Clinical guidelines for a diagnosis of ADHD are provided by the American Psychiatric Association in the diagnostic manual Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). In making the diagnosis, adults should have at least five of the symptoms present. These symptoms can change over time, so adults may fit different presentations from when they were children.
The DSM-5 lists three presentations of ADHD—Predominantly Inattentive, Hyperactive-Impulsive and Combined. The symptoms for each are adapted and summarized below.
ADHD predominantly inattentive presentation
ADHD predominantly hyperactive-impulsive presentation
ADHD combined presentation
Several of the symptoms must have been present prior to age 12. This generally requires corroboration by a parent or some other informant. It is important to note that the presence of significant impairment in at least two major settings of the person’s life is central to the diagnosis of ADHD. Examples of impairment include losing a job because of ADHD symptoms, experiencing excessive conflict and distress in a marriage, getting into financial trouble because of impulsive spending, failure to pay bills in a timely manner or being put on academic probation in college due to failing grades. If the individual exhibits a number of ADHD symptoms, but they do not cause significant impairment, s/he may not meet the criteria to be diagnosed with ADHD as a clinical disorder.
Most adults who seek an evaluation for ADHD experience significant problems in one or more areas of living. The following are some of the most common problems:
Although some ADHD symptoms are evident since early childhood, some individuals may not experience significant problems until later in life. Some very bright and talented individuals, for example, are able to compensate for their ADHD symptoms and do not experience significant problems until high school, college or in pursuit of their career. In other cases, parents may have provided a highly protective, structured and supportive environment, minimizing the impact of ADHD symptoms until the individual has begun to live independently as a young adult.
Although procedures and testing materials may vary, certain protocols are considered essential for a comprehensive evaluation. These include a thorough diagnostic interview, information from independent sources such as the spouse or other family members, DSM-5 symptom checklists, standardized behavior rating scales for ADHD and other types of psychometric testing as deemed necessary by the clinician. These are discussed in more detail below.
The diagnostic interview part I:
Standardized set of questions asking about current ADHD symptoms and symptoms during childhood. Includes questions assessing the degree to which symptoms interfere with the client’s life.
The diagnostic interview part II:
Screening for other psychiatric disorders
Standardized set of questions asking about other psychiatric disorders to determine if client has a co-occurring condition or if ADHD symptoms are due to another disorder.
Gathering additional information from others
At a minimum having parents, spouses or other relatives complete a checklist about the client’s symptoms of ADHD.
Behavior rating scales
Standardized questionnaires that compare the behaviors of people with ADHD to those of people without ADHD.
Depending on the client’s responses during the diagnostic interview, additional tests might be needed to provide information about ways in which ADHD affects the individual. It can also help determine the presence and effects of co-occurring conditions.
Recommended to rule out medical causes for symptoms.
To complete the evaluation write a summary or report with the diagnostic opinion concerning ADHD as well as any other psychiatric disorders or learning disabilities that may have been identified during the course of the assessment. From here review treatment options and assist the individual in planning a course of appropriate medical and psychosocial intervention.
For more information
Barkley, RA. (2014). Attention-deficit hyperactivity disorder, fourth edition: A handbook for diagnosis and treatment. New York, NY: Guilford Press.
Wolraich, M. & DuPaul, G. (2010). ADHD diagnosis and management: A practical guide for the clinic and the classroom. Baltimore, MD: Brooks Publishing.