ADHD Evaluation Form for Children for Mental Health Professionals (PDF & Word Doc)

Diagnosing ADHD in children and adolescents depends on gathering consistent evidence across home and school, since DSM-5-TR requires symptoms to be present in multiple settings and to have emerged before age 12. A structured evaluation template helps clinicians organize parent, teacher, and child-reported information into a coherent diagnostic picture rather than relying on a single informant’s perspective.

TherapyByPro’s ADHD Evaluation Form for Children is a comprehensive, clinician-developed diagnostic evaluation document designed for psychiatrists, psychiatric nurse practitioners, and other mental health professionals evaluating ADHD in children and adolescents. The template guides clinicians through patient and parent/guardian information, presenting concerns, a full DSM-5-TR inattentive and hyperactive-impulsive symptom review with multi-informant reporting, developmental and medical history, educational history and school functioning, behavioral and social-emotional functioning, current medications and prior treatment trials, mental status examination and standardized rating scales, differential diagnosis, risk assessment, a DSM-5-TR criteria checklist and diagnostic formulation, and treatment and follow-up recommendations.

The evaluation opens with patient, parent/guardian, and custody information, consent and assent documentation, and the referral source and reason for evaluation, followed by presenting concerns collected separately from parent, child, and teacher perspectives. A detailed DSM-5-TR inattentive symptom table documents each of the nine Criterion A1 symptoms across parent, teacher, and child report, using the age-appropriate threshold of six of nine symptoms for children age 16 and under. A parallel hyperactive-impulsive symptom table applies the same multi-informant structure and calculates the DSM-5-TR presentation type.

Developmental and medical history sections document prenatal exposures, birth complications, early developmental milestones, and family psychiatric history, while educational history captures academic performance, school support services, IEP or 504 status, and teacher-reported concerns. Behavioral, social, and emotional functioning sections address home behavior, peer relationships, emotional regulation, anxiety and depressive symptoms, trauma history, and autism spectrum screening considerations, since ADHD and ASD frequently co-occur. A nine-domain executive functioning table and adaptive functioning assessment round out the functional picture.

Current medications and a detailed prior ADHD medication trial table support treatment planning, followed by a mental status examination, direct clinical behavioral observations, and a standardized rating scale tracker covering the Vanderbilt ADHD Diagnostic Rating Scales, Conners’ Rating Scales, ADHD Rating Scale-5, Child Behavior Checklist, BASC-3, SNAP-IV, and comorbidity and ASD screeners across parent, teacher, and self-report versions. A structured differential diagnosis table addresses psychiatric and medical conditions that can mimic or co-occur with childhood ADHD, followed by risk assessment, a DSM-5-TR criteria checklist with diagnostic formulation, and treatment recommendations covering medication, school accommodations, and therapeutic interventions.

What Is Included in This ADHD Evaluation Form for Children

This comprehensive evaluation includes documentation commonly used when conducting a diagnostic evaluation for ADHD in children and adolescents:

• Patient and Parent/Guardian Information: Custody status, referral source, primary informant, and parent consent and child assent documentation.
• Presenting Concerns: Parent, child, and teacher-reported concerns, settings where symptoms occur, and parent/guardian goals for the evaluation.
• DSM-5-TR Inattentive and Hyperactive-Impulsive Symptom Review: All 18 Criterion A symptoms rated across parent, teacher, and child report with age-appropriate thresholds.
• Developmental and Medical History: Prenatal and birth history, developmental milestones, sleep concerns, and family psychiatric and developmental history.
• Educational History and School Functioning: Academic performance, school support services, accommodations, and teacher-reported behavioral concerns.
• Behavioral, Social, and Emotional Functioning: Home behavior, peer relationships, emotional regulation, anxiety and depressive symptoms, and autism spectrum screening considerations.
• Executive Functioning and Adaptive Functioning: A nine-domain executive function rating and an age-appropriate independence assessment.
• Current Medications and Prior ADHD Treatment Trials: A detailed medication trial table and current medication monitoring for side effects and duration of benefit.
• Substance Use Screening: Age-appropriate substance use screening with CRAFFT scoring for adolescents.
• Mental Status Examination and Standardized Rating Scales: Direct behavioral observations and a multi-informant rating scale tracker covering Vanderbilt, Conners’, ADHD-RS-5, CBCL, and BASC-3.
• Differential Diagnosis: A structured table addressing psychiatric and medical conditions that mimic or co-occur with childhood ADHD.
• Risk Assessment: Suicidal and homicidal/aggressive ideation screening and ADHD-related safety concerns such as impulsive risk-taking.
• DSM-5-TR Criteria Checklist and Diagnostic Formulation: A criterion-by-criterion checklist, presentation subtype, severity specifier, and narrative diagnostic formulation.
• Treatment and Follow-Up Recommendations: Medication, school, and therapeutic recommendations, along with parent training and psychoeducation guidance.

