How is ADHD diagnosed?

Getting a diagnosis of ADHD isn’t as simple as having a blood or lab test done. In fact, there isn’t a single definitive test to diagnose ADHD. Instead, ADHD diagnosis is based on a comprehensive assessment that includes various factors.

To qualify for an ADHD assessment, an individual must exhibit a persistent pattern of inattention and/or hyperactivity-impulsivity that significantly interferes with their daily functioning or development. This pattern should be present for a certain amount of time and in two or more settings, like school, home, work, or social environments. [i]

For over forty years, the Drake Institute has used advanced treatment technologies to design individually tailored treatment protocols for patients with ADHD, autism, and other brain-based conditions. We use brain map-guided neurofeedback and neurostimulation to help our ADHD patients reduce and/or resolve their symptoms and have better lives.

For more information about how the Drake Institute treats ADHD, anxiety, depression, and other brain-based disorders, please fill out the consultation form or call us at 800-700-4233.

What is ADHD?

ADHD is a neurodevelopmental disorder that can significantly impact a child’s daily life. Brain dysregulation in the ADHD child can result in challenges related to sustaining attention, maintaining focus, and regulating impulses.

While individuals with ADHD may sometimes give the impression that they are not trying hard enough to sit still or pay attention, they may lack the stable neurophysiological mechanisms required for self-regulation.

Current research has suggested that ADHD develops from a combination of genetic and environmental factors.

There is also no cure for ADHD; however proper treatment can enhance attention, reduce hyperactivity and impulsiveness, and support individuals on their path towards a higher quality of life.  [ii] In fact, at the Drake Institute, we have helped some patients who no longer meet the diagnostic criteria for ADHD by the completion of treatment.

Understanding the ADHD diagnostic criteria

ADHD evaluations are aligned with the diagnostic criteria in the American Psychiatric Association’s Diagnostic and Statistical Manual, fifth edition (DSM-5). [iii]

Adhering to these criteria during ADHD assessment ensures a standardized approach for diagnosis. It also ensures that individuals with ADHD are accurately identified so they can be helped.

One fundamental requirement of the criteria is a persistent pattern of inattention and/or hyperactivity-impulsivity that disrupts daily life or development. The pattern should persist for at least six months, demonstrating its chronic course.

A typical diagnosis of ADHD may include interviews with the patient’s parent or parents regarding symptoms in multiple settings and utilizing standardized assessment symptom checklists. Gathering information from a variety of sources can help the diagnosing clinician make an accurate diagnosis. The Drake Institute also utilizes qEEG brain mapping to link ADHD symptoms to areas or networks of the brain that are dysregulated. Understanding ADHD diagnosis criteria will help identify the presence of which specific type of ADHD a patient is experiencing: [iv]

Predominantly Inattentive Presentation

The predominantly inattentive presentation of ADHD is one of the three subtypes of the disorder. Individuals with this subtype primarily struggle with sustaining attention and maintaining focus and follow-through, often experiencing difficulties organizing tasks, following instructions, and paying attention to detail.

To be diagnosed with predominantly inattentive presentation up until the age of 16, individuals must exhibit six or more symptoms of inattention. For adolescents aged 17 years and older and adults, the threshold is five or more symptoms. These symptoms should persist for at least six months and be inappropriate for the individual's developmental level.

The main symptoms of this ADHD subtype include:

  • Inattention
  • Easily distracted
  • Lack of sustained focus on non-preferred tasks
  • Difficulty finishing tasks such as homework without supervision
  • Poor short-term memory (i.e., difficulty following a series of instructions)
  • Often forgetful, such as forgetting homework or turning it in
  • Poor listening skills

Predominantly Hyperactive-Impulsive Presentation

The predominantly hyperactive-impulsive presentation of ADHD is another distinct subtype of ADHD, characterized by significant challenges related to hyperactivity and impulsivity. Individuals with this subtype often find it difficult to control their impulses and manage their activity levels appropriately. To diagnose this type of ADHD, specific criteria must be met. This type of ADHD may be diagnosed earlier than the inattentive presentation because the symptoms can be disruptive and more visible at earlier ages.

For children up to the age of 16 years, the diagnostic criteria require the presence of six or more symptoms of hyperactivity-impulsivity. For those 17 and older, the criteria only require five or more symptoms. Again, for all individuals, symptoms must be present for at least six months before diagnosis.

Some of the most common symptoms of this type of ADHD presentation include:

  • Impulsive (acting without thinking of the consequences, blurting out answers, interrupting, having trouble waiting one's turn)
  • Hyperactive (has difficulty sitting still)
  • Often unable to play or take part in leisure activities quietly
  • Squirms in their seat, fidgets with or taps their hands or feet
  • Behaves as if “driven by a motor”

Combined Presentation

This subtype reflects a comprehensive set of ADHD symptoms involving both inattention and hyperactivity-impulsivity. As with the other subtypes, symptoms should be present for at least six months, disruptive in the child’s life, and be developmentally inappropriate for the individual.

