Diagnostic Scales

The Conners Adult ADHD Diagnostic Interview for DSM-IV separately surveys the presence of the 18 DSM-IV symptoms in both children and adults. Specific prompts and examples of symptoms are provided for each query. Impairment in school or work, home, and social settings is also assessed for children and adults. A definitive diagnosis of ADHD and subtype of condition can then be established by the information that has been gathered. The scale begins by asking patients, "What is going on in your life that leads you to believe you have Attention-Deficit/Hyperactivity Disorder or ADHD?" From there, it goes into childhood history, including gestational, delivery, temperamental, developmental, environmental, and medical history risk factors. Childhood academic history; adult educational, occupational, and social/interpersonal histories; and health and psychiatric histories are queried. Finally, the patient is briefly screened for comorbidity before specific questioning about ADHD diagnostic criteria begins. The Conners Diagnostic Interview is available through Multi Health Systems, Inc.

Assessment can also begin with Barkley's Current Symptoms Scale--Self-Report Form, a scale of 18 items that address the symptoms listed in the DSM-IV diagnostic criteria. Odd-numbered items assess frequency of inattentive symptoms and even-numbered items assess hyperactive/impulsive symptoms on a 0-to-3 Likert-type frequency scale (0 = never or rarely, 1 = sometimes, 2 = often, 3 = very often). Sample items are "Leave my seat in situations in which seating is expected" and "Avoid, dislike, or am reluctant to engage in work that requires sustained mental effort." The scale also asks patients to report the age of onset for ADHD symptoms and to denote how often their symptoms interfere with activities in social arenas like school, relationships, work, and the home. Finally, it addresses Oppositional Defiant Disorder (ODD) comorbidity with 8 questions about symptoms of ODD. Barkley also has a Childhood Symptoms Scale--Self-Report Form; Developmental Employment, Health, and Social History Form; and Work Performance Rating Scale--Self-Report Forms, all of which can be sent to the patient to complete before their first clinic visit. In addition, the Current Symptoms Scale--Other Report Form provides valuable observer ratings and should be completed by someone who currently knows the person well. A parent is the ideal person to complete the Childhood Symptoms Scale--Other Report Form and the Childhood School Performance Scale--Other Report Form. Together these scales form a picture of the patient's past and present symptoms and functioning. The Barkley Scales are contained in Attention-Deficit Hyperactivity Disorder: A Clinical Workbook, Second Edition by Russell A. Barkley and Kevin R. Murphy.^[11]

In addition to the Brown ADD Scale, there is also a Brown ADD Scale Diagnostic Form, which goes into much greater detail and can be used for diagnosing ADHD. The diagnostic interview begins with queries about clinical history, including impact of symptoms on work, school, leisure, peer interactions, and self-image. Patients are also asked whether early schooling was impacted by their symptoms. The clinician asks the patient about the clinical history of his or her family and about the patient's physical health, substance use, and sleep habits. The clinician also obtains collateral data from an observer or significant other and screens for the full array of comorbid disorders. A Wechsler Adult Intelligence Scale is administered to gauge whether the patient's concentration level is below their verbal and spatial capabilities. All of these considerations, as well as the patients' score on the 40-item Brown ADD Scale, lead to the diagnosis. The Diagnostic Form is available from The Psychological Corporation.

Another option for assessing childhood ADHD symptoms is to use the Kiddie-SADS Diagnostic Interview section on Attention Deficit Hyperactivity Disorder. The Kiddie-SADS covers the DSM-IV criteria for ADHD and includes extensive prompts that clinicians can use. For example, the item, "Makes a lot of careless mistakes," prompts for the clinician include, "Do you make a lot of careless mistakes at school? Do you often get problems wrong on tests because you didn't read the instructions right? Do you often leave some questions blank by accident? Forget to do the problems on both sides of a handout? How often do these types of things happen? Has your teacher ever said you should pay more attention to detail?" The item, "On-the-go/Acts like driven by motor," prompts for the clinician include, "Is it hard for you to slow down? Can you stay in one place for long, or are you always on the go? How long can you sit and watch TV or play a game? Do people tell you to slow down a lot?" The Kiddie-SADS is available on the World Wide Web at www.wpic.pitt.edu/ksads.