From the Guidelines
Diagnosing ADHD in adults requires a comprehensive clinical assessment, starting with the Adult ADHD Self-Report Scale (ASRS) to screen for symptoms, followed by a detailed clinical interview, review of childhood records, and collateral information to confirm the diagnosis. The diagnostic process should adhere to the criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, which includes an ongoing pattern of inattentive and/or hyperactive-impulsive symptoms, onset before age 12, presence in two or more settings, and significant impairment in functioning 1.
Key Components of Diagnosis
- A detailed clinical interview to explore current symptoms, developmental history, and functional impairment across different settings
- Use of standardized rating scales such as the ASRS or the Conners' Adult ADHD Rating Scales to quantify symptom severity
- Review of childhood records when available to confirm the onset of symptoms before age 12
- Collateral information from family members, partners, or close friends to corroborate self-reported symptoms
- Careful examination of medical and psychiatric history to rule out other conditions that may mimic ADHD symptoms
Ruling Out Other Conditions
It is crucial to rule out other mental disorders or medical conditions that could explain the symptoms, such as anxiety disorders, mood disorders, substance use, or conditions affecting cognition 1. A thorough medical history, physical examination, and screening laboratory tests can help in this process.
Importance of Recent Guidelines
The most recent guidelines and studies, such as those published in 2024, should be prioritized when making a diagnosis, as they reflect the current understanding and best practices in diagnosing adult ADHD 1.
Diagnostic Criteria
The diagnostic criteria for ADHD, as outlined in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, include:
- At least 6 months of persistent symptoms
- At least 5 symptoms of inattention and/or hyperactivity-impulsivity
- Symptoms must be present in two or more settings
- Symptoms must cause significant impairment in social, occupational, or other areas of functioning
- Symptoms cannot be better explained by another mental disorder or medical condition 1.
From the Research
Approach to Diagnosing ADHD in Adults
The approach to diagnosing Attention Deficit Hyperactivity Disorder (ADHD) in adults involves a comprehensive clinical interview, assessment of symptoms, and evaluation of impairment in various domains of life. The diagnostic procedure for ADHD among adults should be systematic, and a full examination should assess medical conditions associated with ADHD to provide personalized care 2.
Key Components of the Diagnostic Process
- A thorough clinical interview, aided by the use of rating scales for current symptoms and collateral information about childhood from parents or siblings, forms the backbone of the assessment 3.
- Evaluation of impairment in two or more realms, such as home, school/work, and social interactions, is essential for making a diagnosis 3.
- Assessment of symptoms, including inattention, hyperactivity, and impulsivity, as well as associated symptoms like emotional deregulation and executive function-related symptoms 2.
- Consideration of comorbidities, such as mood disorders, anxiety disorders, and substance-use disorders, which are common in adults with ADHD 2, 4.
Tools and Strategies for Diagnosis
- Use of structured interviews and standardized self-report questionnaires, such as those translated and validated in French, to evaluate core and associated ADHD symptoms, comorbidities, and functional impairment 2.
- Semi-structured interviews with open questioning and probing to elicit real-life examples of symptoms and impairments 5.
- Assessment of executive functioning, neuroimaging, and genetics may provide more exact diagnostic guidelines in the future 6.
Importance of a Comprehensive Assessment
- A comprehensive assessment involving various domains of functioning (academic, social, emotional, physical, and familial) provides not only a more accurate diagnosis but also directions as to what difficulties exist and what multifaceted treatment plan is needed to produce current improvement and long-term positive outcome 6.
- The Adult ADHD Assessment Quality Assurance Standard (AQAS) emphasizes the need to evaluate impairment, describes core competencies required by the assessor, and highlights the importance of linking the diagnosis to an appropriate post-diagnostic discussion 5.