What Is an ADHD Evaluation?
An ADHD evaluation is a comprehensive psychological assessment designed to determine whether a client meets DSM-5-TR diagnostic criteria for Attention-Deficit/Hyperactivity Disorder. Unlike a brief clinical screening, a full ADHD evaluation involves multiple data sources (self-report, collateral informants, behavioral observations), multiple methods (clinical interview, standardized rating scales, and often cognitive and attention testing), and differential diagnostic reasoning to rule out conditions that mimic ADHD symptoms.
For psychologists, the ADHD evaluation report is one of the most frequently requested assessments in both pediatric and adult practice. A well-constructed report does more than assign a diagnosis — it identifies specific cognitive and behavioral profiles, documents functional impairment across settings, rules out alternative explanations, identifies comorbid conditions, and provides targeted treatment and accommodation recommendations.
When You Need It
- When a child or adolescent is referred by parents, teachers, or pediatricians for attention, hyperactivity, or behavioral concerns
- When an adult self-refers or is referred for long-standing attention and executive functioning difficulties
- When a school district requests a formal evaluation to determine eligibility for a 504 plan or special education services under IDEA
- When a college student needs documentation to receive academic accommodations through disability services
- When an employer or vocational rehabilitation program requests documentation for workplace accommodations under the ADA
- When a prior ADHD diagnosis needs to be confirmed or updated for medication management
- When differential diagnosis is needed to distinguish ADHD from anxiety, depression, learning disabilities, trauma, or other conditions presenting with attention difficulties
Key Components
Referral Information and Presenting Concerns
Document who referred the client, the specific concerns that prompted the evaluation, and the questions the evaluation is intended to answer. For children and adolescents, include both parent and teacher concerns.
Relevant History
- Developmental history (pregnancy, delivery, milestones, early temperament)
- When the difficulties were first noticed and the records or informants that document childhood functioning (report cards, prior evaluations, pediatric records, a parent or other collateral informant); for adolescents and adults, do not rely on current self-report alone
- Academic history (grades, grade retention, special education services, prior testing)
- Behavioral history (disciplinary actions, peer relationships, activity level)
- Medical history (head injuries, sleep disorders, thyroid conditions, medications)
- Family history of ADHD, learning disabilities, and psychiatric conditions
- Prior mental health treatment and diagnoses
- Substance use history (for adolescents and adults)
Behavioral Observations During Testing
Document the client's behavior, attention, activity level, and effort during the evaluation. Note whether the testing environment represents optimal (one-on-one, quiet, structured) or naturalistic conditions, and how the client's test-session behavior may differ from classroom or workplace behavior.
Assessment Instruments Administered
Cognitive Ability
- WISC-V (ages 6-16) or WAIS-5 (ages 16+; the WAIS-IV remains in use in some settings): Full-scale IQ and composite index scores. Relative weaknesses in working memory and processing speed are common in ADHD.
- WIAT-4 or WJ-IV Achievement: Academic achievement testing to rule out specific learning disorders.
Attention and Executive Functioning
- Conners Continuous Performance Test (CPT-3) or Test of Variables of Attention (TOVA): Objective measures of sustained attention, impulsivity (commission errors), inattention (omission errors), reaction time, and response consistency.
- BRIEF-2 (Behavior Rating Inventory of Executive Function, Second Edition): parent and teacher forms (ages 5-18) and a self-report form (ages 11-18) measuring executive functioning in everyday settings, such as inhibitory control, working memory, and planning and organization. For adults, use the publisher's adult version (BRIEF2A, or the earlier BRIEF-A for ages 18-90).
ADHD-Specific Rating Scales
- Conners 4 (parent, teacher, and self-report forms): Normed rating scales measuring inattention, hyperactivity/impulsivity, executive dysfunction, and associated features. Includes DSM Symptom Scales and validity indicators.
- NICHQ Vanderbilt Assessment Scales (parent and teacher, ages 6-12): Widely used scales keyed to DSM ADHD symptoms, with screens for ODD, conduct problems, and anxiety/depression. NICHQ's 2002 first edition is a free download; the current third edition (2019) is sold by the AAP.
- Brown Executive Function/Attention Scales (Brown EF/A): The successor to the Brown ADD Scales; assess executive function impairments associated with ADHD.
