When evaluating patients for attention-deficit hyperactivity disorder (ADHD), or hyperkinetic disorder (HKD), it is typical to use multiple stages of assessment prior to formal diagnosis.1-4 Following assessment, formal diagnosis is based on symptomatology and conducted by secondary care specialists using validated medical classification systems (e.g. Diagnostic and Statistical Manual of Mental Disorders – 5th edition [DSM-5TM] or International Classification of Mental and Behavioural Disorders 10th revision [ICD-10] classification systems).5,6
Assessment of ADHD typically involves the comprehensive evaluation of information gathered from a number of sources, including parents/carers, family members, teachers, partners and colleagues, depending on the age of the patient (Figure).1-4,6 A range of qualified healthcare professionals may be involved in the assessment and diagnosis of ADHD, such as psychiatrists, psychologists or nurses, who have training and expertise in the diagnosis of ADHD in children, adolescents and/or adults.1-4
Assessment of ADHD1-4,6
Figure created from information in the DSM-5TM and ICD-10 classifications, and CADRRA, ESCAP, and NICE guidelines
Clinical examination aims to identify the presence of other illnesses with symptoms that overlap with those of ADHD.2
- This typically involves inspections for vision or hearing impairments, neurodevelopmental immaturity in relation to gross and fine motor functions and motor or vocal tics, and retardation2
- A general examination of patient’s physical health may also be performed to highlight any evidence of a congenital disorder2
- Clinicians may also look for evidence of comorbidities which are often found in patients with ADHD.2
A healthcare professional will interview the person with suspected ADHD along with any relevant family members, carers, partners, teachers, employers or friends, to ascertain:1-4
- Perceptions of the person with suspected ADHD about their own symptoms, behaviour, functioning, self-esteem or emotions;2 in adults, this will include recall of childhood symptoms and behaviour6
- Observations of symptoms/behaviours in different settings1,2
- Developmental, medical and psychiatric history1,2,4
- Associated family functional difficulties/issues1,2
- Presence of any comorbidities1-4
- Patterns of ADHD or related comorbidities present in the family.4
Behavioural observations may be useful to confirm symptoms reported in interview.1,2
For children and adolescents, teachers in particular may be especially well placed to identify symptoms of ADHD in children1,2 and support symptom reports from parents.7
- Reports from teachers are recognised as one of the optimal sources of information related to problems with behaviour or developmental/social functioning in children and adolescents, with standardised questionnaires considered a useful tool to obtain such information2
- Classroom observations by an educational psychologist are also useful for diagnosing children and adolescents, if feasible.2
For adults, the sources of information may need to be broadened beyond the patient to include spouses, parents or adult siblings.4
A number of rating scales are available to help assess general behaviour and psychosocial functioning, ADHD symptomatology and comorbidities.1-4 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.1-4
- 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.
- Taylor E, Döpfner M, Sergeant J, et al. European clinical guidelines for hyperkinetic disorder -- first upgrade. Eur Child Adolesc Psychiatry 2004; 13 Suppl 1: i7-i30.
- 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.
- Kooij SJ, Bejerot S, Blackwell A, et al. European consensus statement on diagnosis and treatment of adult ADHD: The European Network Adult ADHD. BMC Psychiatry 2010; 10: 67.
- American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. Fifth edition. Washington, DC: American Psychiatric Association, 2013.
- 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.
- Sibley MH, Pelham WE Jr., Molina BS, et al. Diagnosing ADHD in adolescence. J Consult Clin Psychol 2012; 80: 139-150.
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Patient-centred management: every patient is different with unique needs – a Spanish perspective
New eLearning Module on the burden and diagnosis of adult ADHD, supported by Professor Philip Asherson, is now available.
This booklet has been created to assist with clinical assessment of adult patients with ADHD using DSM-5TM criteria and the ASRS checklist.
ADHD is often a lifelong neurobehavioural disorder, which may persist from childhood into adulthood.