To receive a diagnosis, children under 16 must experience six hyperactivity-impulsivity symptoms and six inattention symptoms. Individuals older than 17 must experience five from each category.

Additional diagnostic criteria for ADHD

In addition to the ADHD diagnostic criteria above, several other conditions must be met for a diagnosis.

First, ADHD symptoms must have been present before the age of 12.

It’s also important that the symptoms be noted in at least two distinct settings, such as work, home, school, or social settings. This helps determine whether symptoms are pervasive and related to ADHD or simply related to discomfort in specific situations.

There should be evidence that the individual’s symptoms interfere with or impair social, school, or work functioning. Symptoms also cannot be due to a different brain-based disorder, like anxiety, depression, learning disorder, or others.

How ADHD is diagnosed

So, how is ADHD diagnosed?

Diagnosing ADHD typically involves a structured interview with standardized symptom checklists to ensure accurate evaluation. In addition, the Drake Institute includes a qEEG brain map to identify the specific brain dysregulation linked to symptoms.

Understanding how to get diagnosed for ADHD could facilitate earlier access to diagnosis and treatment, which are helpful for achieving the best outcomes. Here is how the ADHD testing process goes: [v]


The first step in diagnosing ADHD is a comprehensive consultation with a healthcare professional. During this ADHD screening, the clinician gathers detailed information about the individual’s medical history, developmental milestones, and the specific symptoms they are experiencing. They also inquire about the presence of symptoms in different settings and the duration of these symptoms.

ADHD Tests

With the consultation, standardized ADHD questionnaires and rating scales are used to assess the presence and severity of ADHD symptoms.

Continuous performance tests are sometimes used to evaluate attention and impulsivity.

During an ADHD diagnosis, clinicians also consider other conditions or disorders that may be contributing to ADHD symptoms, but which are not coming from ADHD itself, such as anxiety or depression


Once the ADHD assessment is completed, the results are carefully evaluated by the clinician. Clinical history and findings along with qEEG bran map results are utilized to determine the diagnosis and treatment plan. The diagnosis also determines which subtype of ADHD the individual has. Our treatment plan also includes support for the parents, behavioral modification, and a secondary treatment program for auditory processing problems when needed.

ADHD symptoms in boys vs. girls

ADHD is a disorder that affects boys and girls, but there are certain differences in the way symptoms manifest.  

In boys, ADHD is more likely to present with externalizing behaviors. This means that boys with ADHD often exhibit hyperactivity and impulsivity, which are easily noticeable and can be disruptive. They might fidget, interrupt others, or act without thinking about the consequences. These behaviors can be disruptive in classroom settings and social interactions, leading to boys getting tested for ADHD earlier than girls.

Girls, on the other hand, are not as likely to be hyperactive. Instead of overt hyperactivity, they might exhibit inattention or daydreaming. Girls with ADHD may be less disruptive in class, so teachers may not be as concerned unless they’re falling behind significantly academically. Girls with ADHD may also be seen as shy and tend to develop coping mechanisms to mask their symptoms, making it even harder for parents, teachers, and healthcare professionals to recognize the possibility of ADHD. [vi]

Can children outgrow ADHD?

The symptoms of ADHD typically arise from an underlying brain dysregulation that tends to persist into adulthood for most patients. As a result, many individuals with untreated ADHD continue to struggle with symptoms throughout their lives. However, the severity and impact of symptoms may change over time.

Because of dysregulated brain functioning, patients with ADHD have much more difficulty sustaining focus on non-preferred tasks. The non-drug treatment protocols we use at the Drake Institute are developed to help our patients improve brain regulation to reduce symptoms. [vii]

Is ADHD a genetic disorder?

A substantial amount of scientific evidence indicates that there is a strong genetic component to ADHD.

In fact, scientists have identified up to 27 common genetic variants that may influence ADHD. These variants have been found in genes expressed in the frontal cortex, which is involved in memory and attention, and the midbrain dopaminergic neurons, which are involved in voluntary movement and reward processing. [viii]

While there are potential genetic contributors to ADHD, that doesn’t necessarily mean that people are born with ADHD. Instead, they are born with a genetic predisposition to develop ADHD in the neurodevelopmental phase of early childhood. [ix] [x]

Can adults be diagnosed with ADHD?

Yes, adults can be diagnosed with ADHD. In many cases, symptoms of ADHD in childhood were missed or ignored, so a diagnosis was never made. In other cases, the person may have received a diagnosis of another disorder entirely, like depression, anxiety, or a learning disorder, and missed a coexisting diagnosis of ADHD.

