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Attention-deficit hyperactivity disorder (ADHD),1 or hyperkinetic disorder (HKD),2 is a chronic neurodevelopmental disorder that can have a profound impact at school,3,4 and in the workplace,5-8 as well as an impact on relationships.5,6,9 As a consequence, the quality of life of individuals with ADHD, and that of the people around them, can be impaired.3,10-13

ADHD is generally considered to have three component features – inattention, hyperactivity and impulsivity1 – and the contribution of each to an individual’s presentation of ADHD varies from patient to patient and across the lifespan.1,14 These factors, combined with the frequent presence of psychiatric comorbidities, including conduct disorder, oppositional defiant disorder and anxiety/mood disorders,15-17 make the assessment and diagnosis of ADHD challenging.

Assessment

The assessment process involves the comprehensive evaluation of information gathered from a number of sources, including: clinical examination; clinical interviews; assessment of familial and educational needs; and assessment tools and rating scales.1,2,18-21 This process also requires input from the patient and other affected individuals, such as parents, carers, family members and teachers for children and adolescents with suspected ADHD; and spouses, siblings, friends, co-workers and employers for adults with suspected ADHD.1,2,18-21

Diagnosis

Formal diagnosis is made when the nature, frequency and duration of the patient’s symptoms fulfil the criteria set out in one of two medical classification systems:1,2,18-21 the Diagnostic and Statistical Manual of Mental Disorders – 5th edition (DSM-5TM) for ADHD; and the International Classification of Mental and Behavioural Disorders 10th revision (ICD-10) for HKD.1,2

Rating scales

A variety of rating scales are available to help assess the impact of ADHD on multiple aspects of patient well-being, including symptoms, overall functioning and quality of life.18-21 Rating scales may either be completed by parents, teachers or the patient themselves, depending on which scale is chosen, and are considered to be an essential part of the full assessment process for ADHD.18-21

 

  1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. 2013.
  2. World Health Organization. The ICD-10 Classification of Mental and Behavioural Disorders. Available at: www.who.int/entity/classifications/icd/en/bluebook.pdf. Last updated 1993; 1: 1-263. Accessed 04 January 2017.
  3. Caci H, Doepfner M, Asherson P, et al. Daily life impairments associated with self-reported childhood/adolescent attention-deficit/hyperactivity disorder and experiences of diagnosis and treatment: results from the European Lifetime Impairment Survey. Eur Psychiatry 2014; 29: 316-323.
  4. Holmberg K, Bölte S. Do symptoms of ADHD at ages 7 and 10 predict academic outcome at age 16 in the general population? J Atten Disord 2014; 18: 635-645.
  5. Biederman J, Faraone SV, Spencer TJ, et al. Functional impairments in adults with self-reports of diagnosed ADHD: a controlled study of 1001 adults in the community. J Clin Psychiatry 2006; 67: 524-540.
  6. Brod M, Pohlman B, Lasser R, et al. Comparison of the burden of illness for adults with ADHD across seven countries: a qualitative study. Health Qual Life Outcomes 2012; 10: 47.
  7. de Graaf R, Kessler RC, Fayyad J, et al. The prevalence and effects of adult attention-deficit/hyperactivity disorder (ADHD) on the performance of workers: results from the WHO World Mental Health Survey Initiative. Occup Environ Med 2008; 65: 835-842.
  8. Adamou M, Arif M, Asherson P, et al. Occupational issues of adults with ADHD. BMC Psychiatry 2013; 13: 59.
  9. Pitts M, Mangle L, Asherson P. Impairments, diagnosis and treatments associated with attention-deficit/hyperactivity disorder (ADHD) in UK adults: results from the lifetime impairment survey. Arch Psychiatr Nurs 2015; 29: 56-63.
  10. Cussen A, Sciberras E, Ukoumunne OC, et al. Relationship between symptoms of attention-deficit/hyperactivity disorder and family functioning: a community-based study. Eur J Pediatr 2012; 171: 271-280.
  11. Grenwald-Mayes G. Relationship between current quality of life and family of origin dynamics for college students with attention-deficit/hyperactivity disorder. J Atten Disord 2002; 5: 211-222.
  12. Gudjonsson GH, Sigurdsson JF, Eyjolfsdottir GA, et al. The relationship between satisfaction with life, ADHD symptoms, and associated problems among university students. J Atten Disord 2009; 12: 507-515.
  13. O’Callaghan P, Sharma D. Severity of symptoms and quality of life in medical students with ADHD. J Atten Disord 2014; 18: 654-658.
  14. Willcutt EG. The prevalence of DSM-IV attention-deficit/hyperactivity disorder: a meta-analytic review. Neurotherapeutics 2012; 9: 490-499.
  15. Steinhausen HC, Novik TS. ADORE Study Group. Co-existing psychiatric problems in ADHD in the ADORE cohort. Eur Child Adolesc Psychiatry 2006; 15: I/25-I/29.
  16. Kessler RC, Adler L, Barkley R, et al. The prevalence and correlates of adult ADHD in the United States: results from the National Comorbidity Survey Replication. Am J Psychiatry 2006; 163: 716-723.
  17. Piñeiro-Dieguez B, Balanzá-Martinez V, García-García P, et al. Psychiatric comorbidity at the time of diagnosis in adults with ADHD: the CAT study. J Atten Disord 2016; 20: 1066-1075.
  18. National Institute for Health and Care Excellence. Attention deficit hyperactivity disorder: diagnosis and management. Available at: https://www.nice.org.uk/guidance/cg72/resources/attention-deficit-hyperactivity-disorder-diagnosis-and-management-975625063621. Last updated 2016. Accessed 05 January 2017.
  19. Taylor E, Döpfner M, Sergeant J, et al. European clinical guidelines for hyperkinetic disorder — first upgrade. Eur Child Adolesc Psychiatry 2004; 13(Suppl 1): I/7-I/30.
  20. Canadian ADHD Resource Alliance (CADDRA). Canadian ADHD Practice Guidelines. Toronto: CADDRA, 2011.
  21. Kooij SJ, Bejerot S, Blackwell A, et al. European consensus statement on diagnosis and treatment of adult ADHD: The European Network Adult ADHD. BMC Psychiatry 2010; 10: 67.

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