ADHD Rating Scales by Age Group and Reporter Type
Use DSM-5-based rating scales from multiple informants (parents, teachers, self-report when age-appropriate) across all age groups, with the Vanderbilt ADHD Rating Scales recommended for ages 6-12 years and the Conners Rating Scales validated across the lifespan from preschool through adulthood. 1
Preschool-Aged Children (4-5 Years)
Collateral Report (Parent/Caregiver)
- ADHD Rating Scale-IV Preschool Version with preschool-age normative data based on DSM-IV criteria 2
- Conners Rating Scale with preschool-age normative data 2
- Any DSM-based scale can be used systematically to collect information from parents even without normative data, as DSM-5 behaviors are minimally different from DSM-IV 2
Teacher/Childcare Provider Report
- Same scales as parent versions when child attends preschool or childcare 2
- For children not in structured settings, obtaining observations from trained staff by placing child in qualified preschool program (Head Start, public prekindergarten) is recommended 3
Critical Considerations
- Determining symptom presence across multiple settings is challenging when children lack separate observers outside the home 2, 3
- Parent training in behavior management (PTBM) should be implemented before confirming diagnosis, as intervention results may inform diagnostic evaluation 2, 3
Elementary and Middle School Children (6-12 Years)
Collateral Report (Parent)
- Vanderbilt ADHD Rating Scales (Parent Version) - specifically recommended by the American Academy of Pediatrics for this age group 1
- ADHD Rating Scale-5 with normative data for ages 5-18 years 2
- Conners Rating Scale with age-appropriate normative data 2
Collateral Report (Teacher)
- Vanderbilt ADHD Rating Scales (Teacher Version) - both parent and teacher versions should be utilized to gather information across home and school settings 1
- ADHD Rating Scale-5 (teacher version) 2
- Conners Rating Scale (teacher version) 2
- Obtain reports from at least two teachers when possible to clarify symptom patterns 3
Additional Observers
- School guidance counselors, coaches, or community activity supervisors can provide supplementary information 3
Self-Report
- Generally not primary assessment method at younger ages in this range 4
- May be incorporated for older children (ages 10-12) as supplementary information 4
Adolescents (12-18 Years)
Collateral Report (Parent)
- Vanderbilt ADHD Rating Scales can be used for screening 1
- DSM-5-based ADHD rating scales with normative data through age 18 2
- Conners Rating Scale with adolescent normative data 2
Collateral Report (Teacher)
- Obtain current rating scales from at least two teachers, as adolescents typically have multiple instructors 3
- Vanderbilt scales or other DSM-based rating scales 3
- Conners Rating Scale (teacher version) 2
Self-Report
- Self-report scales become increasingly important in adolescence 4
- Adolescent assent to treatment is required, making self-assessment valuable 1
- Pediatric Symptom Checklist and Strengths and Difficulties Questionnaire are well-suited for screening from 48 months through adolescence 1
Retrospective Assessment
- For newly diagnosed adolescents, retrospective parent-completed rating scales help establish symptom onset before age 12 as required by DSM-5 3, 5
- Clinical interview with both adolescent and parents about childhood functioning, academic history, and behavioral patterns is essential 3
Adults (18+ Years)
Self-Report
- Conners Adult ADHD Rating Scales (CAARS) - validated for comprehensive symptom assessment with normative data 2, 6
- Barkley Adult ADHD Rating Scale-IV - used to derive ADHD diagnosis in research settings 7
- Strengths and Difficulties Questionnaire (SDQ) hyperactivity/ADHD subscale has high validity in distinguishing ADHD cases at age 25 years (area under curve=0.90) 7
Collateral Report
- Information from family members, partners, or close friends is mandatory to document functional impairment in at least two settings 6
- Collateral informants help establish childhood onset before age 12, as adults often minimize symptoms 6
Retrospective Assessment
- Patient recall, collateral informants, or historical records (old report cards, school records) establish documented onset before age 12 6
- Detailed developmental history focusing on elementary and middle school years is required 6
Critical Implementation Principles Across All Ages
Multi-Informant Requirement
- Rating scales serve to systematically collect symptom information but do not diagnose ADHD by themselves 1
- Information must be obtained from multiple sources to verify DSM-5 criteria are met 2, 1
- Symptoms and impairment must be documented in more than one major setting (home, school, work, social) 1, 3
Common Pitfalls to Avoid
- Never diagnose based solely on questionnaire scores without clinical interview and multi-informant data 1
- Never diagnose when symptoms are present in only one setting - this may represent environmental factors, parent-child relationship difficulties, or other psychiatric conditions rather than ADHD 3
- Never rely solely on self-report in adults without collateral information 6
- Failing to screen for comorbid conditions (anxiety, depression, learning disabilities, oppositional defiant disorder) that may alter treatment approach 1, 6
Monitoring Treatment Response
- The same rating scales used for diagnosis can monitor treatment response over time 1
- Titrate medication doses to achieve maximum benefit with minimum adverse effects using systematic rating scale feedback 1
Alternative Causes Must Be Ruled Out
- Substance use (especially marijuana and stimulants in adults) can produce identical symptoms 6
- Trauma/PTSD, mood disorders, learning disabilities, and sleep disorders must be systematically excluded 1, 6
- For adults with ambiguous presentations, reassess after sustained abstinence from substances and optimization of mood/anxiety treatment before confirming ADHD diagnosis 6