ADHD is a clinical pattern you recognize across settings — not a score. These DSM-5-TR anchors help you spot it.
Why No single symptom makes the diagnosis — it’s the lasting, impairing pattern that counts.
Why Sets the threshold — scattered or occasional symptoms aren’t enough to call it a disorder.
Why ADHD begins in development — symptoms that first appear in the late teens point somewhere else.
Why A home-only or school-only pattern suggests a situation or relationship, not ADHD.
Why Busy but thriving isn’t a disorder — real-life impairment is the line.
Why Mood, anxiety, sleep problems, and substance use can all mimic ADHD — rule them out first.
Three presentations — predominantly inattentive, predominantly hyperactive-impulsive, or combined. Paraphrased from DSM-5-TR for recognition, not independent diagnosis.
There are three patterns: mostly inattentive (can’t focus, loses things, seems not to listen), mostly hyperactive-impulsive (can’t sit still, blurts out, interrupts), or a mix of both.
- To count as ADHD, the signs start before age 12, appear in more than one place (like home and school), and cause real problems.
There is no blood test or scan for ADHD — it’s a clinical call.
- Gather information from more than one setting using parent and teacher rating scales (such as the Vanderbilt or Conners).
- Rule out look-alikes first: poor sleep, anxiety, trauma, hearing or vision problems, a learning disorder, thyroid issues, or substance use in teens.
- Then check for the conditions that often travel with it: anxiety, depression, oppositional or conduct problems, learning disorders, tics, and sleep problems.
Under age 6
Parent training in behavior management first — not medication.
Track how consistently the plan is used and how the child responds; consider medication only if moderate-to-severe impairment persists.
School-age & teens
A stimulant plus behavior support works best — methylphenidate- or amphetamine-based stimulants are first-line.
Before starting: ask about heart problems and family history of sudden death, and take a baseline heart rate and blood pressure. Then follow height, weight, appetite, sleep, mood, and adherence.
When stimulants don’t fit
Non-stimulants — atomoxetine, guanfacine ER, or clonidine ER — starting low and adjusting slowly per current labeling.
Growth, appetite, sleep, heart rate and blood pressure, and mood; verify every dose against current FDA labeling before any clinical use.
Any medications named here are starting points — verify every drug and dose against current FDA labeling before any clinical use.
How strong is the evidence? Each treatment choice reads on the Evidence ladder — what kind of study, and how sure of the answer. See how a grade is judged →
Browse related medications→Screen before starting, then keep watching.
- Before a stimulant, ask about heart problems and any family history of sudden death, and take a baseline heart rate and blood pressure.
- Once on treatment, keep an eye on height, weight, appetite, sleep, heart rate, blood pressure, mood, and whether the plan is actually being followed.
What you manage
- Diagnose ADHD clinically: gather parent and teacher rating scales across settings and rule out look-alikes such as poor sleep, anxiety, trauma, vision or hearing problems, and learning disorders.
- Start and adjust first-line treatment: stimulants and approved non-stimulants, plus behavior support; parent training before medication under age 6.
- Screen the heart before a stimulant and monitor growth, blood pressure and heart rate, sleep, appetite, mood, and adherence.
- Screen for and manage the conditions that often travel with ADHD, and coordinate care with the family and school.
When to bring in the attending
- Confirming the diagnosis and starting medication in very young children, or whenever the picture is unclear.
- A cardiac problem or family history of sudden death, which calls for the attending's risk judgment and often cardiology involvement.
- Symptoms that persist after adequate trials of more than one agent, or complex regimens needing several medicines.
- Heavy overlap with other conditions (bipolar disorder, substance use, tics, or marked aggression), or new mania, psychosis, or clear worsening on a stimulant.
- Concern about misuse or diversion of a controlled stimulant.
Before you start
ADHD care involves minors, so confirm consent from a parent or guardian and seek the child's assent in an age-appropriate way. Stimulants are controlled substances: counsel families on safe storage and the risk of misuse or diversion, and stay alert to it in teens. If you suspect abuse or neglect, mandated-reporting duties apply. Have a plan for any safety concern and know local crisis resources. Scope and regulations vary by role, setting, and state.
This is an evidence aid, not a verdict — the plan is yours to tailor, and the decision always stays with you and the family.
- AAP Clinical Practice Guideline for ADHD (2019)
- FDA labeling — stimulant and non-stimulant ADHD medications
- DSM-5-TR — Neurodevelopmental Disorders (ADHD criteria, taught in our own words)
Drafted from these sources for education.