From the Guidelines
The diagnostic tests for Attention Deficit Hyperactivity Disorder (ADHD) involve a comprehensive evaluation by a healthcare professional, including a clinical interview, standardized rating scales, and neuropsychological testing, with the most recent and highest quality study recommending the use of the Adult ADHD Self-Report Scale (ASRS-V1.1) as the first step in diagnosis 1. The process of diagnosing ADHD is complex and multifaceted, requiring a thorough assessment of symptoms across different settings. According to the most recent study, the first step in diagnosis is to have patients complete part A of the Adult ADHD Self-Report Scale (ASRS-V1.1), which asks patients to indicate the frequency of a variety of symptoms 1. Key components of the diagnostic evaluation include:
- A clinical interview to assess symptoms of inattention, hyperactivity, and impulsivity
- Standardized rating scales, such as the ADHD Rating Scale, Conners' Rating Scales, or the Brown Attention-Deficit Disorder Scales, to gather information from multiple sources
- Neuropsychological testing to evaluate attention, executive functioning, and rule out other conditions
- Medical examinations, including vision and hearing tests, to exclude physical causes of symptoms The evaluation should follow DSM-5 criteria, which require symptoms to be present before age 12, occur in multiple settings, interfere with functioning, and not be better explained by another condition 1. It is essential to note that no single test definitively diagnoses ADHD, and a comprehensive evaluation by a healthcare professional is necessary to make an accurate diagnosis. The most recent study emphasizes the importance of a thorough approach to diagnosis, as ADHD symptoms can overlap with other disorders like anxiety, depression, or learning disabilities, making accurate diagnosis crucial for effective treatment planning 1.
From the FDA Drug Label
The specific etiology of ADHD is unknown, and there is no single diagnostic test. Adequate diagnosis requires the use not only of medical but also of special psychological, educational, and social resources.
The diagnostic tests for Attention Deficit Hyperactivity Disorder (ADHD) are not explicitly stated as a single test, but rather a comprehensive evaluation that includes:
- Medical assessment
- Psychological evaluation
- Educational assessment
- Social resources The diagnosis must be based upon a complete history and evaluation of the patient and not solely on the presence of the required number of DSM-IV characteristics 2.
From the Research
Diagnostic Tests for Attention Deficit Hyperactivity Disorder (ADHD)
The diagnostic tests for ADHD include:
- Clinical interviews: Key clinical interview questions can help diagnose ADHD, but they have adequate sensitivity and poor specificity when used alone 3
- Behavior rating scales: ADHD behavior rating scales alone have adequate sensitivity but poor specificity in diagnosing ADHD 3
- Symptom validity tests: Response validity and symptom validity tests have reasonably good sensitivity and very good specificity in detecting invalid symptom presentation 3
- Cognitive tests: Cognitive test batteries have inadequate sensitivity and specificity in identifying ADHD, but using them in conjunction with behavior rating scales can improve the specificity of an assessment battery 3
- Executive function behavior rating scales: These scales are unlikely to improve the diagnostic accuracy of ADHD assessment 3
- Functional impairment rating scales: These scales are also unlikely to improve the diagnostic accuracy of ADHD assessment 3
- Attention-Deficit/Hyperactivity Disorder Rating Scale-IV-Parent Version: Investigator-administered and -scored (ADHDRS-IV-Parent:Inv): This scale can be used to assess change in ADHD symptoms 4
- Conners Parent Symptom Questionnaire (PSQ): This questionnaire can be used to assess behavioral and emotional problems 5
- Integrated Visual and Auditory Continuous Performance Test (IVA-CPT): This test can be used to assess core symptoms of ADHD 5
- Wisconsin Card Sorting Test (WCST) and Digit Span Test (DST): These tests can be used to evaluate executive function 5
Diagnostic Criteria
The diagnosis of ADHD requires a comprehensive clinical interview that reviews representative symptoms starting in childhood that continue to cause impairment into adulthood 6. The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders and the eleventh edition of the International Classification of Diseases provide diagnostic criteria for ADHD 7.
Screening for ADHD
ADHD can be screened for in as little as 3 to 5 minutes with a variety of self-report or physician-implemented scales 6. A high index of suspicion and integration of screening for ADHD into psychiatric evaluation is recommended, especially in adults with comorbid psychiatric disorders 6.