What are the most effective diagnostic questions for Adult Attention Deficit Hyperactivity Disorder (ADHD)?

From the Guidelines

To diagnose adult ADHD, healthcare professionals should ask questions focused on attention, hyperactivity, and impulsivity symptoms, using a standardized tool such as the Adult ADHD Self-Report Scale (ASRS-V1.1) as the first step, as recommended by the most recent study 1. The key questions to ask include:

• Do you often have difficulty concentrating or staying focused on tasks?
• Are you easily distracted by external stimuli?
• Do you frequently forget appointments or important deadlines?
• Do you often feel restless or fidgety?
• Do you have trouble organizing tasks and managing time effectively?
• Do you tend to interrupt others or blurt out answers before questions are completed?
• Do you often lose or misplace important items?
• Do you struggle to follow through on instructions or complete tasks?
• Have these symptoms been present since childhood and affected multiple areas of your life? These questions help assess the core symptoms of ADHD in adults, as outlined in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition 1. A formal diagnosis should be made by a qualified mental health professional or physician, typically through a comprehensive evaluation that includes a clinical interview, rating scales, and consideration of other potential causes for symptoms, as suggested by previous studies 1. The assessment may also involve gathering information from family members or reviewing school records to establish a history of symptoms. Diagnosis is based on the presence of multiple symptoms that persist for at least six months and significantly impact daily functioning in two or more settings (e.g., work, home, social relationships), and the healthcare provider will also rule out other conditions that may mimic ADHD symptoms, such as anxiety, depression, or sleep disorders 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

The most effective diagnostic questions for Adult Attention Deficit Hyperactivity Disorder (ADHD) are those that assess the presence and severity of inattentive and hyperactive-impulsive symptoms, as outlined in the DSM-IV criteria. These questions should evaluate the persistence and severity of symptoms, as well as their impact on daily life and functioning, in two or more settings. A complete history and evaluation of the patient is necessary to make an accurate diagnosis 2 2.

From the Research

Diagnostic Questions for Adult Attention Deficit Hyperactivity Disorder (ADHD)

The diagnosis of Adult ADHD is based on the revised criteria described for children, but their application for adults may be difficult due to compensation and comorbid disorders 3.

Effective Diagnostic Tools

• The DIVA 2.0, a semi-structured diagnostic interview, has shown a diagnostic accuracy of 100% when compared with the Conners' Adult ADHD Diagnostic Interview for DSM-IV (CAADID) 4.
• Neuropsychological testing can be useful in the diagnosis of Adult ADHD, particularly in assessing cognitive functions such as attention, interference control, and set-shifting 3, 5.
• The Wender Utah Rating Scale (WURS), the ADHD-Rating Scale, and Sheehan's Dysfunction Inventory are self-reported rating scales that have shown good correlations with the DIVA 2.0 interview 4.

Key Cognitive Deficits

• Inefficient attention, interference control, and set-shifting functions are common cognitive deficits in adults with ADHD 5.
• Interference control deficit may be a core deficit for ADHD, existing across the lifespan in people with ADHD 5.

Limitations and Future Directions

• There is a need for further research to identify possible modes to increase retention to treatment and to develop more effective diagnostic tools for Adult ADHD 6, 7.
• The application of diagnostic criteria for children to adults may be limited, and more research is needed to develop adult-specific diagnostic criteria 3.