From the Guidelines
Diagnosing ADHD in adults should start with the Adult ADHD Self-Report Scale (ASRS-V1.1) to identify individuals who may have the condition, as recommended by the most recent study 1. When diagnosing ADHD in adults, it is essential to consider the diagnostic criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, which includes symptoms of inattention and/or hyperactivity-impulsivity that have been present for at least 6 months, with an onset before the age of 12 years, and are present in two or more settings 1.
Key Diagnostic Criteria
- An ongoing pattern of inattentive and/or hyperactive-impulsive symptoms—at least 6 months
- Multiple inattentive and/or hyperactive-impulsive symptoms—5 or more (for age 17 years and older; 6 or more are required for age under 17 years)
- Several inattentive and/or hyperactive-impulsive symptoms with an onset before the age of 12 years
- Several inattentive and/or hyperactive-impulsive symptoms that are present in 2 or more settings (e.g., home, work)
- Evidence that inattentive and/or hyperactive-impulsive symptoms interfere with or reduce the quality of functioning (e.g., interpersonal, occupational)
Symptoms of ADHD
The symptoms of ADHD in adults can be categorized into two main types: inattentive and hyperactive-impulsive.
- Inattentive symptoms:
- Poor attention to detail
- Difficulty concentrating or sustaining attention on tasks
- Seems preoccupied, difficulty in shifting focus even when spoken to directly
- Difficulty with completing tasks (gets distracted/side-tracked)
- Organizational challenges (e.g., resulting in chronic lateness—for appointments or deadlines, messiness, disorganized work)
- Reluctance to engage in tasks that require sustained mental effort (e.g., preparing reports, reviewing lengthy papers)
- Difficulty keeping track of personal belongings/items required for task completion
- Easily distracted
- Frequently forgetful
- Hyperactive-impulsive symptoms:
- Frequent fidgeting (e.g., tapping a desk)
- Finds it difficult to sit still for prolonged periods
- Feeling of inner restlessness or agitation
- Often loud and disruptive
- Always on the go, difficult for others to keep up
- Often talks excessively
- Frequently interrupts others (difficulty restraining themselves from sharing their perspectives or waiting their turn in conversation)
- Highly impatient (e.g., difficulty waiting in line)
- Often intrudes into others’ activities (e.g., may take over what others are doing) A comprehensive clinical evaluation by a qualified healthcare provider, including a detailed clinical interview and standardized rating scales, is necessary for an accurate diagnosis of ADHD in adults 1.
From the FDA Drug Label
A diagnosis of ADHD (DSM-IV) implies the presence of hyperactive-impulsive or inattentive symptoms that cause impairment and that were present before age 7 years. The symptoms must be persistent, must be more severe than is typically observed in individuals at a comparable level of development, must cause clinically significant impairment, e.g., in social, academic, or occupational functioning, and must be present in 2 or more settings, e.g., school (or work) and at home. For the Inattentive Type, at least 6 of the following symptoms must have persisted for at least 6 months: lack of attention to details/careless mistakes, lack of sustained attention, poor listener, failure to follow through on tasks, poor organization, avoids tasks requiring sustained mental effort, loses things, easily distracted, forgetful For the Hyperactive-Impulsive Type, at least 6 of the following symptoms must have persisted for at least 6 months: fidgeting/squirming, leaving seat, inappropriate running/climbing, difficulty with quiet activities, “on the go,” excessive talking, blurting answers, can’t wait turn, intrusive. For a Combined Type diagnosis, both inattentive and hyperactive-impulsive criteria must be met.
Diagnosing ADHD in adults requires a comprehensive evaluation, including a complete history and assessment of the patient. The diagnosis is based on the presence of hyperactive-impulsive or inattentive symptoms that cause impairment and were present before age 7 years.
- The symptoms must be persistent and severe, causing clinically significant impairment in social, academic, or occupational functioning.
- The symptoms must be present in 2 or more settings, such as work and home.
- The diagnosis must be based on a complete history and evaluation of the patient, not solely on the presence of the required number of DSM-IV characteristics 2. Key points to consider in diagnosing ADHD in adults include:
- Inattentive symptoms: lack of attention to details, lack of sustained attention, poor listener, failure to follow through on tasks, poor organization, avoids tasks requiring sustained mental effort, loses things, easily distracted, forgetful
- Hyperactive-Impulsive symptoms: fidgeting, leaving seat, inappropriate running, difficulty with quiet activities, excessive talking, blurting answers, can’t wait turn, intrusive 2.
From the Research
Diagnosing ADHD in Adults
- ADHD is a neurodevelopmental disorder that can persist into adulthood, with 14.6% of U.S. adults meeting the Diagnostic and Statistical Manual of Mental Disorders, 5th ed., criteria for ADHD 3
- A comprehensive clinical history and evaluation, patient symptom and function assessment, and gathering of collateral information are required for an ADHD diagnosis 3, 4
- Clinical guidelines recommend a subset of amphetamine and methylphenidate stimulants as first-line pharmacotherapy, which may be more effective when combined with psychotherapy 3
- For adults unable to take stimulants or with concurrent anxiety/depression, options include atomoxetine, viloxazine, and bupropion 3
Screening and Assessment
- ADHD can be screened for in as little as 3 to 5 minutes with a variety of self-report or physician-implemented scales 4
- The Adult ADHD Self-Report Scale and Conners Adult ADHD Rating Scales are examples of assessment tools used to evaluate ADHD symptoms 3
- A comprehensive clinical interview that reviews representative symptoms starting in childhood that continue to cause impairment into adulthood is necessary for an accurate diagnosis 4
Treatment Options
- Atomoxetine, a nonstimulant, selective noradrenergic reuptake inhibitor, has been shown to be effective in treating ADHD in adults 5, 6, 7
- Atomoxetine has been found to improve executive function, as measured by the Behavior Rating Inventory of Executive Function-Adult Version (BRIEF-A) Self-Report and Informant T scores 6
- Long-term, open-label safety and efficacy of atomoxetine in adults with ADHD have been demonstrated, with significant decreases in ADHD symptoms and improvement in functional outcomes 7