How do you administer the Diagnostic Interview for Attention Deficit Hyperactivity Disorder (ADHD) survey?

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How to Administer the DIVA Survey for ADHD

The DIVA (Diagnostic Interview for ADHD in Adults) is a semi-structured clinical interview administered by a trained clinician to assess both current and childhood ADHD symptoms based on DSM-5 criteria, systematically evaluating all 18 symptom domains across multiple life settings. 1, 2

What the DIVA Is and When to Use It

The DIVA is specifically designed for adult ADHD diagnosis and serves as a comprehensive diagnostic tool rather than a screening questionnaire. 1, 2 It systematically reviews:

  • Childhood symptoms (retrospectively assessing symptoms before age 12) 1, 3
  • Current adult symptoms (present manifestations) 1, 3
  • Functional impairment across multiple domains 2

The DIVA-5 (current version) is based on DSM-5 criteria and has demonstrated 100% diagnostic accuracy when compared to the gold-standard CAADID interview. 2

Administration Process

Step 1: Prepare the Clinical Interview

  • Obtain collateral information from family members, partners, or others who knew the patient in childhood to verify retrospective symptom reports 1, 2
  • Review any available childhood records (report cards, prior evaluations) to corroborate early symptom onset 1
  • Allocate 45-90 minutes for the complete interview 2

Step 2: Systematically Assess Each Symptom Domain

The DIVA evaluates all 18 DSM-5 ADHD symptoms divided into:

Inattention symptoms (9 items): 1

  • Difficulty sustaining attention
  • Not listening when spoken to directly
  • Failure to follow through on tasks
  • Difficulty organizing tasks
  • Avoidance of sustained mental effort
  • Losing necessary items
  • Easy distractibility
  • Forgetfulness in daily activities
  • Careless mistakes

Hyperactivity/Impulsivity symptoms (9 items): 1

  • Fidgeting or squirming
  • Leaving seat inappropriately
  • Restlessness
  • Difficulty with quiet activities
  • Being "on the go"
  • Excessive talking
  • Blurting out answers
  • Difficulty waiting turn
  • Interrupting others

Step 3: Assess Each Symptom in Two Time Periods

For each of the 18 symptoms, the clinician must assess: 1, 3

  • Childhood presentation (ages 5-12 years): Document specific examples of how the symptom manifested
  • Current adult presentation (past 6 months): Document current manifestations and frequency

Step 4: Document Functional Impairment

The DIVA requires documentation of impairment in at least 2 major life domains: 2

  • Work/occupation
  • Education
  • Home/family relationships
  • Social relationships
  • Leisure activities

Critical pitfall to avoid: The DIVA showed greater sensitivity for inattention in adulthood and greater specificity for hyperactivity/impulsivity in childhood, so pay particular attention to these patterns. 1

Step 5: Rule Out Alternative Explanations

During the interview, systematically assess for: 2

  • Other psychiatric conditions that could explain symptoms
  • Substance use that might mimic ADHD
  • Medical conditions affecting attention/behavior
  • Situational stressors versus pervasive symptoms

Step 6: Score and Interpret

  • Count symptoms meeting threshold in childhood (≥5 symptoms required) 1, 3
  • Count symptoms meeting threshold in adulthood (≥5 symptoms required) 1, 3
  • Verify symptom onset before age 12 1, 3
  • Confirm functional impairment in multiple settings 2
  • Determine ADHD subtype: predominantly inattentive, predominantly hyperactive-impulsive, or combined presentation 1

Validation with Other Measures

Enhance diagnostic confidence by administering concurrent rating scales: 2, 3

  • Conners' Adult ADHD Rating Scale (CAARS) - showed good correlation with DIVA-5 (r = 0.61-0.47) 1
  • ADHD Rating Scale - demonstrated strong correlation (r = 0.720) 2
  • Wender Utah Rating Scale (WURS) - for retrospective childhood symptoms (r = 0.544) 2
  • Adult ADHD Self-Report Scale (ASRS-v1.1) - though correlation was weaker for childhood hyperactivity/impulsivity 1

Key Advantages of the DIVA

  • Free online access for clinical and research use 2
  • Excellent reliability: test-retest and inter-rater reliability are good to excellent 3
  • High diagnostic accuracy: 100% agreement with gold-standard interviews 2
  • Validated in multiple languages: Italian, Farsi, Korean, and others 1, 3

Common Pitfalls to Avoid

  • Relying solely on patient self-report without collateral information, especially for childhood symptoms 1, 2
  • Failing to document functional impairment across multiple life domains - symptoms alone are insufficient 2
  • Not ruling out alternative diagnoses that could explain the symptom presentation 2
  • Using the DIVA as a screening tool - it is a diagnostic interview requiring clinical expertise, not a self-administered questionnaire 2
  • Inadequate assessment of childhood onset - retrospective recall can be unreliable without corroborating evidence 1

References

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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