Comprehensive ADHD Evaluation: Why Quick Screenings Might Miss the Mark

Understanding the Challenges of ADHD Diagnosis

In our practice, we often meet individuals who have been diagnosed with ADHD based on a quick checklist or a brief conversation with a provider. Despite following prescribed treatments, many find themselves still struggling, frustrated by a lack of progress. When they come to us, they’re not just seeking a diagnosis—they’re seeking clarity. Unfortunately, we frequently discover that their initial diagnosis missed the mark, leading to years of unnecessary suffering that could have been avoided with a more thorough evaluation.

The Complexity of ADHD and Symptom Overlap

ADHD is commonly associated with difficulty concentrating, being easily distracted, and impulsivity. However, these symptoms aren’t unique to ADHD; they appear in a variety of psychiatric conditions. For instance, difficulty concentrating is a symptom in 17 different psychiatric diagnoses in the DSM-5-TR (Forbes et al., 2024). In fact, 36.8% of the 628 distinct psychiatric symptoms in the DSM-5-TR overlap across multiple diagnoses. This significant overlap complicates the diagnostic process and increases the risk of misdiagnosis.

What’s more, ADHD isn’t near the top of the diagnostic hierarchy for difficulties with concentration, which means that meaningful differential diagnosis requires consideration of other conditions before arriving at a diagnosis of ADHD.

Consider a child struggling to focus in school. They might have ADHD, or they could be experiencing anxiety, depression, or simply boredom due to being academically gifted. Similarly, an adult feeling overwhelmed and struggling to keep up at work might have ADHD—or they could be dealing with anxiety, depression, or another condition that shares similar symptoms.

The Limitations of Quick ADHD Screenings

Because online tools and quick symptom checklists are so widely available, many people turn to them for answers about ADHD.  While these can be a helpful starting point, they have significant limitations. Screening tools that focus solely on one condition often overlook other potential causes of similar symptoms, leading to misdiagnosis and ineffective treatments. For example, anxiety and depression can impair concentration, mimicking ADHD. If these cognitive symptoms are misattributed to ADHD, individuals may miss out on the appropriate care, such as targeted therapy or mood support, and may also receive inappropriate care or medication, potentially worsening their condition.

The Importance of Comprehensive Psychological Assessments

The question 'Do I have ADHD?' is common, but it’s only part of the picture. In collaboration with the client, an experienced clinician will work to reframe the question, exploring together why concentration and focus are challenging. By broadening the perspective in this way, we can jointly explore a wide range of diagnostic possibilities, ensuring that the treatment plan addresses the underlying issues effectively.

So, why does it matter to broaden the question beyond just 'Do I have ADHD?' Reframing the issue this way is key because if the answer is yes, we can confidently move forward with the right diagnosis and treatment plan. But if the answer is no, you’re still left struggling with concentration and productivity. Simply knowing that you don’t have ADHD isn’t likely to help you perform better at school or work. Understanding the true underlying issue—whether it’s anxiety, depression, or something else—ensures that you’re not left without a roadmap toward recovery and support. A comprehensive assessment provides a clearer understanding, guiding the development of a personalized treatment plan that gives you the best chance to overcome your challenges.

The Bottom Line

Psychiatric symptom overlap makes accurate diagnosis challenging, particularly with conditions like ADHD. A quick screening might suggest ADHD, but without a comprehensive psychological assessment, there’s a significant risk of missing the real issue. If you or someone you know is struggling with symptoms that might suggest ADHD, consider seeking a thorough evaluation. It’s the most reliable way to ensure the right diagnosis and treatment, paving the way for real progress and relief.