ADHD Diagnosis

Aka: ADHD Diagnosis, ADHD DSM V Criteria, Attention Deficit Hyperactivity Disorder Diagnosis, Attention Deficit Disorder Diagnosis

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II. Types

  1. Primarily Inattentive Type
  2. Primarily Hyperactive-Impulsive Type
  3. Combined Type
  4. Not otherwise specified

III. Precautions

  1. Diagnosis should be based on evidence from both parents and at least 2 teachers
    1. Consider involving input from school coaches and group leaders in older children or adolescents
    2. Obtain self-report behavioral rating scale from adolescents
  2. Evaluate for ADHD Comorbid Conditions and for ADHD Differential Diagnosis
    1. Additional mood, behavioral or Developmental Disorder is present in 60% of ADHD children
    2. Initial screening for Attention Deficit should also include screening for other associated conditions
  3. Thorough initial evaluation is imperative (see ADHD)
    1. History: Development, Learning, Family History, Social environment
    2. Exam: Complete inclduing Vision, Hearing, Neurologic Exam
    3. Labs and diagnostics are not routinely recommended
  4. Age related precautions
    1. Attention Deficit Disorder cannot be reliably diagnosed under age 4 years old
    2. New onset of Attention Deficit Disorder is less common after age 12 years old
      1. Inattentive type may have a delayed diagnosis
      2. Increased academic demands, especially after fourth grade may unmask previously compensated ADD
      3. Consider alternative diagnoses
        1. See Attention Deficit Differential Diagnosis
        2. Learning Disorder
        3. Mood Disorder
        4. Sleep disorder (e.g. Sleep Apnea, Insomnia)
        5. Substance Abuse

IV. Diagnostics: Scales for Children - Narrow Focused on ADHD

  1. Vanderbilt ADHD Diagnostic Test
    1. Preferred option since it is freely available
    2. Test Sensitivity: 80% parent (69% teacher)
    3. Test Specificity: 75% parent (85% teacher)
    4. NICHQ Vanderbilt Scales for initial and follow-up parent and teacher evaluations
      1. http://www.nichq.org/childrens-health/adhd/resources/vanderbilt-assessment-scales
  2. Conners Parent and Teachers Questionnaires
    1. Gold standard survey, but copyrighted and expensive
    2. (1985) Psychopharmacology Bulletin 21:816
    3. Available from MHS
      1. http://www.mhs.com/product.aspx?gr=cli&prod=conners3&id=overview
  3. Connors Abbreviated Symptom Questionnaire (CASQ)
    1. Test Sensitivity: 83%
    2. Test Specificity: 84%
    3. May be preferred Connors Questionnaire (brevity, efficacy) but is also costly
  4. ADHD Rating Scale 5
    1. Dupaul (1998) ADHD Rating Scale, Guilford
    2. https://pcptoolkit.beaconhealthoptions.com/wp-content/uploads/2016/01/cms-quality-child_adhd_rating_scale_screener.pdf
  5. Brown ADD Rating Scales
    1. Purchased from Brown Clinic
  6. Copeland Symptom Checklist for ADD
    1. https://cookchildrens.org/SiteCollectionDocuments/pediatrics/ADHD-Checklist.pdf

V. Diagnostics: Scales for Children - Broad Screening for ADHD and Comorbidity

  1. Child and Adolescent Behavior Inventory
    1. https://clinical-practice-and-epidemiology-in-mental-health.com/VOLUME/15/PAGE/44/FULLTEXT/
    2. Test Sensitivity 83%
    3. Test Specificity: 91%
  2. Child Behavior Checklist
    1. https://www.apa.org/depression-guideline/child-behavior-checklist.pdf
  3. Pediatric Symptoms Checklist
    1. https://www.brightfutures.org/mentalhealth/pdf/professionals/ped_sympton_chklst.pdf
  4. Strengths and Difficulties Questionairre
    1. https://sdqinfo.org/

VI. Diagnostics: Scales for Adults

  1. Free Scales
    1. Adult ADHD Self-Report Scale Symptom Checklist v1.1
      1. https://add.org/wp-content/uploads/2015/03/adhd-questionnaire-ASRS111.pdf
    2. ADHD Lifepan Functioning Scale
    3. Adult ADHD Investigator Symptom Rating Scale
    4. Adult ADHD Rating Scale IV and Adult Prompts
    5. Weiss Symptom Record II and Functional Impairment Rating Scale (Self)
  2. Patient Observer Scales
    1. Current Behavior Scale - Partner Report
      1. https://www.aafp.org/dam/AAFP/documents/patient_care/adhd_toolkit/adhd19-assessment-partner-scale.pdf
    2. Retrospective Childhood Behavior Scale - Parent Report
      1. https://www.aafp.org/dam/AAFP/documents/patient_care/adhd_toolkit/adhd19-assessment-parent-scale.pdf
  3. Other Patient Scales (require purchase)
    1. Brown Attention-Deficit Disorder Rating
    2. Connors Adult ADHD Rating Scales
    3. Current Symptoms Scale by Barkley and Murphy
    4. Wender-Reimherr Adult Attention-Deficit Disorder Scale

VII. Diagnosis: DSM 5 Attention Deficit Disorder

  1. General Criteria
    1. ADHD Symptoms and signs onset before 12 years (as of DSM 5)
    2. Symptoms and signs persists for 6 months or longer
    3. Impairment in more than 1 setting
    4. Severity beyond developmental level
    5. Interferes with social, academic or occupational functioning
    6. Not exclusively due to other mental health condition (e.g. Major Depression, Anxiety Disorder, Substance Abuse, Psychosis)
  2. Inattentive ADHD Criteria (6 of 9 present, 5 or more if age >=17 years)
    1. Fails to give close attention to details
    2. Difficulty sustaining attention
    3. Does not appear to listen
    4. Has difficulty following instructions
    5. Difficulty with organization
    6. Avoids tasks requiring sustained attention
    7. Often loses things
    8. Easily distracted
    9. Forgetful in daily activities
  3. Hyperactive, Impulsive ADHD Criteria (6 of 9 present, 5 or more if age >=17 years)
    1. Fidgets or squirms
    2. Difficulty staying seated
    3. Runs or climbs inappropriately (or feeling restless in adolescents and adults)
    4. Difficulty engaging in activities quietly
    5. Always "on the go", "driven by a motor"
    6. Talks excessively
    7. Blurts out answers
    8. Difficulty in waiting their turn
    9. Interrupts or intrudes upon others
  4. References
    1. (2013) DSM 5, APA

VIII. References

  1. Accardo (1999) Pediatr Clin North Am 46:845-56 [PubMed]
  2. Barbaresi (1996) Mayo Clin Proc 71:463-71 [PubMed]
  3. Chang (2020) Am Fam Physician 102(10):592-602 [PubMed]
  4. Felt (2014) Am Fam Physician 90(7): 456-64 [PubMed]
  5. Smucker (2001) Am Fam Physician 64:817-32 [PubMed]
  6. Post (2012) Am Fam Physician 85(9):890-896 [PubMed]

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