Getting an ADHD diagnosis as an adult comes with challenges. The presence of comorbid conditions like anxiety or depression could make a correct diagnosis more challenging, especially when anxiety or depression may be the overwhelming chief complaint. Untreated undiagnosed ADHD may have predisposed the adult patient to developing anxiety and/or depression.

When diagnosing ADHD in adults, it can be helpful to get a thorough childhood history to identify any symptoms of ADHD that may have been present during childhood and adolescence. [xi]

The Drake Institute also uses a qEEG brain map in the adult ADHD evaluation to determine if there are any current dysregulated brain networks linked to ADHD symptoms.

How The Drake Institute Treats ADHD

Over the last 40 years, the Drake Institute has clinically pioneered the use of advanced treatment technologies to treat a variety of brain-based medical disorders such as ADHD, Autism Spectrum Disorder, PTSD, anxiety, panic disorder, depression, insomnia, and more. Using a combination of brain map-guided neurofeedback and sometimes neurostimulation, our Medical Director creates customized treatment protocols to address each patient's needs.

Brain Mapping

To develop our individualized treatment plans, we first complete a qEEG brain map analysis for each patient. Brain mapping helps us identify which specific regions or networks of the brain are dysregulated and linked to symptoms.

To collect this data, 19 sensors are placed around the scalp in areas of the brain responsible for language, focus, memory, executive functioning, social/emotional understanding and behavioral/emotional regulation. The 19 sensors measure and record brainwave activity that is processed through a normative database of neurotypical individuals.

When we compare the patient's results with those of neurotypical individuals, we can identify regions or networks of the brain that are dysregulated and causing symptoms. This information also allows us to determine how these areas are dysregulated so that we can develop specific treatment protocols that help improve brain functioning and reduce symptoms.


During neurofeedback training/treatment, sensors are once again placed on the scalp. The sensors record and display instantaneous brainwave activity visually in real-time on a computer screen with simultaneous auditory feedback as well.

During neurofeedback sessions, the patient is seeing the results of how their brain is working and with this information, they learn to improve their brainwave activity by guiding it toward healthier, more appropriately functional brainwave patterns.

We do not administer any drugs or perform invasive procedures during this process. Instead, the patient is improving their own brain functioning, guided by visual and auditory feedback.


As an adjunct to neurofeedback, we may also use neurostimulation guided by qEEG brain map findings to gently stimulate the brain into healthier functional patterns. In our experience, some patients may benefit even more from neurofeedback if we also use neurostimulation. We have found this particularly helpful for lower-functioning children on the Autism Spectrum.

Contact The Drake Institute Today!

In the last forty years, Drake has helped thousands of patients with various disorders such as autism, ADHD, PTSD, anxiety, panic disorder, depression, insomnia, migraine headaches, irritable bowel syndrome, and hypertension reduce or resolve their symptoms and thereby achieve a better quality of life. Call us at 1-800-700-4233 or fill out the free consultation form to get started.













Contact Us Today

To get the help you or a loved one needs, call now to schedule your no-cost screening consultation.

dr david velkoff headshot

“David F. Velkoff, M.D., our Medical Director and co-founder, supervises all evaluation procedures and treatment programs. He is recognized as a physician pioneer in using biofeedback, qEEG brain mapping, neurofeedback, and neuromodulation in the treatment of ADHD, Autism Spectrum Disorders, and stress related illnesses including anxiety, depression, insomnia, and high blood pressure. Dr. David Velkoff earned his Master’s degree in Psychology from the California State University at Los Angeles in 1975, and his Doctor of Medicine degree from Emory University School of Medicine in Atlanta in 1976. This was followed by Dr. Velkoff completing his internship in Obstetrics and Gynecology with an elective in Neurology at the University of California Medical Center in Irvine. He then shifted his specialty to Neurophysical Medicine and received his initial training in biofeedback/neurofeedback in Neurophysical Medicine from the leading doctors in the world in biofeedback at the renown Menninger Clinic in Topeka, Kansas. In 1980, he co-founded the Drake Institute of Neurophysical Medicine. Seeking to better understand the link between illness and the mind, Dr. Velkoff served as the clinical director of an international research study on psychoneuroimmunology with the UCLA School of Medicine, Department of Microbiology and Immunology, and the Pasteur Institute in Paris. This was a follow-up study to an earlier clinical collaborative effort with UCLA School of Medicine demonstrating how the Drake Institute's stress treatment resulted in improved immune functioning of natural killer cell activity. Dr. Velkoff served as one of the founding associate editors of the scientific publication, Journal of Neurotherapy. He has been an invited guest lecturer at Los Angeles Children's Hospital, UCLA, Cedars Sinai Medical Center-Thalians Mental Health Center, St. John's Hospital in Santa Monica, California, and CHADD. He has been a medical consultant in Neurophysical Medicine to CNN, National Geographic Channel, Discovery Channel, Univision, and PBS.”

More About What Makes Drake Institute Unique