What score on ADHD (Attention Deficit Hyperactivity Disorder) assessment indicates a positive diagnosis?

ADHD Assessment Scoring Thresholds for Positive Diagnosis

According to the DSM-5 criteria, a positive ADHD diagnosis requires at least 5 symptoms of either inattention or hyperactivity-impulsivity for at least 6 months, with symptoms present in multiple settings and causing functional impairment. 1

Diagnostic Criteria for ADHD

Symptom Count Thresholds

• Predominantly Inattentive Type: 5 or more symptoms of inattention for at least 6 months, but fewer than 5 symptoms of hyperactivity-impulsivity 2
• Predominantly Hyperactive-Impulsive Type: 5 or more symptoms of hyperactivity-impulsivity for at least 6 months, but fewer than 5 symptoms of inattention 2
• Combined Type: 5 or more symptoms of inattention AND 5 or more symptoms of hyperactivity-impulsivity for at least 6 months 2

Additional Diagnostic Requirements

• Symptoms must have been present before age 12 1
• Symptoms must be present in two or more settings (e.g., home, school, work) 1
• Clear evidence that symptoms interfere with functioning 1
• Symptoms not better explained by another mental disorder 1

Common ADHD Assessment Tools and Their Scoring

Adult ADHD Self-Report Scale (ASRS-V1.1)

• Screening Tool: 6-question version
• Positive Screen: 4 or more positive responses in the shaded areas of the form 3
• Time to Complete: Average 54.3 seconds (range 22-252 seconds) 3
• Validity: Sensitivity of 1.0, specificity of 0.71, positive predictive value of 0.52, negative predictive value of 1.0 3

Conners' Adult ADHD Rating Scales (CAARS)

• Interpretation: Scores should be interpreted with caution as they demonstrate weak diagnostic accuracy when used alone 4
• Gender Differences: Positive predictive value and specificity are higher in males compared to females 4
• False Positives: Anxiety and depression are the most common conditions that produce false positives 4

Assessment Process Best Practices

1. Multi-Method Assessment:

   • Collect data from multiple sources (self-report, informant report) 5
   • Adults with ADHD tend to be good informants about their symptoms but may underreport severity 5

2. Comprehensive Evaluation:

   • If screening is positive, conduct further evaluation with more comprehensive tools 1
   • Include functional impairment assessment across multiple domains 1

3. Validity Assessment:

   • Consider using both symptom validity tests (SVTs) and performance validity tests (PVTs) 6
   • Invalid symptom reporting occurs in approximately 22% of adults seeking ADHD assessment 6
   • Invalid performance occurs in approximately 16% of adults seeking ADHD assessment 6

Important Considerations

• Executive Function Assessment: Executive functioning problems are consistently important predictors of adult ADHD, even though they're not explicitly included in DSM criteria 7

• Symptom Persistence: Adult persistence is much greater for inattention symptoms than for hyperactivity/impulsivity symptoms 7

• Comorbidity Screening: Always screen for anxiety and depression, which can mimic or co-occur with ADHD and affect assessment validity 4

• Avoid Single-Method Diagnosis: Self-report scales should not be the main method used for diagnostic purposes but can be useful for screening 4

Clinical Pitfalls to Avoid

• Relying solely on self-report without collateral information can lead to diagnostic errors 1

• Failing to assess functional impairment across multiple settings 1

• Not screening for comorbid conditions that may better explain symptoms 1

• Misattributing symptoms to other conditions without comprehensive assessment 1

• Using only symptom counts without considering the impact on functioning and quality of life 1

In summary, while specific score thresholds vary by assessment tool, the core requirement for a positive ADHD diagnosis is meeting the DSM-5 criteria of at least 5 symptoms in either or both domains (inattention and hyperactivity-impulsivity), with symptoms causing functional impairment across multiple settings.