What questions should a provider ask to assess ADHD symptoms?

Essential Questions for Assessing ADHD Symptoms

Providers should systematically assess both inattentive and hyperactive-impulsive symptom domains, requiring at least 5 symptoms from either category present for 6+ months, while obtaining collateral information from multiple sources and evaluating functional impairment across settings. 1

Core Symptom Assessment

Inattentive Symptoms (Ask about these 9 specific behaviors):

1. "Do you make careless mistakes or have poor attention to detail in your work or daily tasks?" 1

2. "Do you have difficulty concentrating or sustaining attention on tasks, even ones you want to complete?" 1

3. "Do you seem preoccupied or have difficulty shifting focus, even when people speak directly to you?" 1

4. "Do you frequently start tasks but get distracted or side-tracked before completing them?" 1

5. "Do you struggle with organization, resulting in chronic lateness for appointments or deadlines, messiness, or disorganized work?" 1

6. "Do you avoid or feel reluctant to engage in tasks requiring sustained mental effort, like preparing reports or reviewing lengthy papers?" 1

7. "Do you frequently lose track of personal belongings or items needed to complete tasks?" 1

8. "Are you easily distracted by external stimuli or unrelated thoughts?" 1

9. "Are you frequently forgetful in daily activities, like keeping appointments or managing household tasks?" 1

Hyperactive-Impulsive Symptoms (Ask about these 9 specific behaviors):

1. "Do you frequently fidget, such as tapping your desk, feet, or hands?" 1

2. "Do you find it difficult to sit still for prolonged periods, like during meetings or meals?" 1

3. "Do you experience inner restlessness or agitation, even when you appear calm externally?" 1

4. "Are you often loud or disruptive in social or work settings?" 1

5. "Do you feel like you're always 'on the go,' making it difficult for others to keep up with you?" 1

6. "Do you talk excessively, even when you know you should stop?" 1

7. "Do you frequently interrupt others or have difficulty restraining yourself from sharing your perspective or waiting your turn in conversation?" 1

8. "Are you highly impatient, such as having difficulty waiting in line or for your turn?" 1

9. "Do you often intrude into others' activities or take over what others are doing?" 1

Critical Diagnostic Context Questions

Childhood Onset and Duration:

1. "When did these symptoms first begin? Can you recall having similar difficulties with attention, organization, or impulsivity before age 12?" This is essential because ADHD requires childhood onset, and adults often underestimate their symptoms. 1 Obtain collateral information from parents or review old school records to confirm childhood symptoms. 1

Functional Impairment Assessment:

"How do these symptoms impact your daily functioning?" Specifically probe:

• Home management: "Do you struggle with cooking, cleaning, or keeping track of household responsibilities?" 1
• Work/school performance: "Have these symptoms affected your job performance, ability to meet deadlines, or academic achievement?" 1
• Relationships: "Do these symptoms cause problems in your relationships with family, friends, or coworkers?" 1
• Time management: "Do you have difficulty keeping track of appointments, children's schedules, or managing your time?" 1

The Weiss Functional Impairment Rating Scale-Self (WFIRS-S) can quantify ADHD-specific impairment. 1

Pervasiveness Across Settings:

"Do these symptoms occur in multiple settings (home, work, social situations), or are they limited to one environment?" ADHD symptoms must be present across multiple settings. 1

Comorbidity Screening:

"Have you experienced symptoms of depression, anxiety, mood swings, substance use, or other mental health concerns?" Adults with ADHD have high rates of comorbid conditions (12-60%), including depression, anxiety, substance abuse, and personality disorders. 1 These must be identified as they may alter treatment approaches. 1

Collateral Information

Obtain information from a spouse, parent, or close friend by having them complete the same symptom assessment with the patient in mind. 1 Adults with ADHD often have poor insight and underestimate symptom severity and resulting impairments. 1

Common Pitfalls to Avoid

• Don't rely solely on patient self-report: Adults with ADHD notoriously underestimate their symptoms. 1
• Don't miss childhood onset: If symptoms only began after age 12, consider alternative diagnoses like bipolar disorder, depression, or substance-induced symptoms. 1
• Don't overlook substance abuse: Obtain detailed drug and alcohol history, as comorbid substance abuse is common and may contraindicate certain treatments. 1
• Don't diagnose based on response to stimulants: Behavioral response to stimulant medication does not distinguish between children with and without ADHD. 2