How This ADHD Evaluation Form Functions in Practice

This evaluation is designed to be completed during an initial diagnostic assessment for childhood or adolescent ADHD, providing a structured framework for integrating multi-informant data into a DSM-5-TR diagnostic formulation.

• Multi-Informant Diagnostic Workup: Structures the collection of parent, teacher, and child-reported symptom and functional evidence needed to meet the cross-setting diagnostic criterion.
• Differential and Comorbidity Assessment: Guides clinicians through conditions that mimic ADHD in childhood and comorbidities — including ASD, anxiety, and learning disabilities — that should be diagnosed alongside it.
• School Collaboration: Documents teacher-reported concerns and rating scale data to support school accommodation and IEP/504 discussions.
• Family-Centered Treatment Planning: Documents parent training, psychoeducation, and behavioral recommendations alongside medication considerations.

Documentation Features

• Designed specifically for psychiatrists, psychiatric nurse practitioners, and mental health professionals evaluating children and adolescents.
• Structured around all DSM-5-TR diagnostic criteria for ADHD, including the ASD-specific Criterion F consideration.
• Includes multi-informant (parent, teacher, child) symptom tables for both inattentive and hyperactive-impulsive presentations.
• Provides a nine-domain executive functioning assessment and autism spectrum screening considerations.
• Includes a standardized rating scale tracker and a detailed prior medication trial table.
• Documents school accommodations, IEP/504 status, and parent/family recommendations.
• Includes parent/guardian consent, child assent, and clinician and supervisor signature sections.

Practical Integration Notes

This evaluation is intended to be completed by the evaluating clinician based on direct interview with the child and parent/guardian, multi-informant rating scales, review of available records, and clinical judgment. Diagnosis requires integrating multiple data sources and cannot be made by rating scales alone. Clinicians should customize sections to reflect their practice setting, patient population, and applicable state minor patient confidentiality and licensing board requirements. The completed evaluation should be shared with the child’s school and medical providers only with appropriate written authorization, and maintained as part of the patient’s clinical record in accordance with HIPAA and applicable documentation standards.

References

• American Psychiatric Association. (2022). Diagnostic and Statistical Manual of Mental Disorders (5th ed., text rev.). Resource
• Wolraich, M. L., Lambert, W., Doffing, M. A., Bickman, L., Simmons, T., & Worley, K. (2003). Psychometric properties of the Vanderbilt ADHD Diagnostic Parent Rating Scale in a referred population. Journal of Pediatric Psychology, 28(8), 559–568. Resource
• Knight, J. R., Sherritt, L., Shrier, L. A., Harris, S. K., & Chang, G. (2002). Validity of the CRAFFT substance abuse screening test among adolescent clinic patients. Archives of Pediatrics & Adolescent Medicine, 156(6), 607–614. Resource
• Kooij, S. J. J., et al. (2010). European consensus statement on diagnosis and treatment of adult ADHD: The European Network Adult ADHD. BMC Psychiatry, 10, 67. Resource
• Kessler, R. C., et al. (2005). The World Health Organization Adult ADHD Self-Report Scale (ASRS): A short screening scale for use in the general population. Psychological Medicine, 35(2), 245–256. Resource