History

According to the American Academy of Family Physicians: For both children and adults, positive findings to support a new ADHD diagnosis are typically found in the patient history. Emphasis should be placed on the following:

• Developmental History – to help pinpoint when symptoms began and identify contributing or resultant developmental problems.  

• Psychiatric History – to identify co-morbid psychiatric disorders, both known and unknown.

• Family History – to evaluate for family history of ADHD, psychiatric disorders, tics, and substance abuse.

(Post & Kurlansik, 2012)

Physical Exam

Pediatrics:

According to the American Academy of Pediatrics, a physical and neurologic examination should be conducted to determine if further medical or developmental assessments are indicated.

  • Baseline height, weight, blood pressure, and pulse measurements should be taken.
  • Among the signs to note are hearing and visual acuity, cardiovascular status, and any dysmorphic features – ADHD might be associated with genetic syndromes (eg, fetal alcohol syndrome and fragile X).
  • The neurologic evaluation should include developmental and mental status observations including affect; communication skills, including speech and language; tics; and gross and fine motor coordination.
  • Many children with ADHD will have poor coordination, which might be severe enough to warrant a diagnosis of developmental coordination disorder. The findings can affect how well the child can perform in competitive sports and can also adversely affect his or her writing skills.

Adults:

According to the American Academy of Family Physicians, the clinician should perform a thyroid and neurologic examination to rule out thyroid abnormalities and neurologic disorders (e.g., head injury, seizure disorder), and a general exam to identify possible contraindications of stimulant therapy (e.g., hypertension or cardiac dysfunction). Baseline weight should be recorded for comparison in future monitoring.

(Post & Kurlansik, 2012)

Level of Impairment:

For both children and adults, it is important to assess the patient’s level of impairment related to the symptoms described. The assessment should include multiple environments, such as work, home, school, etc. A wide variety of formal screening tools are available for this purpose, and some of the most common are outlined below.

Pediatric Assessment Tools:

NICHQ Vanderbilt Assessment Scale

  • The National Initiative for Children’s Healthcare Quality (NICHQ) Vanderbilt Assessment screening exams are used to assess behavioral patterns in multiple environments for children ages 6-12. The child’s parent and teacher will each complete an initial assessment scale, and then a follow-up assessment scale after treatment has begun. Each scale has two sections: symptom assessment and impairment in performance.
  • The initial scales screen for symptoms of inattentive and hyperactive ADHD, as well as oppositional-defiant disorder, conduct disorder, and anxiety/depression. 
  • The follow-up scales re-screen for ADHD symptoms, but not other co-morbidities. Additionally, it includes an area for informants to document potential medication side effects. 

The Child Behavior Checklist

CBLC – (Child Behavior Checklist) – Ages 1.5 – 5 years

CBLC – (Child Behavior Checklist) – Ages 6 – 18 years

  • The Child Behavior Checklist is a non specific screening tool that assesses behavioral and social issues for children ages 1.5 to 5 years, and 6 to 18 years. This should be filled out by parents, the teacher or caregiver, and the child, if appropriate.
  • Best used as a general screening tool for emotional or behavioral problems. Also asks open ended questions regarding general functioning and background.
  • Questions are rated on a Likert scale that assesses for symptoms on eight syndrome scales, including sleep disorders, social withdrawal, and aggressive behavior, among others. There are also questions related to ADHD, anxiety, post traumatic stress disorder, obsessive compulsive disorder, oppositional defiant disorder, conduct disorders, and other mood disorders. Additionally, in the teacher report form, adaptive functioning scales include questions regarding academic performance and learning in the classroom.
  • Eight syndrome scale scores are generated, as well as three summary scores: Internalizing problems, externalizing problems, and total problems. In addition, there are 6 DSM-Oriented scores, and three competence based scores that assess the child’s level of functioning in activities, social settings, and school.
  • These scales must be purchased from ASEBA for clinical use. A package of 50 questionnaires and 50 scoring sheets costs $65. ASEBA Store Link

The Conners Comprehensive Behavior Rating Scale

Conners Comprehensive Behavior Rating Scale – Sample Report

  • The Conners Comprehensive Behavior Rating Scale is a computer-administered scale used to assess for emotional, behavioral, and social issues in children ages 6-18, and is frequently used to diagnose ADHD.
  • The behavioral scale assesses emotional distress, aggressive behaviors, academic difficulties, hyperactivity/impulsivity, separation fears, violence potential, and physical symptoms as well as DSM-IV symptom scales, consistent with disorders such as ADHD, ODD, anxiety, and OCD.
  • There is a long version and a short version. Regardless of length, the test should be completed by the parent, teacher, and child.

Adult Assessment Tools:

Studies reveal that the prevalence and incidence of ADHD in adults have increased, and it is largely associated with the presence of co-morbid psychiatric diagnoses. There are a variety of rating scales for adults, and they vary in scope and purpose. Some are used to assist in diagnosis, others measure symptom severity and/or frequency, and a few can be used to gauge improvement in behaviors. While rating scales do provide valuable information, they must be performed in conjunction with a full history and physical assessment in order to diagnoses ADHD. Providers must remember the diagnosis cannot be made from a rating scale alone.

Adult ADHD Self-report Scale

  • The Adult ADHD Self-Report Scales was developed by psychiatrists, researchers and the world health organization as a screening tool. It is a self administered assessment based on DSM-IV criteria, and highlights symptom severity and frequency.

Download Screenings/Scales in multiple languages

Diagnostic Interview for ADHD in Adults

  • The Diagnostic Interview for ADHD in Adults (DIVA) only asks about the core symptoms of ADHD, and does not address any other potential comorbid psychiatric conditions. This is an interview style assessment, and is used for diagnostic purposes.
diva_2_enDownload

DIVA – 2 app for Apple and Android

Adult ADHD Investigator Symptom Rating Scale

  • Adult ADHD Investigator Symptom Rating Scale (AISRS)- An 18 item semi-structured interview scale used to further assess symptoms of ADHD. Prompts are included with questions to reduce the chance of inter-rater variability. For more information on this clinician-administered interview/assessment method, click below:
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Conners Adult ADHD Rating Scale

  • The Conners Adult ADHD Rating Scale includes symptoms and behaviors used in the diagnosis and treatment of ADHD. There is a self reported and observer format, both available in long, short and screening versions. The items on the scale are correlated to the DSM-IV ADHD diagnosis.

Conners Adult ADHD Rating Scale: Details and Pricing

Clinical Global Impression Scales

Clinical Global Impression Scales are validated psychiatric rating instruments that are used by clinicians to quickly assess a patient’s status. They can be utilized for many different diagnoses, but the following have been specifically adapted for use in treating ADHD:

  • ADHD Severity Scale – This scale is a single item list that allows clinicians to rate severity of illness relative to other patients seen with previous presentations.
  • ADHD Improvement Scale – allows clinicians to assess improvements in symptoms from baseline.

About Clinical Global Impression Scales