What are the recommended Attention Deficit Hyperactivity Disorder (ADHD) assessment scales for patients of different ages, including children and adults?

ADHD Assessment Scales by Age Group

Use DSM-5-based rating scales from both parents and teachers as your primary assessment tools, with specific scales varying by age: Vanderbilt ADHD Rating Scales for children 6-12 years, Conners Rating Scales across all ages including preschool and adult versions, and the Adult ADHD Self-Report Scale (ASRS-V1.1) for adolescents and adults. 1, 2

Preschool-Aged Children (4-5 Years)

For collateral informants:

• DSM-based ADHD rating scales completed by parents (primary tool for systematic symptom collection) 1, 2
• DSM-based ADHD rating scales completed by teachers/childcare providers when the child attends preschool or daycare 1, 2
• Conners Rating Scale Preschool Version with preschool-age normative data based on DSM-IV criteria 2, 3

For direct assessment:

• Clinical interview with parents combined with direct examination and observation of the child 1, 3

Critical caveat: Determining the presence of key symptoms in preschool-aged children is challenging, particularly when observing symptoms across multiple settings if the child does not attend preschool or childcare 1. Even without normative data, any DSM-based scale provides a systematic method for collecting information since there are minimal changes in specific behaviors from DSM-IV to DSM-5 1.

School-Aged Children (6-12 Years)

For collateral informants:

• Vanderbilt ADHD Rating Scales (both parent and teacher versions) - specifically recommended by the American Academy of Pediatrics as part of their comprehensive ADHD toolkit for this age group 2
• ADHD Rating Scale-5 (DSM-5-based) completed by parents and teachers 2, 3
• Conners Rating Scales for standardized assessment across home and school environments 2

For screening broader issues:

• Pediatric Symptom Checklist for screening from 48 months through adolescence 2
• Strengths and Difficulties Questionnaire for screening from 48 months through adolescence 2

Implementation requirement: Both parent AND teacher versions must be utilized to gather information across home and school settings, as DSM-5 criteria require documentation of impairment in more than one major setting 1, 2, 3

Adolescents (12-18 Years)

For collateral informants:

• Vanderbilt ADHD Rating Scales (parent and teacher versions) for screening ADHD, related behavior disorders, and general academic/behavioral performance 2
• DSM-5-based rating scales from teachers and other school personnel - particularly important when adolescents have multiple instructors 2, 3
• Conners Rating Scales validated for adolescent age groups 2

For patient self-report:

• Adult ADHD Self-Report Scale (ASRS-V1.1) Part A for initial screening 4
• ASRS Part B to further elucidate symptoms if Part A screen is positive 4
• Self-report measures should be included as part of comprehensive assessment 3

Additional assessment: Screen for substance use in this age group 3

Adults

For patient self-report:

• Conners Adult ADHD Rating Scale (CAARS) to evaluate ADHD symptoms 2, 5, 6, 7
• Adult ADHD Self-Report Scale (ASRS-V1.1) 6, 7
• Brown Attention-Deficit Disorder Scale for Adults 6, 7
• Current Symptoms Scale (CSS) by Barkley and Murphy 6, 7
• ADHD Rating Scale-IV 7
• Attention Deficit Hyperactivity Disorder Self Report Scale (ADHD-SR) 6

For collateral informants:

• Obtain collateral information from someone who knows the patient well - this is a required component of comprehensive evaluation 4
• Brown ADD Rating Scale (clinician or significant other administered) 6
• Attention Deficit Hyperactivity Disorder Other Report Scale (ADHD-OR) 6
• CAARS other report forms 6
• CSS other report forms 6

For retrospective childhood assessment:

• Wender-Utah Rating Scale (WURS) for retrospective assessment of childhood ADHD symptoms 6, 7
• Childhood Symptoms Scale by Barkley and Murphy 6

Comprehensive diagnostic interviews:

• Brown ADD Diagnostic Form (most comprehensive procedure) 6
• Adult Interview (AI) by Barkley and Murphy 6
• Wender Reimherr Interview (WRI) - uses a diagnostic algorithm different from DSM-IV, contains only items from adult psychopathology rather than symptoms designed for children 6

Critical Implementation Principles Across All Ages

Rating scales do NOT diagnose ADHD by themselves - they serve only to systematically collect symptom information as part of a comprehensive evaluation that includes clinical interview, examination, and multi-informant data 2. The American Academy of Pediatrics explicitly warns against relying solely on questionnaire scores without clinical interview and multi-informant data 2.

Mandatory multi-setting documentation: Functional impairment must be documented in more than one major setting (home, school, work, social) using information from parents, teachers, and other observers 1, 2, 3, 4. This is a DSM-5 requirement that cannot be bypassed 1, 2.

Screen for comorbidities systematically: Assess for anxiety, depression, oppositional defiant disorder, conduct disorder, learning disabilities, sleep disorders, tics, and substance use (in adolescents/adults), as these conditions may alter treatment approach or explain symptoms 2, 3, 4.

Rule out alternative causes through clinical interview and examination before confirming ADHD diagnosis 2, 3, 4.

Use scales for treatment monitoring: Once diagnosis is established, the same rating scales can monitor treatment response over time 2.