From the Guidelines
Adults with suspected ADHD should undergo a comprehensive psychiatric evaluation to determine the presence of the disorder.
Diagnostic Tests
The evaluation should include:
- A complete psychiatric evaluation with a focus on core ADHD symptoms starting in childhood 1
- A detailed history of drug and alcohol use, and consideration of a urine drug screen to rule out substance abuse 1
- Information from a spouse, parent, or friend, as adults with ADHD often have poor insight into their symptoms 1
- A medical history and physical examination to rule out medical conditions that may masquerade as ADHD 1
- Screening laboratory tests to rule out other conditions 1
Rating Scales
Structured rating scales can be useful in the diagnosis of ADHD in adults, including:
- The Wender Parent’s Rating Scale and the Wender Utah Rating Scales 1
- The Brown Attention-Deficit Disorder Scale for Adults 1
- The Conners Adult ADHD Rating Scale 1 These tests can help identify ADHD symptoms and differentiate them from other conditions, such as bipolar disorder, depression, and learning disabilities.
From the Research
Diagnostic Tests for Attention Deficit Hyperactivity Disorder (ADHD) in Adults
The diagnostic tests for ADHD in adults include:
- Clinical interviews: A thorough clinical interview is the cornerstone of the assessment, aided by the use of rating scales for current symptoms and collateral information about childhood from parents or siblings 2, 3, 4.
- Rating scales: Diagnostic and symptom assessment scales, such as the ASRS Screening Scale, can be a significant help in diagnosing and establishing the symptoms of ADHD in adults 3, 4, 5.
- Behavior rating scales: Standard and novel ADHD behavior rating scales can augment the clinical interview and improve the diagnostic accuracy of adult ADHD assessment 6.
- Symptom validity tests: Response validity and symptom validity tests have reasonably good sensitivity and very good specificity in detecting invalid symptom presentation 6.
- Cognitive tests: Cognitive test batteries have inadequate sensitivity and specificity in identifying ADHD, but using cognitive tests in conjunction with behavior rating scales can significantly improve the specificity of an assessment battery 6.
- Executive function behavior rating scales: These scales are unlikely to improve the diagnostic accuracy of ADHD assessment 6.
- Functional impairment rating scales: These scales are also unlikely to improve the diagnostic accuracy of ADHD assessment 6.
Key Considerations
- Adult ADHD remains a clinical diagnosis, and there is no consensus on diagnostic criteria for adult ADHD 2.
- The DSM criteria have never been validated in adults and do not include developmentally appropriate symptoms and thresholds for adults 2.
- Laboratory assessment measures, including neuropsychological tests and brain imaging, are not justified in diagnosing adult ADHD due to insufficient scientific data 2.
- A comprehensive clinical interview that reviews representative symptoms starting in childhood that continue to cause impairment into adulthood is essential for an accurate diagnosis of ADHD in adults 4.