Rating scales are an essential part of the full assessment process for attention-deficit hyperactivity disorder (ADHD). Versions for completion by parents, patients themselves and teachers are available; recognising the need for multidisciplinary input on a patient’s condition and symptomatology as addressed in guidelines for ADHD,1-4 with teachers in particular recognised to have a crucial role in assisting with accurate clinical case identification in children with ADHD.1-3 Healthcare professionals may also use standardised symptom and side effect rating scales throughout the course of ADHD treatment to support clinical assessment.1-4 Standardised rating scales enable clinicians to evaluate multiple aspects of well-being, including symptoms, overall functioning and quality of life and compare these results with specific clinical subgroups, the general population, or both.
ADHD-specific scales that rate symptoms include the ADHD Rating Scale IV (ADHD-RS-IV) for children5 and the Adult ADHD Self-Report Scale (ASRS) for adults.6 Quality of life and economic impact of ADHD is measured by the ADHD Impact Module (AIM) adult questionnaire (AIM-A),7 and a child version (AIM-C) is completed by parents/carers and captures impact of ADHD on the child and on the quality of life in the home.8 More information on these, and many other scales, is available in the interactive module below.
Rating scales are only one component of a comprehensive assessment process,1-4 and the National Institute for Health and Care Excellence (NICE) guidelines recommend that the diagnosis should only be made after a full clinical and psychosocial evaluation, and never on the basis of rating scale data alone.1 This is because rating scales have less sensitivity and specificity for diagnosis compared with a full diagnostic assessment and they can be subject to inter-rater variability.1 Many rating scales describe symptoms only with no consideration given to the level of impairment or developmental appropriateness.1
- 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 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 et al. European consensus statement on diagnosis and treatment of adult ADHD: The European Network Adult ADHD. BMC Psychiatry 2010; 10: 67.
- DuPaul GJ et al. ADHD Rating Scale IV: Checklists, norms, and clinical interpretation. New York, NY: Guilford Press, 1998.
- Adult ADHD Self-Report Scale (ASRS) Checklist. Available at: http://webdoc.nyumc.org/nyumc_d6/files/psych_adhd_checklist.pdf. Last accessed March 2015.
- AIM-A: ADHD Impact Module – AdultTM. Available at: http://www.thechq.com/aim-a-adhd.php. Last accessed March 2015.
- AIM-C: ADHD Impact Module – ChildTM. Available at: http://www.thechq.com/aim-c-adhd.php. Last accessed March 2015.
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How do current guidelines measure up in managing ADHD?