- Adult ADHD Self-Report Scale (ASRS-v1.1): WHO-developed screening tool for adult ADHD.
Broadband Behavior and Emotional Functioning
- BASC-4 (Behavior Assessment System for Children, Fourth Edition; the BASC-3 remains in use in some settings) or the ASEBA school-age forms (CBCL parent form, TRF teacher form, YSR self-report): Comprehensive behavioral and emotional rating scales that assess for comorbid conditions (anxiety, depression, conduct problems, social difficulties).
Results and Multi-Informant Findings
Report each measure's scores with a plain-language interpretation, then show where the findings converge. Present each informant's ratings and interview findings, note which settings (home, school, work, social) each informant and record covers, and explain discrepancies between informants rather than averaging them away.
Diagnostic Formulation and Differential Diagnosis
Integrate all data sources into a coherent clinical narrative in your own words, naming the source of each finding. Describe the symptom picture as a whole (how problems with attention, activity level, and impulse control show up in this client's life and how they have changed with age), the concrete consequences for academic, occupational, social, or family functioning, and the evidence for and against alternative explanations such as anxiety, depression, trauma, sleep problems, learning disorders, medical factors, or substance use. Document comorbid conditions identified.
The diagnostic criteria for ADHD are set out in the DSM-5-TR (American Psychiatric Association). Consult the manual directly rather than reproducing its criteria in the report; the APA's What Is ADHD? page is a plain-language overview you can share with families. Name the presentation that best fits the evidence with its ICD-10-CM code: F90.0 (predominantly inattentive type), F90.1 (predominantly hyperactive type), or F90.2 (combined type). When the picture does not fit one of these presentations, Other Specified ADHD (F90.8, other type) or Unspecified ADHD (F90.9, unspecified type) may apply.
Recommendations
Provide specific, actionable recommendations for treatment (therapy, medication, coaching), school accommodations (504 plan or IEP), workplace accommodations, and home strategies.
ADHD Evaluation Report — Adolescent, Age 14
CONFIDENTIAL PSYCHOLOGICAL EVALUATION
Client: L.C. | DOB: 08/22/2011 | Age at Testing: 14 years, 6 months Grade: 9th | School: Jefferson High School Dates of Evaluation: 03/05/2026, 03/12/2026 Date of Report: 03/19/2026 Evaluator: [Name], PhD, Licensed Psychologist
Referral Information: L.C. is a 14-year-old ninth-grade male referred by his parents and pediatrician (Dr. Amara Okafor) for a comprehensive evaluation to assess for possible ADHD. His parents report that L.C. has struggled with organization, task completion, and sustained attention since elementary school, but that these difficulties have become significantly more problematic since entering high school. His current GPA is 2.1, down from 3.2 in eighth grade. His English teacher recently recommended evaluation after observing that L.C. "seems to understand the material but cannot get assignments done on time or stay focused during independent work." In a phone interview for this evaluation, the same teacher added that L.C. is restless at his desk, often shifting position or getting up during independent work, often makes poorly timed comments during class discussion, and hands in written work that is disorganized or unfinished. His parents describe nightly conflict over homework, assignments that are completed but never turned in, and long delays getting started on writing tasks.
Relevant History: L.C. was born full-term following an uncomplicated pregnancy and delivery. Developmental milestones were met within normal limits. Parents describe him as an active, talkative child who "never stopped moving" but was well-behaved in structured settings. Elementary school report cards consistently noted: "L.C. is bright and capable but needs to work on staying on task and completing work." Parents date his difficulties with organization and staying on task to the early elementary grades; his activity level has eased with age, while the organizational problems have become more noticeable as school demands increased. He received no special education services or prior testing. Medical history is unremarkable — no head injuries, seizures, or chronic medical conditions. Currently takes no medications. Vision and hearing screening within normal limits (09/2025). Sleep is reported as adequate (8-9 hours). Family history is significant for ADHD in the biological father (diagnosed in adulthood, currently taking methylphenidate) and a maternal aunt with generalized anxiety disorder. L.C. denies substance use. No prior mental health treatment.
