Screening and Diagnostic Tools

Screening and Diagnostic Tools for Use With Adults

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The following scales have been developed to help screen, diagnose, evaluate, and track symptoms of adults who have ADHD.

Note that the answers patients and loved ones provide to the questions on these scales are subjective, because they are based on personal observation that is influenced by a person's frame of reference and experience. When there are discrepancies about the possibility or severity of ADHD symptoms, it may be beneficial to ask someone with a different perspective (eg, a boss or coworker) to complete a rating scale for the patient, to gain another frame of reference. The results of all rating scales must be interpreted in the context of the overall evaluation of the patient.1-2

Common Behavior Rating Scales Used in Adults to Assess ADHD and Monitor ADHD Management1,3,4

Adult ADHD Self-Report Scale (ASRS Screening Version) v1.1

  • An 18-item scale that can be used as an initial symptom assessment to identify adults who may have ADHD3
  • A 6-question subset of the 18-item checklist scale that is used to screen for ADHD symptoms3
  • Can be used as an initial self-assessment tool to identify adults who may have ADHD but is not diagnostic in and of itself3
  • The 6 items (4 inattentive, 2 hyperactive-impulsive) were selected based on stepwise logistic regression analysis of diagnostic interviews of patients with/without ADHD in the National Comorbidity Survey Replication sample4
  • Scoring is based on how often a symptom occurs3,4

Adult ASRS Symptom Checklist v1.1

  • The scale has a question for each of the 18 domains identified by DSM criteria, with modifications to account for the adult presentation of ADHD symptoms3

Adult ADHD Clinical Diagnostic Scale (ACDS) v1.2

  • A primary diagnostic measure developed to establish the presence of current adult symptoms of ADHD5
  • The 18-item, clinician-based, semi-structured interview employs adult-specific language to ensure adequate probing of adult manifestations of ADHD symptoms5
  • The 18 items in the scale correspond to the 18 diagnostic criteria in the DSM criteria5

Brown Attention-Deficit Disorder Symptom Assessment Scale (BADDS) for Adults

  • A broad-based 40-item rating scale providing a rating of the frequency of symptoms in many domains3
  • It queries about clinical history, including impact of symptoms on work, school, leisure, difficulties with mood, and sensitivity to criticism3
  • Items represent 5 symptom "clusters": organizing work, sustaining attention and concentration, sustaining alertness and effort, managing frustration and other emotions, and using working memory.
  • The scale can be used as a self-report or as a clinician-administered scale3
  • Scoring is based on a 4-point frequency scale ranging from 0 = never to 3 = almost daily3,6

ADHD Rating Scale IV (ADHD-RS-IV) With Adult Prompts

  • An 18-item scale corresponding to the 18 items in the DSM criteria, providing physicians with a method to rate adults by the frequency and severity of symptoms3,6
  • Contains 9 items assessing inattentive symptoms and 9 items assessing hyperactive-impulsive symptoms7
  • Scoring is based on a 4-point Likert-type severity scale ranging from 0 = never to 3 = very often7
  • Extensive prompts can be used to elicit a numbered response for the item6
  • The clinician should score the highest score generated from the prompts for each item6

References

  1. Pliszka S; AACAP Work Group on Quality Issues. Practice parameter for the assessment and treatment of children and adolescents with attention-deficit/hyperactivity disorder. J Am Acad Child Adolesc Psychiatry. 2007;46(7):894-921.
  2. Subcommittee on Attention-Deficit/Hyperactivity Disorder, Steering Committee on Quality Improvement and Management. ADHD: clinical practice guideline for the diagnosis, evaluation, and treatment of attention-deficit/hyperactivity disorder in children and adolescents. Pediatrics. 2011:128(5):1007-1022, SI1-SI21.
  3. Adler L, Cohen J. Diagnosis and evaluation of adults with attention-deficit/hyperactivity disorder. Psychiatr Clin North Am. 2004;27(2):187-201.
  4. Kessler RC, Adler L, Ames M, et al. The World Health Organization Adult ADHD Self-Report Scale (ASRS): a short screening scale for use in the general population. Psychol Med. 2005;35(2):245-256.
  5. Kessler RC, Adler LA, Gruber MJ, Sarawate CA, Spencer T, Van Brunt DL. Validity of the World Health Organization Adult ADHD Self-Report Scale (ASRS) Screener in a representative sample of health plan members. Int J Methods Psychiatry Res. 2007;16(2):52-65.
  6. Murphy K, Adler LA. Assessing attention-deficit/hyperactivity disorder in adults: focus on rating scales. J Clin Psychiatry. 2004;65(suppl 3):12-17.
  7. DuPaul GJ, Power TJ, Anastopoulos AD, Reid R. ADHD Rating Scale-IV: Checklists, Norms, and Clinical Interpretation. New York, NY: The Guilford Press. 1998.