From the Guidelines
To evaluate for Attention Deficit Hyperactivity Disorder (ADHD), clinicians should ask questions about persistent patterns of inattention, hyperactivity, and impulsivity across multiple settings, using standardized rating scales like the Adult ADHD Self-Report Scale (ASRS) or Conners' scales for children, as recommended by the most recent study 1. When evaluating for ADHD, it is essential to inquire about symptoms such as:
- Difficulty sustaining attention during tasks
- Frequent careless mistakes
- Problems with organization
- Forgetfulness in daily activities
- Trouble following through on instructions
- Hyperactive symptoms like fidgeting, inability to remain seated, excessive talking, difficulty waiting turns, and interrupting others It is crucial to determine if these symptoms have been present for at least six months, began before age 12, occur in multiple settings (home, school, work), and cause significant impairment in functioning. The evaluation should also include questions about:
- Developmental history
- Academic performance
- Work difficulties
- Relationship problems
- Family history of ADHD
- Other potential causes of symptoms, including sleep disorders, anxiety, depression, learning disabilities, substance use, and medical conditions As noted in the study 1, the Adult ADHD Self-Report Scale (ASRS-V1.1) is a useful tool for evaluating ADHD symptoms, and a screen is positive when a patient checks often or very often for 4 or more of the 6 questions. Additionally, the study 1 highlights the importance of considering the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria for ADHD, which include symptoms of inattention, hyperactivity, and impulsivity, and require that symptoms be present in multiple settings and cause significant impairment in functioning. While other studies, such as 1, 1, and 1, provide additional guidance on evaluating and diagnosing ADHD, the most recent and highest-quality study 1 should be prioritized when making a definitive recommendation.
From the Research
Evaluation of Attention Deficit Hyperactivity Disorder (ADHD)
To evaluate for ADHD, several questions should be asked to assess the presence and severity of symptoms. These questions can be categorized into several areas, including:
- Inattention:
- Does the individual have difficulty sustaining attention in tasks or activities?
- Does the individual have difficulty organizing tasks and activities?
- Is the individual easily distracted or interrupted by others?
- Hyperactivity:
- Does the individual fidget or tap hands or feet when sitting still?
- Does the individual have difficulty engaging in quiet leisure activities?
- Is the individual often "on the go" or acting as if "driven by a motor"?
- Impulsivity:
- Does the individual have difficulty waiting for their turn?
- Does the individual often interrupt or intrude on others?
- Is the individual often impatient or impulsive in their actions? These questions can help identify the presence and severity of ADHD symptoms, as well as any potential comorbidities or associated disorders 2, 3.
Associated Disorders and Comorbidities
ADHD often co-occurs with other psychiatric disorders, such as mood disorders, anxiety disorders, and substance-use disorders 2. Therefore, it is essential to assess for these potential comorbidities when evaluating for ADHD. Questions to ask may include:
- Has the individual experienced any symptoms of depression or anxiety?
- Has the individual ever been diagnosed with a substance-use disorder?
- Are there any other psychiatric or neurodevelopmental disorders present?
Assessment Tools and Diagnostic Criteria
Several assessment tools and diagnostic criteria can be used to evaluate for ADHD, including standardized self-report questionnaires and structured interviews 2. These tools can help identify the presence and severity of ADHD symptoms, as well as any potential comorbidities or associated disorders. The diagnostic criteria for ADHD, as outlined in the DSM-5, include the presence of at least five symptoms of inattention and/or hyperactivity-impulsivity, with symptoms persisting for at least six months and causing significant impairment in social, occupational, or other areas of functioning 4.