Behavioral Observations: L.C. presented as a friendly, cooperative adolescent who appeared his stated age. He was casually dressed with adequate grooming. Rapport was established quickly — he was talkative and engaged, particularly during conversation, but became visibly restless during paper-and-pencil tasks. He frequently shifted position, tapped his pencil, and glanced around the room during timed tests. He required redirection to task three times during the CPT-3 (a 14-minute sustained attention task). Effort appeared adequate on most measures, though he rushed through several subtests and made careless errors on items he likely could have completed correctly with more time. On tasks with immediate feedback or novelty, his attention and performance improved noticeably. These observations are consistent with the profile of an individual who performs better in structured, novel, one-on-one settings than in unstructured, routine classroom environments — a pattern common in ADHD.
Assessment Results:
Cognitive Ability — WISC-V:
| Composite | Standard Score | Percentile | Classification |
|---|---|---|---|
| Full Scale IQ (FSIQ) | 108 | 70th | Average |
| Verbal Comprehension (VCI) | 115 | 84th | High Average |
| Fluid Reasoning (FRI) | 112 | 79th | High Average |
| Working Memory (WMI) | 94 | 34th | Average |
| Processing Speed (PSI) | 89 | 23rd | Low Average |
L.C.'s Full Scale IQ of 108 places him in the Average range, though significant variability across index scores makes the FSIQ a less meaningful summary. His verbal reasoning and fluid reasoning abilities are in the High Average range, indicating strong intellectual potential. However, his Working Memory (94) and Processing Speed (89) are significantly lower than his reasoning abilities — a 26-point discrepancy between his Verbal Comprehension Index and Processing Speed Index. This pattern of strong reasoning with relatively weaker working memory and processing speed is one of the most consistently documented cognitive profiles in ADHD.
Academic Achievement — WIAT-4 (selected subtests and composites):
| Subtest / Composite | Standard Score | Percentile |
|---|---|---|
| Word Reading | 105 | 63rd |
| Reading Comprehension | 101 | 53rd |
| Spelling | 98 | 45th |
| Math Problem Solving | 107 | 68th |
| Written Expression (composite) | 88 | 21st |
Academic achievement is broadly consistent with cognitive ability, ruling out a specific learning disorder in reading or math. Written Expression is a relative weakness (88, 21st percentile), consistent with his teacher's report of disorganized or unfinished written work and his parents' report of long delays starting writing tasks; his written output lags well behind his verbal ability. This pattern is common in ADHD and likely reflects executive function deficits (planning, organization, sustained effort) rather than a language-based writing disorder.
Attention — Conners CPT-3:
| Measure | T-Score | Classification |
|---|---|---|
| Omission errors | 71 | Very Elevated |
| Commission errors | 62 | Elevated |
| Response speed consistency (HRT SD) | 72 | Very Elevated |
Results indicate significant attentional difficulties. Omission errors were Very Elevated (T=71), indicating frequent lapses in attention. Commission errors were Elevated (T=62), suggesting impulsive responding. Most notably, HRT SD (response speed consistency) was Very Elevated (T=72), reflecting highly inconsistent response speed — a pattern frequently reported in ADHD. Consistent with these scores, he needed redirection three times during the task (see Behavioral Observations).
ADHD Rating Scales — Conners 4:
| Scale | Parent T-Score | Teacher T-Score |
|---|---|---|
| Inattention/Executive Dysfunction | 74 | 78 |
| Hyperactivity | 65 | 70 |
| Impulsivity | 68 | 72 |
| ADHD Inattentive Symptoms | 76 | 80 |
| ADHD Hyperactive/Impulsive Symptoms | 64 | 68 |
Teacher ratings fall in the Elevated to Very Elevated range on every ADHD-related scale. Parent ratings are Very Elevated for inattention/executive dysfunction and inattentive symptoms, Elevated for hyperactivity and impulsivity, and Slightly Elevated for hyperactive/impulsive symptoms. Inattention and executive dysfunction are the most elevated domains for both informants. Parent ratings and interview cover home, where the difficulties center on homework; teacher ratings and the English teacher's interview cover school. Convergence across informants and settings strengthens diagnostic confidence.
