Assessment & diagnosis

Attention-deficit hyperactivity disorder (ADHD),1 or hyperkinetic disorder (HKD)2 is a complex and diverse neurobehavioural disorder that can have a profound impact on patients’ functioning and quality of life.4-6 ADHD is generally considered to have three component features – inattention, hyperactivity and impulsivity – and the contribution of each to an individual’s presentation of ADHD varies from patient to patient and across the lifespan.1,6,7 These factors, combined with the frequent presence of comorbidities,7 add further complexity to ADHD, making the assessment and diagnosis process challenging.

Assessment

Assessment and diagnosis of ADHD is a comprehensive process that typically involves multiple steps.7-10 The assessment process involves the comprehensive evaluation of information gathered from a number of sources, including: clinical examination; clinical interviews; assessment of familial and educational needs; and assessment tools and rating scales.7-10 This process also requires input from the patient and other affected individuals, such as parents, carers, family members and teachers for children and adolescents with suspected ADHD; and spouses, siblings, friends, co-workers and employers for adults with suspected ADHD.7-10

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Diagnosis

Formal diagnosis is made using evidence accumulated from the initial clinical assessment and utilising medical classification systems to accurately evaluate a patient’s symptomatology.1,2,7-10 The medical classification systems commonly used for the diagnosis of ADHD are: the Diagnostic and Statistical Manual of Mental Disorders – 5th edition (DSM-5TM) for ADHD; and the International Classification of Mental and Behavioural Disorders 10th revision (ICD-10) for HKD.1,2,7

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Rating scales

In addition to the two medical classification systems, a variety of rating scales are available to help assess the impact of ADHD on multiple aspects of patient well-being, including symptoms, overall functioning and quality of life.7-10 Rating scales can be completed by parents, teachers or the patient themselves, depending on which scale is chosen, and are considered to be an essential part of the full assessment process for ADHD.7-10

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  1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. Fifth edition. Washington, DC: American Psychiatric Association, 2013.
  2. World Health Organization. The ICD-10 Classification of Mental and Behavioural Disorders. Available at: www.who.int/entity/classifications/icd/en/bluebook.pdf. Last updated 1993; 1: 1-263. Last accessed March 2015.
  3. Biederman J et al. Functional impairments in adults with self-reports of diagnosed ADHD: A controlled study of 1001 adults in the community. J Clin Psychiatry 2006; 67: 524-540.
  4. Brod M et al. Comparison of the burden of illness for adults with ADHD across seven countries: a qualitative study. Health Qual Life Outcomes 2012; 10: 47.
  5. Klassen AF et al. Health-related quality of life in children and adolescents who have a diagnosis of attention-deficit/hyperactivity disorder. Pediatrics 2004; 114: e541-e547.
  6. Lara C et al. Childhood predictors of adult attention-deficit/hyperactivity disorder: results from the World Health Organization World Mental Health Survey Initiative. Biol Psychiatry 2009; 65: 46-54.
  7. NICE (2008) Attention Deficit Hyperactivity Disorder: Diagnosis and Management of ADHD in Children, Young People and Adults. NICE clinical guideline 72. Available at www.nice.org.uk/CG72 [NICE guideline]. Last accessed May 2015.
  8. Kooij SJ et al. European consensus statement on diagnosis and treatment of adult ADHD: The European Network Adult ADHD. BMC Psychiatry 2010; 10: 67.
  9. Taylor E et al. European clinical guidelines for hyperkinetic disorder – first upgrade. Eur Child Adolesc Psychiatry 2004; 13 Suppl 1: i7-i30.
  10. The Canadian Attention Deficit Hyperactivity Disorder Resource Alliance (CADDRA). Canadian ADHD Practice Guidelines (CAP-Guidelines) Third Edition. 2011. Available at: http://caddra.ca/practice-guidelines/download. Last accessed March 2015.

 


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