Prepare for your child's ADHD evaluation

The basics

• Child's name: · Date of birth / / · Age
• Birth month, and the school-year cutoff where you live: · Is your child among the youngest in the class? ☐ yes ☐ no ☐ not sure
• Grade: · School: · Teacher:
• Who first raised a concern, and when:
• What made you book this appointment now:

Why the birth month is the first question. Among 407,846 US children, those born in August in states with a September 1 cutoff were diagnosed at 85.1 per 10,000 against 63.6 per 10,000 for those born in September — and no such gap appeared in states with different cutoffs, or for asthma, diabetes or obesity.² It is worth raising explicitly: "She is one of the youngest in the class. How is that being accounted for?"

Two weeks of observations, not adjectives

"He can't focus" tells a clinician nothing. "Homework took 90 minutes on Tuesday, of which about 20 were working, with 6 restarts and one argument" tells them a great deal. Track for two weeks.

The moments most worth tracking: the morning routine · homework · mealtimes · transitions between activities · bedtime · screens ending · being asked to do something in the middle of something else · unstructured time with other children.

And the four numbers that carry the most information:

• Minutes homework takes, against minutes of actual work inside that: /
• Number of times instructions have to be repeated on an average morning:
• Bedtime · Time actually asleep · Wake time · Hours:
• Days in the last two weeks that ended in tears, a row, or a refusal:

The impairment question, in both directions

The diagnosis requires "documentation of symptoms and impairment in more than 1 major setting (ie, social, academic, or occupational)."¹ Fill in both columns, and be honest where a column is empty.

And a third column people forget: what it costs your child internally — effort, exhaustion after school, giving up activities, redoing work, what they say about themselves. A child who is holding it together at school by working twice as hard is impaired, and that impairment is invisible on a behaviour form.

Internal cost:

What to ask the school, in writing

Send this by email so you get a written answer. Generic praise is useless to an assessor; these questions are not.

I am taking [name] for an assessment on [date] and the clinician needs information from school. Could you answer these specifically, in writing?

1. Does [name] start work promptly when the class begins a task?
2. Does [name] finish tasks within the time given, compared with classmates?
3. How often do instructions need to be repeated or rephrased?
4. Does [name] appear to be listening but not retaining, or not listening?
5. What happens during unstructured time — playground, transitions, group work?
6. Is [name] out of seat, fidgety, or blurting more than classmates?
7. How does [name] compare with the youngest and the oldest children in the class?
8. Have you noticed anything about reading, writing or maths specifically?
9. Does [name] seem anxious, tearful or withdrawn at any point in the day?
10. Anything else you would want a clinician to know?

Sent / / · Reply received ☐ on / / · Printed for the appointment ☐

If the school offers a rating scale, that is useful — but the guideline is clear that a diagnosis "should not be made solely on the basis of rating scale or observational data," with rating scales described as "valuable adjuncts."³ Ask for prose as well as scores.

What has been ruled out

The guideline asks the clinician to "rule out any alternative cause" and to "at least screen for comorbid conditions, including emotional or behavioral conditions… developmental conditions… and physical conditions (eg, tics, sleep apnea)."¹ Arrive with as much of this already done as you can.

• ☐ Hearing checked — date / · Result
• ☐ Vision checked — date / · Result
• ☐ Sleep: hours per night · Snoring, gasping or pauses in breathing? ☐ yes ☐ no · Screens ending at
• ☐ Reading, writing and maths ever formally assessed? ☐ yes ☐ no · When
• ☐ Anxiety, low mood, worries — what you have noticed:
• ☐ Big changes or hard things in the last two years — moves, losses, separations, illness, anything frightening:
• ☐ Family history — anyone diagnosed, or anyone who "was just like that":
• ☐ Medical history and current medications:

On sleep specifically. In an experiment with typically developing children and blinded teachers, cutting sleep by about 54 minutes over a few nights measurably worsened restlessness and emotional lability in the classroom; extending it by about 27 minutes improved them.⁴ It is worth fixing regardless of what the assessment concludes.

Six questions to ask before you leave

Write the answers down in the room.

