Review articleDiagnosis and evaluation of adults with attention-deficit/hyperactivity disorder
Section snippets
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
References (30)
- et al.
Attention-deficit/hyperactivity disorder in adults: an overview
Society of Biological Psychiatry
(2000) - et al.
Atomoxetine in adults with ADHD: two randomized, placebo-controlled studies
Biol Psychiatry
(2003) - et al.
Implications of early versus late onset of attention-deficit/hyperactivity disorder symptoms
J Am Acad Child Adolesc Psychiatry
(2000) - et al.
Attention-deficit/hyperactivity disorder adults: comorbidities and adaptive impairments
Compr Psychiatry
(1996) - et al.
Adult attention-deficit/hyperactivity disorder: assessment guidelines based on clinical presentation to a specialty clinic
Compr Psychiatry
(1997) - et al.
A clinical and demographic profile of a sample of adults with attention-deficit/hyperactivity disorder, residual state
Compr Psychiatry
(1990) Cultural issues in diagnosis and treatment of ADHD
J Am Acad Child Adolesc Psychiatry
(1999)- et al.
Assessment and management of attention-deficit/hyperactivity disorder in adults
Can Med Assoc J
(2003) Diagnostic and statistical manual of mental disorders
(2000)Attention-deficit/hyperactivity disorder in adults
(1995)