What are the key questions to ask patients when diagnosing Attention Deficit Hyperactivity Disorder (ADHD)?

Key Questions for ADHD Diagnosis

The most important questions to ask when diagnosing ADHD should focus on assessing specific inattentive and hyperactive-impulsive symptoms across multiple settings, their onset before age 12, and their impact on functioning. 1

Core Diagnostic Criteria Questions

Inattentive Symptoms

• Do you have difficulty paying attention to details or make careless mistakes in work/school tasks?
• Do you struggle to sustain attention during tasks or activities?
• Do you seem preoccupied or have difficulty shifting focus when spoken to directly?
• Do you have trouble completing tasks due to getting distracted or side-tracked?
• Do you face organizational challenges (resulting in chronic lateness, messiness, disorganized work)?
• Do you avoid tasks requiring sustained mental effort (like preparing reports or reviewing papers)?
• Do you frequently lose items necessary for tasks or activities?
• Are you easily distracted by external stimuli or unrelated thoughts?
• Are you often forgetful in daily activities? 1

Hyperactive-Impulsive Symptoms

• Do you frequently fidget or tap hands/feet?
• Do you find it difficult to remain seated when expected to?
• Do you experience feelings of inner restlessness or agitation?
• Are you often loud or disruptive in inappropriate situations?
• Do you feel like you're always "on the go" or "driven by a motor"?
• Do you talk excessively?
• Do you blurt out answers before questions are completed?
• Do you have difficulty waiting your turn (e.g., in lines, conversations)?
• Do you frequently interrupt or intrude on others' activities? 1

Essential Follow-up Questions

Symptom Context and Impact

• In which settings do these symptoms occur? (Must be present in 2+ settings) 1
• When did these symptoms first appear? (Must have onset before age 12) 1
• How do these symptoms interfere with your daily functioning (social, academic, occupational)? 1
• How would someone who knows you well (parent, spouse, close friend) describe these behaviors? 1

Functional Impairment Assessment

• How do these symptoms affect your ability to manage your home (cooking, cleaning, organization)?
• Do you have difficulty keeping track of appointments?
• How do these symptoms impact your relationships with others?
• How do these symptoms affect your performance at work/school? 1

Screening for Comorbidities

Mental Health Conditions

• Do you experience persistent sadness, hopelessness, or loss of interest? (Depression)
• Do you worry excessively or experience frequent anxiety?
• Do you have frequent angry outbursts or difficulty controlling your temper? (Oppositional behaviors)
• Do you use alcohol or substances to help manage your symptoms? 1

Developmental/Learning Issues

• Have you been diagnosed with any learning disabilities?
• Do you have difficulty with reading, writing, or mathematics beyond what would be expected?
• Have you had any speech or language difficulties? 1

Physical Health

• Do you have trouble falling or staying asleep?
• Do you experience tics or repetitive movements?
• Are there any other medical conditions you've been diagnosed with? 1

Practical Assessment Approach

1. Begin with validated screening tools:

   • For adults: Adult ADHD Self-Report Scale (ASRS-V1.1) - a positive screen is indicated when the patient checks "often" or "very often" for 4+ of the 6 questions in part A 1
   • Have someone who knows the patient well complete the same scale for additional perspective 1

2. Assess functional impairment using the Weiss Functional Impairment Rating Scale-Self (WFIRS-S) 1

3. Document symptom duration (must be present for at least 6 months) 1

4. Rule out alternative explanations for symptoms:

   • Symptoms are not better explained by another mental disorder
   • Symptoms are not solely occurring during psychotic disorders or substance use 1

Common Pitfalls to Avoid

• Overlooking inattentive symptoms: Adults with ADHD more commonly present with inattentive rather than hyperactive symptoms 1

• Missing gender differences: Girls/women with ADHD are more likely to have inattentive symptoms and comorbid internalizing conditions (anxiety, depression) 1

• Failing to obtain collateral information: Self-reporting alone may be insufficient; information from others who know the patient well is crucial 1

• Not assessing for common comorbidities: ADHD frequently co-occurs with other psychiatric conditions that may complicate diagnosis and treatment 1

• Relying solely on cognitive tests: These have inadequate sensitivity and specificity for diagnosing ADHD and should be used in conjunction with behavioral assessments 2

By systematically addressing these key questions and avoiding common diagnostic pitfalls, clinicians can more accurately identify ADHD and develop appropriate treatment plans that will improve patients' quality of life and reduce morbidity associated with untreated ADHD.