When evaluating patients for attention-deficit hyperactivity disorder (ADHD), or hyperkinetic disorder (HKD), it is typical to use multiple stages of assessment prior to formal diagnosis.1-4 Following assessment, formal diagnosis is based on symptomatology and conducted by secondary care specialists using validated medical classification systems (e.g. the Diagnostic and Statistical Manual of Mental Disorders – 5th Edition [DSM-5TM] or the International Statistical Classification of Diseases and Related Health Problems, 10th Revision [ICD-10] classification systems).5,6
Assessment of ADHD typically involves the comprehensive evaluation of information gathered from a number of sources, including parents/carers, family members, teachers, partners and colleagues, depending on the age of the patient (Figure).1-4 A range of qualified healthcare professionals may be involved in the assessment and diagnosis of ADHD, such as psychiatrists, psychologists or nurses, who have training and expertise in the diagnosis of ADHD in children, adolescents and/or adults.1-4
Assessment of ADHD. Figure developed based on information from international guidelines.1-4
Who are the key specialists you collaborate with in your clinical practice? | Prof Michel Lecendreux | Hôpital Universitaire Robert Debré, Paris, France
Clinical examination aims to identify the presence of other illnesses with symptoms that overlap with those of ADHD.1-4
- This typically involves inspections for vision or hearing impairments, neurodevelopmental immaturity in relation to gross and fine motor functions and motor or vocal tics, and retardation.
- A general examination of patient’s physical health may also be performed to highlight any evidence of a congenital disorder.
- Clinicians may also look for evidence of psychiatric comorbidities, which are often found in patients with ADHD.
Which other health professionals or non-health professionals involved in your patients’ care do you engage with to help with decision-making? | Dr David Coghill | Royal Children’s Hospital, Melbourne, Australia
Behavioural observations may be useful to confirm symptoms reported in interview.1,7
For children and adolescents, parent rating scales and teachers in particular may be especially well placed to identify symptoms of ADHD.7
- Reports from teachers are recognised as one of the optimal sources of information related to problems with behaviour or developmental/social functioning in children and adolescents, with standardised questionnaires considered a useful tool to obtain such information.7
- Classroom observations by an educational psychologist are also useful for diagnosing children and adolescents, if feasible.7
For adults, information from a family member or spouse is useful for lifetime assessment.8
A number of rating scales are available to help assess general behaviour and psychosocial functioning, ADHD symptomatology and comorbidities.1-4 Rating scales can 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.1-4
- NICE guideline 2018. Attention deficit hyperactivity disorder: diagnosis and management. Available at: https://www.nice.org.uk/guidance/ng87. Accessed February 2019.
- Canadian ADHD Resource Alliance (CADDRA). Canadian ADHD Practice Guidelines. Fourth Edition. Toronto, ON; CADDRA, 2018.
- Banaschewski T, Hohmann S, Millenet S. Aufmerksamkeitsdefizit-/Hyperaktivitätsstörung (ADHS) im Kindes-, Jugend- und Erwachsenenalter. DGKJP, DGPPN and DGSPJ German guidelines. 2018.
- Guías de Práctica Clínica en el SNS. Grupo de trabajo de la Guía de Práctica Clínica sobre las Intervenciones Terapéuticas en el Trastorno por Déficit de Atención con Hiperactividad (TDAH). 2017.
- American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. 2013.
- World Health Organization. The ICD-10 Classification of Mental and Behavioural Disorders. Available at: http://www.who.int/entity/classifications/icd/en/bluebook.pdf. Last updated 1993; 1: 1-263. Accessed February 2019.
- 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.
- Kooij JJS, Bijlenga D, Salerno L, et al. Updated European Consensus Statement on diagnosis and treatment of adult ADHD. Eur Psychiatry 2019; 56: 14-34.