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ADHD in Children: Diagnostic Processes

Dr. Yuval Raveh, Specialist in Child and Adolescent Psychiatry, Director of the Department of Child and Adolescent Psychiatry in the Ministry of Health
15 June 2025

Diagnosing ADHD is a complex clinical process that is not based on conclusive auxiliary tests. A pediatrician with expertise in the area, a developmental physician, a pediatric neurologist, or a pediatric psychiatrist performs the diagnosis, which entails several stages:

  1. A comprehensive clinical interview with the child and parents.
  2. Compilation of information from the educational and therapeutic staff occasionally includes symptom questionnaires that describe behaviors pertaining to attention, hyperactivity and impulsiveness.
  3. Additional tests may be conducted, such as computerized tests (such as TOVA, MOXO) or psychological tests (such as psycho-didactic diagnosis).

Differences between ADHD and learning disabilities

Diagnosis: although the events occasionally appear together, there is a difference in a diagnosis of ADHD and a diagnosis of learning disabilities. A psycho-didactic diagnosis is primarily designed to diagnose learning disabilities but may also provide information about symptoms of ADHD.

Treatment: ADHD is mostly treated with medication, sometimes in conjunction with academic accommodations and psychological therapy, while learning disabilities are mainly treated by learning and practicing learning strategies and through academic accommodations.

When should one seek a diagnosis?

A diagnosis is generally performed during elementary school, when academic demands increase. It is important to note chronic symptoms that interfere with the child’s function and environment over time.

In general, when a certain disease is suspected, various objective tests can be performed, such as blood tests, imaging, etc. with clear, conclusive results received about the presence of a certain disease. When discussing a diagnosis of ADHD, there is no one auxiliary test that provides conclusive results. if you suspect that your child has ADHD, it is important to seek a diagnosis. This article will discuss the diagnostic process and everything you need to know about it.

ADHD occurs when the following three conditions are present at the same time:

  1. The appearance of several symptoms at the same time.
  2. The intensity and frequency of these symptoms are high; in other words, the symptoms occur on a daily basis at an intensity that affects the child’s normal function.
  3. The symptoms occur in more than one life environment: home, clubs, youth movements, school, preschool. If your child experiences symptoms at home, consult the educational staff at school and in other areas to determine whether they also occur outside the home.

The age at which ADHD is diagnosed

The attention system and the executive systems continue to develop as one grows. The attention and executive function of a 4-year-old child are inferior to that of an 8-year-old child. Accordingly, the academic requirements change based on the various ages: a preschooler is required to sit for brief sessions, while a first grader will be required to sit, not get up and to focus for the duration of the entire one-hour lesson. Subsequently, children will generally be referred to a diagnosis in the lower grades. In cases where symptoms such as significant unrest and severe impulsiveness are visible in the child throughout the day in several frameworks that significantly affect their function, ADHD may be diagnosed as early as preschool but this is not common. Medication under the age of 6 is also rare.

Occasionally, there is certain confusion and it is important to clarify that not every child who moves around on a chair or who gives rude answers immediately needs to be sent for a diagnosis. When is the right time? When there is prolonged difficulty and problems that do not improve. For example, if the educational staff in preschool or school notices that the child is hyperactive throughout the day, and finds it difficult to sit for the lessons or for a prolonged period of time, appears distracted and disorganized, and finds it difficult to learn. If a rule of thumb must be formulated: ADHD is a disorder that interferes with the child himself and largely the environment for a long period of time. The ‘red flags’ are waving and do not stop. The child is restless, finds academic performance difficult over time, regularly and significantly avoids doing homework, encounters extreme difficulties in getting organized in the morning, forgets and loses items, and is impulsive.

Not every situation of inattention is ADHD. If at home the child exhibits various symptoms that you believe are ADHD, for example, he is not attentive, forgets things or runs around the house, this does not necessarily indicate that he is dealing with ADHD. Most children occasionally lose things, forget, burst out or demonstrate a low frustration threshold as well as low motivation to perform various tasks at home. However, if the educational staff informs you that even at school the child exhibits similar behavior, has difficulty sitting on the chair, sways, does not stop chatting, and is impulsive, it is definitely recommended to consider seeking a diagnosis.

Referral for an ADHD diagnosis

If a significant problem has occurred in the classroom, you should contact the pediatrician or the therapeutic team at the school that includes the educational consultant and the school psychologist. These therapists will refer you to a diagnostician or relevant practitioner. When the picture is complex and mixed, the professional staff may consult a pediatric and adolescent psychiatrist.