1. "What did you conclude, and on what evidence from which settings?" —
2. "What did you rule out, and how?" —
3. "What else did you screen for, and what did you find?" — (77.9 percent of children with a current ADHD diagnosis have at least one co-occurring condition⁵)
4. "What is the plan, and what is the non-medication half of it?" — (For ages 4 to 5 the guideline's first line is behavioural parent training; from 6 upward it recommends medication together with parent training and classroom support¹)
5. "If we start medication: what are we treating, what would count as it working, when do we review, and what gets monitored?" — (Height and weight at minimum)
6. "What goes to the school, and who writes it?" — (Educational supports are described as "a necessary part of any treatment plan," often through an IEP or 504 plan¹)

Next appointment / / · Review of whether it is working / /

Afterwards

• ☐ Ask for the written report and read it. How to request records →
• ☐ Start the school process in writing if it has not started. A written request from a parent is a legal referral with deadlines attached. Request a school assessment → · 504 plans and IEPs →
• ☐ Put the review date in the calendar the same day, with one question on it: what is different that I could describe to someone else?
• ☐ If the answer was "not ADHD," ask what it is and what happens next. A no is only useful if something follows it.
• ☐ If a plan denies an assessment or a treatment, that is appealable and the review is free. Appeal a denial →

Q&A

Q: What should I bring to my child's ADHD evaluation? A: Two weeks of dated, specific observations from home; a written account from school answering specific questions; and a list of what has already been checked — hearing, vision, sleep, learning, anxiety, family history. The guideline requires documentation of impairment in more than one setting and screening for co-occurring conditions, and most of that raw material comes from you.¹

Q: The school won't fill anything in. A: Send the ten questions by email so a written reply exists, and note the non-reply if there is one. You can also start the formal assessment process yourself in writing, which puts the school on a legal timeline. Request a school assessment →

Q: Will there be a test? A: There may be rating scales, and possibly computerised tests. Neither settles it. The guideline says neuropsychological testing "has not been found to improve diagnostic accuracy in most cases, although it may have benefit in clarifying the child or adolescent's learning strengths and weaknesses."¹ What the tests can and cannot do →

Q: How long should this take? A: More than one appointment, usually. Information has to come from more than one setting, and that takes time to gather.¹

Q: My child behaves perfectly in the clinic. A: Expected, and not evidence of anything. A short novel one-to-one interaction with an interested adult is the easiest environment your child will encounter all week. That is precisely why the guideline asks for information from home and school rather than from the room.

Q: What if they say it is ADHD and I don't agree? A: Ask question 2 and question 3 above, and ask for the report. A second opinion is reasonable, and so is asking for the specific evidence from each setting that the conclusion rests on.

Ready to find someone who evaluates children properly? Filter by approach, schedule and payment route → · ADHD in children: the parent map → · What else looks like ADHD →

Sources

1. Wolraich ML, Hagan JF Jr, Allan C, et al., "Clinical practice guideline for the diagnosis, evaluation, and treatment of attention-deficit/hyperactivity disorder in children and adolescents," Pediatrics 144(4), 2019, e20192528 — key action statement 2, "including documentation of symptoms and impairment in more than 1 major setting (ie, social, academic, or occupational)… The PCC should also rule out any alternative cause"; key action statement 3 on screening for comorbid conditions; key action statements 5a, 5b and 5c on treatment by age; the description of educational interventions as "a necessary part of any treatment plan"; and "The use of neuropsychological testing has not been found to improve diagnostic accuracy in most cases, although it may have benefit in clarifying the child or adolescent's learning strengths and weaknesses" — pmc.ncbi.nlm.nih.gov.
2. Layton TJ, Barnett ML, Hicks TR, Jena AB, "Attention deficit-hyperactivity disorder and month of school enrollment," New England Journal of Medicine 379(22), 2018, 2122–2130 — 407,846 children; 85.1 against 63.6 diagnoses per 10,000 for August- versus September-born children in states with a September 1 cutoff, with no equivalent differences in states with other cutoffs or for asthma, diabetes or obesity — doi.org.
3. National Institute for Health and Care Excellence, "Attention deficit hyperactivity disorder: diagnosis and management," NICE guideline NG87, recommendation 1.3.2 — "A diagnosis of ADHD should not be made solely on the basis of rating scale or observational data. However, rating scales such as the Conners' rating scales and the Strengths and Difficulties Questionnaire are valuable adjuncts" — nice.org.uk.
4. Gruber R, Cassoff J, Frenette S, Wiebe S, Carrier J, "Impact of sleep extension and restriction on children's emotional lability and impulsivity," Pediatrics 130(5), 2012, e1155–e1161 — 34 typically developing children with teachers blinded to sleep condition; a cumulative extension of 27.36 minutes improved and a restriction of 54.04 minutes worsened classroom emotional lability and restless-impulsive behaviour — doi.org.
5. Danielson ML, Claussen AH, Bitsko RH, et al., "ADHD prevalence among U.S. children and adolescents in 2022: diagnosis, severity, co-occurring disorders, and treatment," Journal of Clinical Child and Adolescent Psychology 53(3), 2024, 343–360 — "77.9% had at least one co-occurring disorder" — doi.org.

Paid for by participating therapists. Inclusion is computed from availability data — never purchased. No ads, no data sold.