Disentangling ADHD Symptoms: The Diagnostic Process

Can your child sit and focus while building an intricate Lego set or battling monsters through several stages of a beloved video game, but teachers report difficulty concentrating during independent work time? Or perhaps your child shows the opposite presentation of timely task completion at school but homework is an emotional and logistical disaster at home? We commonly receive questions about how we determine if an attentional or executive functioning problem is getting in the way of a child’s success or if another challenge is the culprit.


Attention-Deficit/Hyperactivity Disorder (ADHD) is a condition that can make it difficult for an individual to sit still, manage their behavior, and pay attention. These difficulties usually begin before the person is seven years old. However, these behaviors may not be noticed until the child is older, especially as demands in their environment intensify.  We know that approximately 5 out of every 100 children and 2.5 percent of adults may have ADHD. Boys are three times more likely than girls to have ADHD.  Consulting with a psychologist or neuropsychologist can be a critical step to understand the underlying cause of such challenges.  At the Portsmouth Neuropsychology Center, Drs. Cook and Rubin gather data from a number of sources to better determine if a child has ADHD, a learning challenge, or potential social-emotional challenge which negatively impacts their ability to focus or regulate their behavior.

Such information gathering includes:

  • Review of records
  • Clinical interview with parents
  • Phone conversations with teachers and other providers
  • Standardized parent-, teacher-, and self-rating forms of attention, hyperactivity/impulsivity, and executive functioning
  • Direct measures of attention that may include selective, sustained, or divided attention
  • Direct measures of executive functioning including inhibition, working memory, planning, organization, and cognitive flexibility
  • Observations during testing and if needed, at school


It is critical that such evaluations use multiple-methods, establish the developmental trajectory of symptoms, and understand the impact of attentional challenges on home, school, and community functioning. A comprehensive look at a person’s presentation greatly improves validity and can help us apply evidence-based recommendations more appropriately to the individual.


Conducting a comprehensive evaluation is critical in order to provide appropriate differential diagnosis and accurately tease apart why symptoms are occurring. For some children and adults, the presence of inattention and executive functioning deficits may be solely related to neurobiological differences such as ADHD. For others, a sudden onset of attentional difficulties might emerge due to another mental health concern. For example, anxiety and depressive disorders include such overlapping symptoms as difficulty concentrating, trouble making decisions, mind going blank, and restlessness. In addition, children with undiagnosed learning disabilities begin to look highly inattentive because they are struggling with academic material and may zone out when confused.


Drs. Cook and Rubin are highly trained in providing thoughtful evaluations for children, adolescents, and adults which can identify underlying causes for attentional or behavioral regulation problems, provide accurate differential diagnosis, and generate individualized recommendations that can be used at home, school, or the workplace. Their evaluations can help you to make sense of your child’s functioning and to know how to best help them at home and school.


Check out the following resources for more information!

ADHD: Questions And Answers

Understanding ADHD In Children

Basic Facts about ADHD

Key Components of Evaluation