ADHD Screening vs. Diagnosis: Why Screeners Are Only the First Step in an ADHD Diagnosis

Screeners can be a helpful starting point when someone is concerned about Attention-Deficit/Hyperactivity Disorder (ADHD). However, it’s important for parents, educators, and professionals to understand that ADHD is a complex condition. Many other factors—such as learning styles, personality, anxiety, or developmental differences—can cause behaviors that look like ADHD. Because of this, screeners should be used only as a first step, not as the final answer.

When a screener suggests possible ADHD, the next step should be a referral to a professional who specializes in ADHD and neurodevelopmental testing. A clinical psychologist with the right training can complete a thorough evaluation that looks at the whole person—not just a checklist of symptoms. These evaluations often include testing of intelligence, academic skills, executive function, attention, memory, sensory and motor skills, and daily functioning, as well as other factors that may look like or overlap with ADHD.

What Is ADHD and How Is It Diagnosed?

ADHD is a clinical diagnosis given to individuals who show a certain number and level of symptoms related to inattention, impulsivity, and/or hyperactivity. These symptoms are defined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), which clinicians use as a guide. (At Individual Matters, we view ADHD as closely connected to executive function—brain skills that affect planning, focus, organization, and emotional control.)

In many cases, ADHD is diagnosed using a screener and a short clinical interview. Screeners are questionnaires—usually completed by parents, teachers, or individuals themselves—that ask about behaviors and rate how often they occur. While screeners are standardized and useful, they rely on personal opinions and observations, which can be biased or influenced by specific situations. Based on screener scores and a brief interview, some individuals may receive an ADHD diagnosis and medication.

Is That Enough?

While this approach is common, it is not very in-depth. Because screeners are subjective and limited, they cannot clearly show how often symptoms occur, how severe they are, or what is actually causing them. Without a thorough evaluation, it can be difficult to know whether someone truly has ADHD or whether something else is affecting their behavior.

Screeners are called “screeners” for a reason—they are meant to identify who may need further evaluation. ADHD-like symptoms can come from many sources, including learning disabilities, anxiety, sensory processing challenges, fine motor delays, executive function difficulties, and other neurocognitive or neurodevelopmental disorders, as well as mood issues, environmental factors, or a poor fit between a student and their classroom. Even for specialists, it can be challenging to sort out these overlapping causes without careful testing.

Do Screeners Have Value?

Yes—screeners are valuable tools when used correctly. They help narrow down concerns and guide referrals to the right professionals. Many healthcare providers and educators work with limited time and resources and cannot complete in-depth ADHD evaluations themselves. Screeners allow them to recognize when a concern may require specialized assessment and to refer appropriately.

Who Should Provide an In-Depth ADHD Evaluation?

Psychologists who specialize in neurodevelopmental evaluations have the training, tools, and experience needed to accurately diagnose ADHD and tell it apart from other conditions. This level of evaluation helps prevent misdiagnosis and unnecessary medication, ensures that other underlying issues are identified, and provides clear guidance for treatment and support.

For individuals who do have ADHD, comprehensive testing can explain what type of ADHD they have, how it interacts with their strengths and challenges, and which strategies will help them the most.

At Individual Matters, we do use screeners and interviews, but we also include objective attention measures, executive function testing, and assessments of IQ, academics, sensory processing, fine motor skills, and personality. We believe that people are complex, and understanding ADHD requires a whole-person approach.

As I’ve seen time and time again in my work: if you’ve met one child with ADHD, you’ve met one child with ADHD. No two individuals are the same, and neither are the ways ADHD affects their lives.

-Dr. Katen

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