Paediatric ADHD Diagnostic Reports: A Structure for Australian Clinicians

The 10-section structure

A defensible ADHD diagnostic report includes:

1. Identifying information — name, date of birth, school, year level, language(s) at home.
2. Referral question — exactly what the referrer asked.
3. Information sources — parent interview, child interview, teacher rating scales, school observation, medical history, prior assessments.
4. Developmental history — pregnancy, birth, milestones, medical history, family history of ADHD or other neurodevelopmental conditions.
5. Educational history — schools attended, current adjustments, academic profile, behavioural concerns at school.
6. Behavioural observations — including standardised rating scales (Conners, Vanderbilt, BASC) with scores reported.
7. Cognitive and academic assessment (if conducted) — full-scale and index scores, reading/spelling/maths achievement.
8. Differential diagnosis — what alternative explanations were considered (sleep disorder, ASD, anxiety, language disorder, learning disability, sensory impairment) and how each was excluded.
9. Diagnostic conclusion — DSM-5-TR criteria met (with citations to specific criteria), presentation type (inattentive, hyperactive-impulsive, combined), severity (mild/moderate/severe), age of onset evidence.
10. Recommendations — school adjustments, family supports, follow-up, referral pathways. Avoid prescriptive medical recommendations beyond your scope.

DSM-5-TR criteria coverage

The report must explicitly address each Criterion A–E. The clearest format is a numbered list:

• Criterion A — at least 6 of 9 inattentive symptoms (or 5 if ≥17), at least 6 of 9 hyperactive-impulsive symptoms (or 5 if ≥17). Cite the specific symptoms with examples from history.
• Criterion B — symptoms before age 12. Cite specific evidence (e.g. "teacher report from Year 2 indicated marked inattention").
• Criterion C — symptoms in two or more settings. Cite which settings.
• Criterion D — symptoms cause functional impairment. Cite specific examples.
• Criterion E — symptoms not better explained by another condition. Cite the differentials considered.

Differential diagnosis section

This section is where ADHD reports most often fall short. Audit the differentials with a single line per condition:

• Sleep disorder — screened via [insert tool / question]. Result: [no clinical concern / referred for sleep study / etc.].
• Autism spectrum disorder — screened via [SRS-2 / ASQ / clinical interview]. Result: [no concern / co-occurring features documented separately].
• Anxiety disorder — screened via [SCAS / RCADS]. Result: [no clinical concern / sub-threshold / referred].
• Language disorder — screened via [history / formal assessment]. Result.
• Learning disability — academic achievement scores reviewed. Result.
• Sensory impairment — vision and hearing screening status.

School-actionable recommendations

Recommendations should be specific enough that a teacher can implement them tomorrow:

• Seating placement (front of class, away from high-traffic areas).
• Instruction strategies (chunking, visual schedules, repetition).
• Assessment adjustments (extended time, separate room, breaks).
• Behaviour support (reward systems, movement breaks, clear expectations).

Related reading

• Structuring ASD Diagnostic Reports for Paediatricians in Australia
• Writing Effective School Letters: Paediatricians from Clinic to Classroom