Which subjective measures should I use alongside objective ADHD tests?
A robust ADHD assessment process is one that combines objective and subjective measures to get a balanced and holistic understanding of your patient’s symptoms – there is no single medical test that can decide if your patient has ADHD.
While objective ADHD tests offer unbiased, evidence-based insights into core symptoms, subjective information is required to fully understand and interpret the results, including the impact of comorbidities and environmental factors.
What does the ideal ADHD assessment process look like?
- Information collation
Time can be saved by gathering as much information as possible. Have your patient complete a QbTest or QbCheck as well as an ADHD rating scale answered in the context of at least two different settings, for example, home and an education setting or work. Get additional details about their developmental and family history and any existing diagnoses considering physical health, mental health, neurodevelopmental and other learning needs. - Interview
Conduct a diagnostic interview with your patient and where appropriate their family or someone who plays a key role in their life (like their friend or partner) to explore any areas of concern that have been highlighted in the information that has been collected. - Multi-disciplinary team discussion
A diagnosis can’t be made by one person alone – it’s important to discuss the presenting concerns with someone from another team. - Follow-up appointment
Share the diagnostic outcome with the patient and discuss treatment options. - Titration of treatment
You can monitor treatment effects by contacting y our patient to find the correct plan for them. Different treatments have different effects in duration and schedules may be planned every two weeks. - Objective test at 6-8 weeks
Retest with QbTest or QbCheck to gather standardized insights into your patients’ ADHD symptoms. From here, you can discuss with your patient around whether it is felt treatment is optimised, or whether to titrate or taper based on their response to treatment. Objective measures can also be used when a medication care plan is being changed or cross-titrated.
What are the different ADHD rating scales?
ADHD-RS IV
The ADHD-RS IV is to be used on children and adolescents and is validated for ages 5-17. The child and adolescent version includes 18 items measuring ADHD according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and assesses six domains of impairment including:
- Relationships with significant others
- Peer relationships
- Academic functioning
- Behavioral functioning
- Homework performance
- Self-esteem
The main benefit of the widely used ADHD-RS IV is that it has been expanded to include self-report measures for both children and adolescents (alongside the parent and teacher questionnaires), enhancing the ability to gather the child’s voice within the assessment process.
Vanderbilt Assessment Scale
Created for children and adolescents, this 55-item scale is split into two parts – analyzing ADHD across different settings as well as additional domains like oppositional-defiant behavior, conduct disorder, anxiety, and depression. The Vanderbilt is validated for ages 6-12 and includes parent and teacher informant questionnaires.
The Vanderbilt also includes an assessment follow up questionnaire based on treatment side effects to aid with medication management.
Conners 4 Rating Scale
The Conners Rating Scale is now fully digitized within the 4th edition of the rating scale. This outcome measure is validated for ages 6-18 and includes parent and teacher reports. The self-report form is validated between the ages of 8 and 18. The 4th edition of Conner’s has a critical and indicators overview highlighting risk concerns linked to severe symptoms of conduct disorder, self-harm, and also indicates sleep difficulties.
Co-occurring needs including emotional dysregulation, anxiety, low mood, and oppositional defiant disorder symptoms are scored for and impact on function across settings (schoolwork, family life, and peer relationships).
The validity measure looking at positive and negative response style from the informant is maintained from previous editions of the outcome measure.
Adult ADHD Self-Report Scale (ASRS)
The ASRS is routinely used for symptom screening in those over 18. It is an 18-item self-report questionnaire, and should be used alongside a clinical interview.
The questions are consistent with DSM-V criteria, but reworded to better reflect symptom manifestation in adults, and this scale can therefore be helpful in determining the ADHD subtype defined in the DSM-V.
WEISS Functional Impairment Rating Scale
The Weiss functional impairment scale can be effectively used alongside the ASRS and clinical interview in adult ADHD.
This scale is useful because ADHD symptoms and the actual impairment a patient experiences can overlap but are still distinct from each other. Both should be measured as someone who is highly symptomatic might not be impaired – and vice versa. When measuring treatment, this scale can help you find out if your patient’s functional difficulties have also improved.
Other rating scales
- Behavior Assessment System for Children (BASC-3)
- Child Behavior Checklist (CBCL)
- Swanson, Nolan, and Pelham-IV Questionnaire (SNAP-IV)
- Brown Attention-Deficit Disorder Symptom Assessment Scale for Adults (BADDS)
- Adult ADHD Clinical Diagnostic Scale (ACDS)
- Strength and Difficulties Questionnaire SDQ
Are there different types of ADHD clinical interviews?
Clinical interviews provide an opportunity for your patients to articulate their personal experiences. A combination of structured and semi-structured clinical interviews is best for gathering information about ADHD symptoms including duration and severity, issues they cause, and if there are any potential comorbid conditions that might explain other or co-occurring symptoms.
Structured clinical interviews
Diagnostic Interview for ADHD in Adults (DIVA)
Structured clinical interviews like the DIVA gives you a comprehensive framework for gathering detailed clinical and symptom history through guided questioning. It is split into three parts:
- The criteria for attention deficit
- The criteria for hyperactivity impulsivity
- The age of onset and impairment accounted for by ADHD symptoms
- The Young DIVA-5 is a structured clinical interview assessing ADHD symptoms in 5–17-year-olds and the DIVA-5 assesses symptoms in adults aged over 18.
ACEV.2 and ACE+V.2
Both are semi-structured clinical interviews for the assessment and diagnosis of ADHD in children aged 5-16 years by discussing symptoms of ADHD and possible co-morbid conditions.