From the Guidelines
There are no specific pathological tests used to diagnose ADHD in adults, and diagnosis relies primarily on clinical evaluation, including comprehensive psychiatric interviews, standardized rating scales, and questionnaires. The diagnostic process for ADHD in adults involves assessing symptoms and their impact on daily functioning, using criteria from diagnostic manuals like the DSM-5, which require symptoms of inattention and/or hyperactivity-impulsivity that persist for at least six months, began before age 12, occur in multiple settings, and significantly impair functioning 1. Some key points to consider in the diagnosis of adult ADHD include:
- The use of standardized rating scales, such as the Adult ADHD Self-Report Scale (ASRS), which asks patients to indicate the frequency of a variety of symptoms, with a screen being positive when a patient checks often or very often for 4 or more of the 6 questions 1.
- The importance of comprehensive psychiatric interviews to assess symptoms and functional impairment.
- The need to rule out other conditions that might mimic ADHD symptoms, such as anxiety, depression, or thyroid disorders.
- The use of neuropsychological testing to evaluate executive functioning, but not as a diagnostic tool on its own. The most recent and highest quality study, published in 2024, highlights the importance of clinical evaluation and the use of standardized rating scales in the diagnosis of adult ADHD 1. In contrast, older studies, such as the one published in 2002, may provide less relevant information for current clinical practice 1. The diagnosis of ADHD in adults requires specialized clinical expertise and a thorough evaluation of behavioral patterns and functional impairment across different life domains.
From the Research
Pathological Tests for Adult ADHD
The diagnosis of Attention Deficit Hyperactivity Disorder (ADHD) in adults involves a comprehensive assessment of symptoms, behavior, and functioning. The following are some of the pathological tests used to diagnose ADHD in adults:
- Structured interviews: These are used to assess the presence of symptoms of inattention, hyperactivity, and impulsivity during both childhood and adulthood 2, 3.
- Screening scales: These include the Adult Self-Report Scale Screener, which can be used to differentiate between ADHD and other comorbid psychiatric disorders 4.
- Adult ADHD symptom inventories: These are used to assess the severity of symptoms and track treatment progress 2.
- Measures of associated features of ADHD: These include assessments of disorganization, poor time management, and procrastination, among others 2.
- Ratings of impairment and functioning: These are used to assess the impact of ADHD on daily life and functioning 2, 5.
Diagnostic Challenges
The diagnosis of ADHD in adults can be challenging due to the presence of comorbid psychiatric disorders, such as major depressive disorder, anxiety disorder, and substance abuse disorder 4, 5. Therefore, a comprehensive diagnostic assessment should include:
- A clinical interview to assess past and present symptoms
- Rating scales to assess symptoms and functioning
- Collateral information from multiple informants
- Assessment of a broader spectrum of psychiatric and somatic conditions 5
Limitations of Current Diagnostic Tools
There are no objective, laboratory-based tests that can establish a diagnosis of ADHD 5. Current diagnostic criteria are formulated primarily according to behavior in childhood, and other symptoms, such as mood instability and frustration intolerance, are not included in current criteria for ADHD 5. Therefore, further research is needed to develop more effective diagnostic tools and criteria for ADHD in adults.