Review article
Diagnosis and evaluation of adults with attention-deficit/hyperactivity disorder

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History of the disorder and current symptom criteria

An encephalitis lethargica pandemic that occurred in the late 1910s and early 1920s provided the first clues to ADHD symptomatology, because those who survived experienced residual symptoms quite similar to those of ADHD. For children and adolescents, postencephalitis symptoms included overactivity, lack of coordination, learning disability, impulsivity, and aggression. As von Economo, a physician of the period, wrote, “formerly normal children… become more talkative, importunate, impertinent,

Diagnosis

Most authors agree that there are several key steps to diagnosing a patient, including discussion of current symptoms, childhood histories, and comorbidities. Particular aspects of the adult experience clinicians should query patients about include current functioning/presenting symptoms, family history, academic/vocational indicators, marital functioning, and physical signs. Rating scales, such as the ADHD Rating Scale (ADHD-RS) or the Conners Adult Attention-Deficit Rating Scale (CAARS), can

Rating scales

Rating scales are useful for assessing whether a patient meets the DSM-IV diagnostic criteria necessary for an adult ADHD diagnosis. Because they provide structure, and, in some cases, extensive prompts that can be used to probe patients further, rating scales are especially helpful for clinicians with less adult ADHD experience. Rating scales also can be useful in assessing current symptoms. In terms of diagnosis and severity, the use of the 18 core DSM-IV symptoms has been established as

Summary

Although some areas of adult ADHD knowledge remain unclear, there is a strong sense of how to proceed with diagnosis using current DSM-IV criteria as a guide. Thorough clinical interview, aided by the use of rating scales for current symptoms and collateral information about childhood from parents or siblings, forms the backbone of the assessment. The poor psychosocial outcomes of patients with ADHD, often a consequence of unrecognized, untreated disorder manifestation, also can serve as a

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