Important to know

Important to know

The first signs of ADHD usually appear in early childhood. If onset was sudden, during adolescence, this is most likely not the correct diagnosis, and you should investigate other causes for the symptoms, such as an adjustment disorder or trauma that was a trigger for the onset of the symptoms. In these cases, a more in-depth medical examination is recommended.

Who is authorized to diagnose ADHD?

  • A pediatrician specializing in diagnosing ADHD.
  • Developmental physician.
  • Pediatric neurologist.
  • Pediatric and adolescent psychiatrist.

If your child is already receiving psychological therapy or has undergone a psychological diagnosis, and the psychologist believes or assesses that he has ADHD, he must recommend completion of the medical diagnosis to examine comorbidity and to consider medication.

Physicians specializing in ADHD (Hebrew)

The diagnostic process for ADHD

The ADHD diagnosis is a process involving several stages:

The interview includes specific questions that focus on symptoms of the disorder, as well as general questions about the child’s condition and background. In children suffering from ADHD, these symptoms will appear in at least two life environments—one being home and the second outside the home, such as school.

Information from the educational, therapeutic, and social staff who surround the child is a critical stage in diagnosis. The physician will occasionally speak with these practitioners and will occasionally request and ask for a written impression, and sometimes he will ask them to complete symptom questionnaires (details below).

Additional tests may occasionally be required to obtain a more accurate diagnosis, or if the diagnosing physician is deliberating about the nature of the disorder. These tests can include a physical examination, computerized attention tests, blood tests, EEG, psycho-didactic diagnosis, etc.

You should know

You should know

During the clarification of the various stages, the diagnosing physician will rule out more common and less common conditions that may diminish the ability to concentrate and focus and create restlessness and impulsivity, such as learning disabilities, anxiety, adjustment disorder, PTSD, depression, bipolar disease, ASD, psychosis, thyroid gland disorder, convulsions, and sleep disorders.

Methods for diagnosing ADHD

Symptom questionnaires, a key diagnostic too that describe various symptoms that characterize the disorder, are critical for determining the nature of the disorder. The person completing the questionnaire (the child himself, parent, teacher, counselor) must rate every symptom based on the level of severity of the manifestation in the child. The common questionnaires are based on the psychiatric diagnosis manual, the DSM.

To receive support for the ADHD diagnosis, the answers to these questionnaires must reveal a minimum of 6 symptoms (out of 9 possible symptoms in each category) of significant severity, in one of 2 categories: ADHD, restlessness, and impulsivity.

Questionnaire format

The questionnaires examine 2 categories and include questions about the child's function: 9 questions on attention and concentration, 6 questions on hyperactivity (restlessness), and 3 questions on impulsivity (hyperactivity and impulsivity are included under one category in the questionnaire). These are the questions that were asked:

Questions on attention
  • Has difficulty concentrating on details or makes mistakes as a result of inattention in homework, work, or other activities.
  • Difficulty concentrating on an activity or game that requires prolonged concentration.
  • Appears to not be listening when spoken to directly.
  • Has difficulty following instructions and in completing school activities or other assignments but not because he does not understand instructions or objects to following them.
  • Has difficulty organizing tasks or activities.
  • Avoids, is not interested, or reluctantly participates in tasks that require prolonged mental effort (such as homework).
  • Forgets objects that are needed to complete a task or activity, such as toys, homework instructions, stationery and books.
  • It is susceptible to distraction from outside stimuli.
  • Tends to lose items during daily activities.
Questions on hyperactivity
  • Shakes arms or legs nervously, or squirms in his chair.
  • Gets off the chair in the classroom or in other places where he is expected to remain seated.
  • Runs or climbs excessively in situations where such behavior is not acceptable (in adults and teenagers, it can lead to feelings of restlessness).
  • Difficulty in quietly participating in games or leisure activities .
  • Constantly moving or behaves as if "driven by a motor".
  • Tends to talk too much.
Questions on impulsiveness
  • Answers before the end of the question.
  • Finds it difficult to wait on line.
  • Bullies, lashes out or disturbs others (for example, interrupts a conversation or game).

There are several computerized tests to facilitate a diagnosis. It is important to note that, contrary to popular opinion, these tests are neither necessary nor sufficient to diagnose ADHD. They are another tool that allows the diagnosing physician to more accurately diagnose or determine the nature of the disorder. Sometimes, when the clinical interview fails to provide a conclusive result, the physician will recommend this type of test (or a psychological diagnosis). A test that is repeated, once without medication and once with medication, can provide information on the possible effect of medication on the various symptoms. In any case, it is important to note that these tests cannot be an exclusive diagnostic tool on its own, as specified. It is also important to know that when a child is excited, tired or nervous, his computerized test results can be positive, even though he does not suffer from the disorder, so the clinical interview is always the most important tool for diagnosis.

