From the Guidelines
Adult-Onset Attention Deficit Hyperactivity Disorder (ADHD) diagnosis requires a comprehensive evaluation, focusing on core ADHD symptoms starting in childhood, as well as a detailed history of substance use and medical conditions that may masquerade as ADHD 1.
Key Diagnostic Criteria
- A complete psychiatric evaluation with a focus on core ADHD symptoms
- A detailed history of drug and alcohol use
- Information from a spouse, parent, or friend to compensate for the patient's potentially poor insight
- Medical history, physical examination, and screening laboratory tests to rule out other conditions
Useful Diagnostic Tools
- Structured rating scales, such as:
- Wender Parent’s Rating Scale
- Wender Utah Rating Scales
- Brown Attention-Deficit Disorder Scale for Adults
- Conners Adult ADHD Rating Scale
Differential Diagnosis
- Bipolar disorder
- Depression
- Axis II personality disorders
- Learning disabilities
- Narcolepsy
- Undiagnosed borderline intellectual functioning A thorough evaluation, including these criteria and tools, is necessary to accurately diagnose Adult-Onset ADHD and develop an effective treatment plan 1.
From the Research
Diagnostic Criteria for Adult-Onset Attention Deficit Hyperactivity Disorder (ADHD)
The diagnostic criteria for Adult-Onset Attention Deficit Hyperactivity Disorder (ADHD) are not universally agreed upon, but several studies have shed light on the key aspects of diagnosis.
- The Wender Utah criteria and DSM-based approaches are two commonly used methods for diagnosing adult ADHD, with both identifying significantly impaired ADHD adults with similar neurocognitive, biological, and treatment response patterns to pediatric ADHD patients 2.
- The DSM-5 includes three phenotypes of ADHD: predominantly inattentive, predominantly hyperactive/impulsive, or combined, which must begin before age 12, be present in at least two settings, and cannot be explained by another condition 3.
- A comprehensive interview is the most important diagnostic procedure, with rating scales, collateral reports, and neuropsychological testing also being useful 4.
- Executive functioning (EF) problems are a consistent and discriminating predictor of adult DSM-IV /ACDS ADHD, suggesting that the number of EF symptoms should be increased in the DSM-V/ICD-11 5.
Challenges in Diagnosing Adult ADHD
- There is no consensus on diagnostic criteria for adult ADHD, with the DSM criteria never being validated in adults and failing to include developmentally appropriate symptoms and thresholds for adults 2.
- Adult ADHD often lacks the full symptom complex, especially hyperactivity, and mood-associated symptoms are often present 4.
- Comorbidities are common in adult ADHD, which can increase the negative impact on everyday life 3.
- The diagnosis of adult ADHD requires consideration of many facets, including prior medical history and comorbid conditions, and the use of an individualized, evidence-based treatment approach 6.
Importance of Accurate Diagnosis
- Adult ADHD is often underdiagnosed and inappropriately treated, highlighting the need for increased awareness and guidance for management in the primary care community 6.
- Accurate diagnosis is crucial for effective treatment, with pharmacotherapy and behavior interventions being commonly used 6.
- Adult ADHD can have significant impacts on daily life, including unemployment, financial difficulties, and an unsuccessful personal life, making accurate diagnosis and treatment essential 6.