From the Guidelines
The optimal method for evaluating Attention Deficit Hyperactivity Disorder (ADHD) in adults involves a comprehensive clinical assessment, including the use of standardized rating scales such as the Adult ADHD Self-Report Scale (ASRS-V1.1), as recommended in the most recent study published in 2024 1. This evaluation should include a detailed clinical interview covering current symptoms, developmental history, educational background, work performance, and psychosocial functioning.
- Key components of the evaluation process include:
- A thorough clinical interview to assess current symptoms and history
- The use of standardized rating scales like the ASRS-V1.1 to objectively measure symptom severity
- Collateral information from family members, partners, or close friends to provide additional insight into symptoms
- Screening for common comorbidities such as anxiety, depression, substance use disorders, and learning disabilities
- Consideration of medical causes of attention problems through medical history and possibly laboratory testing According to the study published in the American Journal of Obstetrics and Gynecology in 2024 1, the first step in evaluating ADHD is to have patients complete part A of the ASRS-V1.1, which asks patients to indicate the frequency of a variety of symptoms, with a screen considered positive when a patient checks often or very often for 4 or more of the 6 questions.
- The diagnostic criteria for ADHD, as outlined in the study 1, include:
- An ongoing pattern of inattentive and/or hyperactive-impulsive symptoms for at least 6 months
- Multiple inattentive and/or hyperactive-impulsive symptoms, with 5 or more required for adults
- Symptoms must be present in two or more settings and interfere with or reduce the quality of functioning
- Symptoms must not be better explained by another mental disorder or medical condition By following this comprehensive evaluation process, clinicians can accurately diagnose and effectively manage ADHD in adults, improving morbidity, mortality, and quality of life outcomes.
From the Research
Evaluating Attention Deficit Hyperactivity Disorder (ADHD) in Adults
The optimal method for evaluating ADHD in adults involves a combination of clinical interviews, rating scales, and informant ratings.
- A semi-structured interview, such as the Diagnostisch Interview Voor ADHD 2.0 (DIVA), can simplify the task of performing a rigorous evaluation of both the symptoms of the disorder in adulthood and the dysfunctions generated by ADHD 2.
- Quick screening instruments, such as the Adult Self-Report Scale 1.1 (ASRS), can allow for better detection of ADHD in adults 2, 3, 4.
- The Conners' Adult ADHD Rating Scales (CAARS) is another instrument that can be used to evaluate ADHD in adults, although its psychometric properties have been found to have some limitations 5.
Rating Scales and Assessment Tools
Various rating scales and assessment tools are available for evaluating ADHD in adults, including:
- The Wender-Utah Rating Scale (WURS) and the Childhood Symptoms Scale by Barkley and Murphy, which assess retrospective childhood ADHD symptoms 4.
- The Brown ADD Rating Scale (Brown ADD-RS) and the Attention Deficit Hyperactivity Disorder--Other Report Scale (ADHD-OR), which are instruments for use by clinicians or significant others 4.
- The Adult ADHD Assessment Quality Assurance Standard (AQAS), which provides a framework for ensuring high-quality diagnostic assessments and reports 6.
Best Practices for Assessment
Best practices for assessing ADHD in adults include:
- Conducting a full psychiatric and neurodevelopmental review 6.
- Using good interview skills, with a semi-structured interview and open questioning and probing to elicit real-life examples of symptoms and impairments 6.
- Allowing sufficient time for the assessment, with a recommended minimum of 2 hours 6.
- Linking the diagnosis to an appropriate post-diagnostic discussion 6.