

(2) Six (or more) of the following symptoms of hyperactivity-impulsivity have persisted for at least six months to a degree that is maladaptive and inconsistent with developmental level:

Hyperactivity
(a) often fidgets with hands or feet or squirms in seat
(b) often leaves seat in classroom or in other situations in which remaining seated is expected
(c) often runs about or climbs excessively in situations in which it is inappropriate (in adolescents or adults, may be limited to subjective feelings of restlessness)
(d) often has difficulty playing or engaging in leisure activities quietly
(e) is often “on the go” or often acts as if “driven by a motor”
(f) often talks excessively
Impulsivity
(g) often blurts out answers before questions have been completed
(h) often has difficulty awaiting turn
(i) often interrupts or intrudes on others (e.g., butts into conversations or games)

B. Some hyperactive-impulsive or inattentive symptoms must have been present before age 7 years.
C. Some impairment from the symptoms is present in at least two settings (e.g., at school [or work] and at home).
D. There must be clear evidence of interference with developmentally appropriate social, academic or occupational functioning.
E. The disturbance does not occur exclusively during the course of a Pervasive Developmental Disorder, Schizophrenia, or other Psychotic Disorders and is not better accounted for by another mental disorder (e.g., Mood Disorder, Anxiety Disorder, Dissociative Disorder, or a Personality Disorder).