Administration and Interpretation of DIVA-5 and SCARED
The DIVA-5 is a semi-structured diagnostic interview for adult ADHD that requires trained clinicians to systematically assess DSM-5 criteria across childhood and adulthood, while the SCARED is a self-report screening questionnaire for pediatric anxiety disorders that uses a 41-item format with parent and child versions.
DIVA-5 Administration for Adult ADHD Assessment
Interview Structure and Requirements
The DIVA-5 must be administered by trained psychologists or psychiatrists who systematically evaluate all 18 DSM-5 ADHD symptoms across both childhood (before age 12) and current adult functioning 1, 2.
Each symptom domain requires concrete behavioral examples from the patient demonstrating how inattention and hyperactivity/impulsivity manifested in childhood and persist into adulthood 1.
Collateral information from a spouse, parent, or significant other is mandatory, as adults with ADHD systematically underestimate their symptom severity and functional impairment 3, 4.
Critical Diagnostic Elements to Document
Verify symptom onset before age 12 with specific childhood examples (school performance, peer relationships, family functioning) 1, 5.
Document moderate-to-severe functional impairment in at least two settings: occupational/academic, social, and family domains must be explicitly assessed 3.
Rule out conditions that mimic ADHD including bipolar disorder, depression, anxiety disorders, learning disabilities, narcolepsy, substance use disorders, and borderline intellectual functioning 3, 6.
Interpretation of DIVA-5 Results
The DIVA-5 demonstrates good internal consistency (Cronbach's alpha 0.61-0.78) and shows greater sensitivity for inattention in adulthood and greater specificity for hyperactivity/impulsivity in childhood 1.
Diagnostic agreement between DIVA-5 and SCID-5 reaches 81.66%, with test-retest and inter-rater reliability ranging from good to excellent 5.
A positive DIVA-5 requires confirmation through medical history, physical examination, and screening laboratory tests to exclude medical conditions mimicking ADHD 3.
Common Pitfalls to Avoid
Never rely on self-report alone—the DIVA-5 cannot differentiate ADHD from overlapping conditions without comprehensive clinical evaluation 3, 6.
Substance use disorders are highly comorbid with ADHD; consider urine drug screening as part of the diagnostic workup 3.
Anxiety and depression frequently co-occur with ADHD (comorbidity rates 16.76%-57.6% for perinatal depression alone), requiring careful differential diagnosis 7, 8.
SCARED Questionnaire Administration for Anxiety Screening
Questionnaire Format and Scoring
The SCARED is a freely available 41-item screening tool with separate parent and child versions designed for children and adolescents 9.
Access the SCARED at https://www.pediatricbipolar.pitt.edu/resources/instruments for both parent and child versions 9.
The SCARED screens for multiple anxiety disorder categories including panic disorder, generalized anxiety disorder, separation anxiety disorder, social anxiety disorder, and school avoidance 9.
Clinical Application
The SCARED functions solely as a screening instrument, not a diagnostic tool—positive screens require comprehensive clinical evaluation including structured interviews 9.
For gold-standard anxiety assessment, use the Anxiety Disorders Interview Schedule (ADIS), which addresses all DSM anxiety disorders with screening sections for psychiatric comorbidities 9.
Alternative free structured interviews include the K-SADS-PL DSM-5, which assesses panic, agoraphobia, separation anxiety, social anxiety, selective mutism, specific phobia, and generalized anxiety disorders 9.
Integration with ADHD Assessment
Screen for anxiety disorders in all children and adolescents evaluated for ADHD, as comorbid emotional and behavioral conditions (anxiety, depression, oppositional defiant disorder) are highly prevalent 10.
Anxiety symptoms can mimic or mask ADHD symptoms—the SCARED helps identify anxiety that may confound ADHD diagnosis or represent true comorbidity 6, 8.
When ADHD and anxiety coexist, both conditions require separate assessment and treatment, as comorbidity increases disease burden and reduces treatment efficacy 8.
Limitations and Follow-Up
Standardized rating scales like SCARED have adequate sensitivity but poor specificity—they cannot establish diagnosis without clinical interview 4.
Mental status examination findings (poor eye contact, clinginess, tremor, fidgetiness, hypervigilance, worry-laden thought content) are nonspecific and adjunctive to other diagnostic information 9.
After positive SCARED screening, conduct structured diagnostic interviews (ADIS or K-SADS-PL) to confirm anxiety disorder diagnosis and characterize symptom breadth 9.