Executive Functioning — BRIEF-2:
| Score | Parent T-Score | Teacher T-Score |
|---|---|---|
| Global Executive Composite | 70 | 73 |
| Working Memory | 75 | 78 |
| Plan/Organize | 74 | 77 |
| Initiate | 72 | 76 |
The Global Executive Composite is clinically elevated on both forms. The highest elevations were on the scales tapping working memory, planning and organization, and task initiation (parent and teacher T-scores 72-78). Parent and teacher ratings converge on difficulty getting started on work and keeping multistep assignments organized, which matches the referral concerns and the homework and written-work problems described above.
Broadband Behavior — BASC-3 (Parent and Teacher):
Attention Problems: Clinically Significant (Parent T=72, Teacher T=76). Hyperactivity: At-Risk (Parent T=63, Teacher T=67). Anxiety: Average range (Parent T=52, Teacher T=49). Depression: Average range (Parent T=48, Teacher T=51). Conduct Problems: Average range (Parent T=50, Teacher T=53). Adaptive Skills composite within normal limits.
Diagnostic Formulation: L.C. presents with a consistent pattern of inattention, restlessness and impulsive responding, and executive dysfunction that is supported by converging evidence across multiple sources (parent, teacher, school records, clinician observation) and multiple methods (clinical interview, standardized rating scales, cognitive testing, continuous performance testing). Problems with sustaining focus, finishing work, and keeping multistep assignments organized are the most prominent and most impairing part of the picture: both informants rate inattention and executive dysfunction in the Very Elevated range, BASC-3 Attention Problems is Clinically Significant on both forms, and the CPT-3 shows Very Elevated omission errors and highly inconsistent response speed (HRT SD). Restlessness and impulsive responding are less pronounced but appear across most data sources: teacher and parent Conners 4 ratings, At-Risk BASC-3 Hyperactivity scores, the teacher's interview, the examiner's observations of fidgeting during timed tasks, and Elevated CPT-3 commission errors. His cognitive profile — strong verbal and fluid reasoning with relatively weaker working memory and processing speed — fits this picture.
These difficulties are long-standing rather than new. Elementary report cards repeatedly note problems staying on task and completing work, and parents date them to the early elementary grades; the ninth-grade decline reflects heavier organizational demands, not a new problem. They affect him both at home (nightly homework conflict, assignments not turned in) and at school (late and unfinished work, disorganized writing). The functional cost is substantial: his GPA fell from 3.2 to 2.1 after the move to high school despite High Average verbal and fluid reasoning, and his written output lags his verbal ability (WIAT-4 Written Expression composite 88, 21st percentile).
Alternative explanations were considered. Anxiety and depression were ruled out as primary explanations based on BASC-3 ratings in the average range on both forms and a clinical interview that did not identify a mood or anxiety disorder. A specific learning disorder in reading or math was ruled out based on achievement scores broadly consistent with cognitive ability. Sleep is adequate, vision and hearing screening was normal, medical history is unremarkable, and L.C. denies substance use. Taken together, the evidence best fits ADHD, combined presentation, with inattention the more prominent and more impairing component.
DSM-5-TR Diagnosis:
- Attention-Deficit/Hyperactivity Disorder, Combined presentation, Moderate (F90.2)
Recommendations:
Treatment:
- Refer to pediatrician or child psychiatrist for medication evaluation. Stimulant medication (methylphenidate or amphetamine class) is the first-line evidence-based pharmacological treatment for moderate to severe ADHD in adolescents.
- Individual therapy focused on organizational skills training and executive function coaching. Consider an adolescent organization and planning protocol such as Supporting Teens' Autonomy Daily (STAND), or a similar structured program.
- Psychoeducation for L.C. and his parents about ADHD, including its neurobiological basis, to reduce self-blame and support effective management.
School Accommodations (recommended for Section 504 Plan):
- Extended time on tests and major assignments (time-and-a-half)
- Preferential seating near the teacher and away from distractions
- Written instructions for multi-step assignments
- Permission to use a planner or digital organizational tool; weekly check-ins with a teacher or counselor to review planner
- Break long assignments into smaller segments with intermediate deadlines
- Reduce penalties for late work while organizational skills are developing
- Access to a quiet testing environment for exams
- Permission to use a word processor for written assignments
Home Strategies:
- Establish a consistent homework routine with a designated, distraction-reduced workspace
- Use visual checklists for daily routines (morning, after school, bedtime)
- Implement a system for organizing school materials (color-coded folders by subject)
- Provide brief, one-step instructions rather than multi-step verbal directions
- Build in physical activity breaks during homework
This is a sample for educational purposes only — not real patient data.
