ADHD is a neurodevelopmental disorder, meaning symptoms must have been present since childhood (APA, DSM-5). Understanding a patient’s early development is critical when assessing and treating ADHD. A thorough developmental history helps clinicians differentiate symptoms from comorbid conditions like autism, learning disorders, or anxiety.
The latest webinar, led by our clinical experts Jess Brunett, Ryan Martin, and Penny Lazell, delves into the critical role data gathering and developmental history play in an ADHD diagnosis.
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Why developmental history is essential for an accurate ADHD diagnosis
Accurately tracking ADHD symptoms from a patient’s early life can be challenging, especially if developmental history isn’t properly recorded. Jess mentions how “clinicians are looking at symptoms present right from birth and early childhood, and their development to present when you’re seeing that individual in clinic.”
Penny Lazell reflected on the need for a more proactive approach to developmental history in clinical practice. "We need to start thinking about neurodevelopmental disorders right from pregnancy, neonatal care, and early infancy, not just when a child is struggling in school. If we could build a robust developmental history from birth, we might not have so many children bouncing between different assessments before finally getting the support they need."
Ryan Martin emphasised how "understanding parental history is crucial. Parental age, health, and stress before and after birth can all play a role. We also need to gather information about the birth itself, early childhood experiences, and neuropsychological assessments to understand a child’s developmental trajectory.”
Parental and prenatal risk factors for ADHD
Both genetic and environmental risk factors during pregnancy influence ADHD development. A key theme during the discussion was the importance of the manner of birth itself, maternal and paternal health histories, and postpartum stress.
Jess reflected, "I’ve noticed in clinical practice that we often focus on maternal health and don’t ask about paternal health preconception.”
Parental age at the time of conception matters. The research around parental age and ADHD is fascinating, said the group. While older fathers have been linked to higher risks for autism and schizophrenia, ADHD risk factors seem to be higher in younger parents, particularly those under 20 years of age.
Exposure to substances in utero, including alcohol and tobacco, can have lasting effects on neurodevelopment.
Ryan added, "We also need to consider in-utero substance exposure, as fetal alcohol syndrome can mimic ADHD symptoms like hyperactivity and impulsivity. The challenge comes when children are adopted, and we don’t have access to maternal health records."
Preterm birth and early developmental milestones
Preterm birth is a significant risk factor for ADHD and other neurodevelopmental conditions. Babies born before 33 weeks are two to three times more likely to develop ADHD. "In neonatal care, we focused on physical health outcomes, but the long-term neurodevelopmental impact wasn’t always considered. The Apgar score, a measure of a newborn's condition at birth, is clinically significant. Scores under seven at one and five minutes can indicate potential neurodevelopmental issues," notes Penny.
When assessing children for ADHD or comorbidities, clinicians look at expressive and receptive language, motor coordination, and social engagement. The group discussed how these skills tie into brain function. For example, if a child struggled with breastfeeding, had a late speech onset, or had difficulties with fine motor skills, it might indicate underlying neurodevelopmental challenges, said Ryan.
The challenges of gathering developmental histories in adults
Our experts reveal how clinicians assessing adults with ADHD often struggle to obtain a complete developmental history. Many adults don’t remember their early years, and parents may not have detailed records. This makes ADHD diagnosis more complex and time consuming.
Jess informed about her experience when assessing adults, how she would often receive ambiguous responses like ‘I don’t know’ or ‘I’d have to check with someone.’ In such instances, she shifted focus to indirect questions like ‘Did you struggle with handwriting?’ or ‘Could you ride a bike?’ or ‘Were you excluded from school?’ to help her reconstruct the missing pieces and diagnose with more accuracy.
The discussion emphasised the need to improve clinical practice, especially regarding sensitivity and record-keeping. Penny stressed how important it is that clinicians approach developmental history gathering with sensitivity, particularly for parents who have experienced trauma.
Ryan Martin shared a deeply personal perspective on the challenges of recounting developmental history, particularly for parents of children with complex medical needs. "My daughter was born prematurely and had an Apgar score of one. She spent two months in the NICU, and my wife went through an incredibly stressful pregnancy with pre-eclampsia and constant medical monitoring," he explained. "Every time we see a new provider, we have to relive that experience, retelling the same traumatic story. It becomes exhausting, especially when the information should already be in her records. Clinicians need to maintain thorough documentation, so parents don’t have to go through this over and over again."