After detailing the important caveats, let's talk a little about the tests themselves. The tests commonly used in Israel are "TOVA" and "MOXO", in which the child sits in front of a computer, and when a certain stimulus appears, he has to press a button and refrain from pressing when the relevant stimulus does not appear.

These tests can examine:
  • Impulsiveness: the child presses the button when no stimulus appears.
  • Distraction: when the stimulus appear, the child does not press the button.

The test occasionally includes the appearance of vocal or visual distractions (stimuli that the subject is supposed to ignore).

These tests do not directly test the hyperactivity component; the examiner can get an impression of the degree of restlessness of the person taking the test and note this.

Tests with and without taking medication

The computerized tests can also be repeated: once with a special medication for ADHD and once without, and then see whether function improves when taking the medication. It should be remembered that because these tests are part of a diagnostic process, the physician usually gives a one-time drug treatment, and depending on the results, he decides on the need for continued permanent medication.

Preparation for an ADHD diagnosis

There is no way or need to prepare for an ADHD diagnosis. In the clinic of the diagnosing physician, you will occasionally be asked to complete forms or questionnaires before the appointment or to bring various documents, such as a medical background, a letter from the school staff, from the teachers in the classes or from the therapists, if the child is under the care of a psychologist. The physician will occasionally ask for all of these only after the examination, or he will ask to talk to the various professionals himself to determine his diagnosis.

The difference between diagnosing ADHD and diagnosing learning disabilities

We often hear that children are referred for a psycho-didactic diagnosis because the parents and the educational staff want to determine if the child has ADHD. This is where to sort things out and clarify that there is an occasional tendency to confuse ADHD with learning disabilities, which can be diagnosed with this diagnosis. The fact that in 50% of the cases where a child suffers from ADHD, they also suffer from learning disabilities is confusing in and of itself. However, these are two completely different disorders. More precisely: learning disabilities are manifested in the impairment of the child's specific educational abilities, such as difficulty in writing or reading, difficulty in performing mathematical operations, difficulty in learning a foreign language. In "isolated" ADHD, these abilities are not affected.
 
Where is the confusion? A child who finds it difficult to read and write may avoid doing homework, interrupt the lesson and chat, and then a suspicion of ADHD will arise. In addition, a child suffering from ADHD may experience difficulty reading, writing or math due to distractions, raising the suspicion of a learning disability. Therefore, although it may appear the same, it is important to remember that these are two different disorders and that a psycho-didactic diagnosis is designed for those who are suspected of having learning disabilities. It should be noted that psycho-didactic diagnosis also sheds light on symptoms of ADHD (executive skills) and helps in diagnosing this disorder.

The treatment of disorders is also completely different: the treatment of learning disabilities includes learning and studying techniques, remedial teaching, and educational accommodations. The effective treatment of ADHD is largely based on medication. ADHD often requires various accommodations in educational settings as well as psychological therapy.

Psychological diagnoses

There are several types of psychological diagnoses, of which we will discuss the most common ones.

Both diagnoses reveal information about the subject's cognitive abilities (IQ). A physician should, as previously mentioned, continue the investigation when a psychological diagnosis suggests attention disorders.

Diagnosis performed by a clinical psychologist. This diagnosis uses valid tools and sheds light on the child’s mentality as well as on his cognitive abilities. The diagnosis helps to create a better understanding of the child’s mentality, thereby facilitating a diagnosis and therapeutic plan.

When a diagnostic question arises regarding the child's mental state, seek a psychodiagnostic diagnosis.

This diagnosis consists of 2 sections: a psychological section and a didactic section. The diagnosis is usually carried out by 2 professionals: a psychologist (usually educational or clinical) and a special education practitioner who specializes in remedial teaching. In this diagnosis, the psychological section sheds light, as specified, on the child’s mentality and cognitive abilities, while the didactic section reveals strengths and weaknesses in the child's various educational competencies. The summary of the diagnosis will include a discussion of the child's diagnosis as well as recommendations for treatment, accommodations, and appropriate placement at school.

When a diagnostic question arises regarding academic abilities and learning disabilities, it is recommended to seek a psycho-didactic diagnosis.