How to Write It Step by Step
Step 1: Gather comprehensive history before testing. Conduct a thorough clinical interview with the client and (for minors) parents or caregivers. Obtain prior report cards, previous evaluations, and teacher feedback. For adults, seek collateral history from a parent, partner, or other informant who can speak to childhood functioning. The history is the foundation of the diagnostic formulation.
Step 2: Select an appropriate test battery. Choose measures that provide converging evidence across methods. Guidelines do not require cognitive or performance testing for every ADHD diagnosis, but a comprehensive psychological evaluation commonly includes a cognitive measure (WISC-V, or WAIS-5/WAIS-IV for older adolescents and adults), a continuous performance test (CPT-3 or TOVA), ADHD-specific rating scales from multiple informants (Conners 4 or Vanderbilt), an executive function measure (BRIEF-2), and a broadband behavior measure (BASC-4 or BASC-3, or the ASEBA forms) to screen for comorbidities. Add academic achievement testing if learning disorders are a concern.
Step 3: Administer tests in a standardized manner and document behavioral observations. Note the client's attention, effort, fidgeting, response to frustration, and need for redirection throughout testing. These observations are diagnostically valuable and provide ecological validity to the test scores.
Step 4: Score and interpret results within the context of the referral question. Do not simply list scores — interpret them. Explain what each score means in plain language, how scores relate to one another, and how the pattern of results supports or fails to support an ADHD diagnosis. Identify convergent findings across measures.
Step 5: Integrate the evidence in your own words. Write the formulation as a narrative that names the source of each finding (parent, teacher, self-report, records, observation, test data) and explains how the findings fit together. Check your conclusion against the DSM-5-TR itself rather than restating its criteria in the report. This makes your diagnostic reasoning transparent and defensible.
Step 6: Address differential diagnoses. ADHD symptoms overlap substantially with anxiety, depression, trauma, sleep disorders, giftedness, and learning disabilities. Document which alternatives you considered and the evidence that supported or ruled out each.
Step 7: Write actionable recommendations. Tie every recommendation to a specific finding in the evaluation. If you recommend extended time on tests, cite the Processing Speed deficit. If you recommend organizational coaching, cite the BRIEF-2 Plan/Organize score. Recommendations without supporting data appear arbitrary.
Common Mistakes
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Diagnosing ADHD based solely on rating scales. Rating scales are one data source, not the entire evaluation. Elevated Conners scores alone do not make a diagnosis — they must be corroborated by developmental history, reports from other informants and settings, behavioral observations, and clinical judgment, together with any cognitive or performance test data you obtained. Rating scales are also susceptible to rater bias, particularly when parents are seeking a specific diagnosis for accommodation purposes.
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Failing to establish childhood onset. The DSM-5-TR requires evidence that symptoms began in childhood (see the DSM-5-TR for the specific criterion). For adult evaluations, this means obtaining childhood history through records, report cards, or collateral informants. Diagnosing ADHD in an adult without credible evidence of childhood onset, ideally corroborated by records or a collateral informant, leaves the diagnosis open to challenge.
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Ignoring alternative explanations. Before diagnosing ADHD, you need to show that another condition does not account for the attention problems. If a client has an untreated anxiety disorder, sleep apnea, or recent trauma causing concentration difficulties, you must address whether these conditions account for the attention symptoms before diagnosing ADHD. Comorbidity is common, but document your reasoning for why ADHD is present as a separate condition rather than a secondary manifestation of another disorder.
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Writing reports that are inaccessible to parents and educators. ADHD reports are frequently shared with schools, parents, and primary care physicians who are not psychologists. Use plain language to explain test scores and clinical concepts. A parent who cannot understand your report cannot implement your recommendations. Define technical terms, explain what percentile ranks mean, and write recommendations in language a teacher can use directly.
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Providing vague or generic recommendations. "Provide accommodations for ADHD" is not useful. Specify exactly which accommodations are supported by the evaluation data and why. Schools need actionable, specific recommendations they can implement — and insurance companies need to see that your recommendations are grounded in your findings, not boilerplate.