Adult ADHD Assessment and Diagnosis

Evaluation of adults presenting with ADHD symptoms typically requires at least two visits. As well as allowing for a thorough evaluation, two visits allows the clinician to assess motivation for follow up, persistence of symptoms and dysfunction, and likelihood for alternative diagnoses. The following components of a complete evaluation should be considered during both visits:

• Review and corroboration of current symptoms and dysfunction
• Determination of a childhood onset
• Evaluation for comorbid and /or mimicking psychiatric problems, medical disorders or substance abuse.

Diagnostic Criteria

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), published by the American Psychiatric Association, outlines diagnostic criteria for making a diagnosis of ADHD in children and adults. For a formal diagnosis of ADHD, symptoms of hyperactivity-impulsivity and/or inattention should meet the diagnostic criteria outlined in DSM-5 (DSM-5 Diagnostic Criteria for ADHD).

Differential Diagnosis

The symptoms of ADHD are common in other mental health disorders and non-psychiatric conditions. An appropriate evaluation must consider whether the symptoms belong to ADHD, another mental health condition, another physical health condition, or if they represent more than one disorder. Other explanations for presenting symptoms should also be ruled out (Overview of Possible Causes for Presenting Symptoms Similar to ADHD and Differential Diagnosis of ADHD in Adults).

Screening and Assessment Tools

The following scales have been developed to screen, evaluate and monitor adults with ADHD. Since rating scales are based on self-reported perceptions, and are, therefore, subjective, it is recommended that significant persons in the adult’s life also complete the forms. These can include the person’s spouse, a close relative, employer and/or colleague.

ADHD Screeners:

• ADHD Rating Scale IV (ADHD-RS-IV) With Adult Prompts
• Adult ADHD Clinical Diagnostic Scale (ACDS) v1.2
• Adult ADHD Investigator Rating Scale (AISRS)
• Adult ADHD Self-Report Scale (ASRS) v1.1
• Adult ADHD Self-Report Screening Scale for DSM-5 (ASRS DSM-5) Screener
• Adult ASRS Symptom Checklist v1.1
• Barratt Impulsiveness Scale (BIS-11)
• Brown Attention-Deficit Disorder Symptom Assessment Scale (BADDS) for Adults
• Clinical Global Impression (CGI)
• Conners’ Adult ADHD Rating Scales (CAARS)
• Diagnostic Interview for ADHD in Adults (DIVA) 2.0
• Wender Utah Rating Scale (WURS)

Informant Questionnaires:

• Childhood Behavior Scale - Parent Report (See Informant - Parent)
• Current Behavior Scale - Partner Report (See Informant - Partner)

Note: there may be a fee associated with the use of some of these tools for you and/or the patient.

Quality of Life Assessments:

• Adult ADHD Quality of Life Measure (AAQoL) 2
• Driving Behavior Survey (DBS) 3
• Work Productivity and Activity Impairment Questionnaire General Health V2.0 (WPAI:GH) 4

References:

1. Ginsberg Y, Quintero J, Anand E, Casillas M, Upadhyaya HP. Underdiagnosis of Attention Deficit/Hyperactivity Disorder in Adult Patients: A Review of the Literature. Prim Care Companion CNS Disord. 2014;16(3).

3. Clapp JD, Olsen SA, Beck JG, et al. The Driving Behavior Survey: Scale Construction and Validation. J Anxiety Disord. 2010;25(1):96–105. doi:10.1016/j.janxdis.2010.08.008