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Screening Adults for Attention-Deficit/Hyperactivity Disorder (ADHD)

  • Authors: Authors: Lenard A. Adler, MD; Julie Cohen, BA
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Target Audience and Goal Statement

This activity is intended for physicians, nurses, psychologists, and healthcare professionals.

The goal of this activity is to provide clinicians with the latest information on the screening and assessment tools for adult ADHD.

Upon completion of this activity, participants will be able to:

  1. Review our current screening tools for ADHD.
  2. Evaluate ADHD in adults.
  3. Discuss comorbidity in the diagnosis of ADHD.


  • Lenard A. Adler, MD

    Associate Professor of Clinical Psychiatry & Neurology, NYU School of Medicine; Director, Department of Neurology ADHD Program, NYU School of Medicine, New York, NY


    Disclosure: Dr. Adler has disclosed that he has minor stock holdings in Lilly, Pfizer, Johnson & Johnson/McNeil, and Merck. He has received grants for clinical research from Lilly, Abbott Labs, Pfizer, Novartis, Johnson & Johnson/McNeil, and Merck. He has received grants for educational activities from Lilly, Pfizer, Novartis, Johnson & Johnson/McNeil, and Forest Labs. He has also served as an advisor or consultant for Lilly, Abbot Labs, Pfizer, Novartis, Johnson & Johnson/McNeil, and Merck. Dr. Adler reported that he does not discuss any investigational or unlabeled uses of commercial products in this activity.

  • Julie Cohen, BA

    Department of Neurology, New York University School of Medicine, New York, NY


    Disclosure: Ms. Cohen has no significant financial interest to disclose.

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Screening Adults for Attention-Deficit/Hyperactivity Disorder (ADHD)


DSM-IV Criteria for the Diagnosis

Familiarity with the diagnostic criteria for ADHD is extremely important. Most of the major rating scales used for screening patients are modeled on the criteria laid out in the DSM-IV.[3] There are 3 critical aspects of the diagnosis: (1) at least 6 of 9 symptoms for one of the ADHD subtypes, (2) childhood onset of symptoms, and (3) impairment in at least 2 areas like work/school, home, and social settings.

According to the DSM-IV, ADHD can be divided into 3 subtypes: predominantly inattentive; predominantly hyperactive-impulsive; and the combined type, for which a patient must fully meet the criteria for both of the other 2 subtypes. Inattentive symptoms include failure to pay close attention to detail, difficulty sustaining attention, not listening when spoken to, failure to follow through on instructions or finish tasks, difficulty organizing, reluctance to engage in activities that require sustained mental effort, often losing things, being easily distracted, and often being forgetful. A patient must have at least 6 of these 9 symptoms to be considered to have the inattentive subtype.

The symptoms of the hyperactive-impulsive subtype include frequent fidgeting; frequently leaving one's seat in situations where staying seated is expected; running about, climbing excessively, or a feeling of internal restlessness; difficulty engaging quietly in leisure activities ; often "on-the-go" or acting like one is "driven by a motor"; talking excessively; blurting out answers; having difficulty waiting one's turn; and interrupting or intruding on others. Again, at least 6 of these symptoms must be present for diagnosis of the hyperactive-impulse subtype. Patients who meet all criteria for both the inattentive and hyperactive-impulsive subtypes are diagnosed with the combined subtype.

The symptoms that patients describe cannot be episodic -- they must persist for 6 months or longer and must affect at least 2 areas of functioning (ie, school, work, home, social life). Age of onset is also an important adult ADHD diagnostic criterion. Symptoms must date back to age 7 or younger. If the childhood history is not present, the patient does not meet criteria for a diagnosis. Ways of documenting childhood history include the ADHD module from the Kiddie-SADS and the Connors, Barkley, and Brown diagnostic symptoms scales (see Diagnostic Scales), which are described in detail below.

One must also consider whether the symptoms are ADHD or evidence of another disorder. Comorbidity can occur in as many as 80% of ADHD patients,[4] but one must also consider whether the observed symptoms are comorbid conditions or if they are the result of a mood disorder or anxiety disorder and not due to ADHD.