ADHD Diagnostic Flowchart .pdf
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ADHD diagnosis
–
Start
Has a comprehensive mental health assessment been done?
Assess
no
yes
Does the young person have significant personal and social impairment
Exit
no
yes
Do the problems include severe developmentally inappropriate
inattention, impulsivity and hyperactivity that impairs functioning?
Consider other
diagnoses
no
yes
Are these problems present in more than the home environment?
no
yes
Have these problems been present since before age 7?
no
yes
Have reliable and valid rating scales been administered
to parent and teacher (or other caregivers)
Can it be done?
no
yes
no
Do the ratings indicate ADHD?
no
yes
yes
Is there good
evidence of ADHD
from other sources?
Diagnose ADHD
yes
no
Are the problems of hyperactivity, impulsivity and inattention
equally disabling?
no
yes
Diagnose ADHD
Mixed HI and
Inattentive type
yes
Diagnose
ADHD HI type
yes
Diagnose ADHD
Inattentive type
Are the problems primarily hyperactivity and impulsivity?
no
Are problems primarily inattention?
Consider other
diagnoses
no
re-enter
Are there other severe behavioural or learning problems?
yes
no
Are these longstanding, serious, cross-situational problems of intentional,
developmentally inappropriate defiance and/or rule breaking?
no
yes
Are these serious problems of learning not due to inadequate education?
no
yes
Are there other serious problems not accounted for by any of the above?
Diagnose comorbid
Oppositional Defiant or
Conduct Disorder & consider
ODD/CD guidelines
re-enter
Diagnose comorbid learning
disorders or Mental Retardation and
appropriate care
re-enter
no
Go to
ADHD Care Plan Decision Tree
over
yes
Consider other comorbid
diagnoses (eg; Anxiety Dis)
and appropriate care
re-enter
New Zealand Guidelines for the Assessment and Treatment of ADHD. July 2001
ADHD care plan
Start
–
Have the needs of the young person and family/whanau for holistic and
culturally safe care been considered?
no
yes
Holistic/cultural care guidelines
Have all the care plans for comorbid diagnoses been considered?
no
yes
Other diagnoses care guidelines
Has written information on ADHD, medication and care been given?
yes
no
Give information
no
Consider other stimulant or
antidepressant
(or behaviour therapy)
Can stimulant (other) medication be safely given?
yes
Are guardian and young person willing to try this medication?
Discuss further or other med or
behaviour therapies
no
yes
Have systems of assessment of effect/side effects been set up for
home and school systems?
no
yes
Set up assessment systems
Is 24-hour medical advice on medication available to caregivers?
no
yes
Set up 24-hour call system
Commence stimulant (other) medication in low dosage
Assess 1–2 weekly. Adjust dosage and regimen
To behaviour therapies
Do caregivers, young person, teachers etc notice significant improvement
judged to be in young person’s best interest and without overriding
side effects and with response and timing consistent with medication?
no
yes
Review no less than 3–12 monthly
Re-enter at any time or tree point
yes
Go to “Consider other stimulant”
(above)
Consider other stimulant or antidepressant?
no
Consider evidence-based caregiver/youth/social behavioural interventions?
no
yes
Has information been given and informed consent and assent obtained?
no
yes
Give information
Get consent
Have caregiver/school systems of assessing behavioural interventions
been set up?
no
yes
Set up systems
Start behavioural interventions
Do caregivers, young person, teachers etc notice significant improvement judged
to be in young person’s best interest and without overriding negative effects?
no
yes
Is response to medication and/or behavioural interventions partial
and insufficient?
Re-assess often
Re-enter decision tree at any point
if needed still
no
yes
Consider neuroleptic medication instead of or in combination with
above treatments?
no
yes
Is modified care plan still unsatisfactory?
no
yes
Reconsider diagnosis (eg PDD, Anxiety or Conduct Disorder)
Get second opinion or refer to another facility if possible
Exit
Re-enter above at
“Can stimulant (other) medication
be safely given”

