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Diagnosing ADHD

Diagnosing ADHD

The diagnosis of ADHD in children and adults can be challenging because the core symptoms of ADHD are present in everyone to some degree. Additionally, many adults diagnosed with ADHD also have comorbid psychiatric disorders that can complicate the diagnostic picture. Nothing can replace the clinical evaluation interview performed by a trained mental health clinician. The clinical interview is a comprehensive process in which the clinician needs to confirm the following:

1. Existence of core symptoms of inattention, hyperactivity, impulsivity and emotional dysregulation.

2. Evidence that the symptoms cause significant impairment in at least 2 of the following areas: school, work, social life and in daily adaptive functioning.  (For example repeated academic problems despite high intelligence, repeated inability to hold the same job for an extended period of time, unstable relationships, and repeated difficulty with upkeep of daily house chores or tasks)

3. Existence of symptoms in multiple situations since childhood.

ADHD Rating scales

ADHD rating scales can aid in the diagnosis of Adult ADHD and help with measuring response to treatment.. ADHD rating scales for adults include the Conners’ Adult ADHD Rating Scales (CAARS), the Wender Utah Rating Scale (WURS), and the Adult ADHD Self-Report Scale-v1.1 (ASRS-v1.1).

If designed well and administered properly, ADHD rating scales can accurately reflect the frequency and severity of ADHD symptoms. However, research has shown that no rating scale alone will provide sufficient evidence to reliably make the diagnosis of ADHD.

One should be aware that adult psychopathology can distort perceptions on rating scales and therefore if diagnosis is questionable it is important to get collateral information from the patient’s family.

Continuous Performance Tests

The Continuous Performance Test (CPT) is a computerized test of sustained attention that can also help with establishing the diagnosis of ADHD and measuring the response to treatment. There are several free-standing computerized tests that are commercially available at this time including the BRC, TOVA (Test of variables of Attention) and the MOXO.

The BRC and TOVA are equally sensitive (85%) in demonstrating attention dysfunction in children and adults who have been diagnosed with ADHD. The TOVA, however, generates high false positive rates (30%) in normal controls and children with other psychiatric disorders (28%).

The MOXO test created by an Israeli startup company, measures attention, hyperactivity, impulsivity and timing. It is unique in that it uses visual and auditory distracters during the test –providing information about each examinee's personal and unique performance abilities. The company that developed the test claims it to have 90% certainty with identifying the existence of ADHD.

Due to its complexity, the diagnosis of ADHD is best made with using all of the above mentioned methods. The most important tool for diagnosing the disorder is the clinical interview done by a specialist in the mental health field.

The rating scales and computerized CPTS act as adjunct diagnostic tools for determining the existence of ADHD and should not be relied upon alone for diagnosis of ADHD.

 


References:

ADHD: Is Objective Diagnosis Possible? C. Thomas Gualtieri, MD and Lynda G. Johnson, PhDPsychiatry (Edgmont). 2005 November; 2(11): 44–53. PMCID: PMC2993524

Assessing Attention-Deficit/Hyperactivity Disorder in Adults – Focus on Rating Scales. Kevin R. Murphy, Ph.D., and Lenard A. Adler, M.D. (J Clin Psychiatry 2004;65[suppl 3]:12–17)

Assessing Adolescents Using ADHD Rating Scales. Lenard A. Adler, MD (Chair) Departments of Psychiatry and Child and Adolescent Psychiatry, New York University School of Medicine, and Psychiatry Service, New York VA Harbor Healthcare System, New YorkJeffrey H. Newcorn, MDDivision of Child and Adolescent Psychiatry, Department of Psychiatry, Mount Sinai School of Medicine, New York, New York  Journal of Clinical Psychiatry CME 2009

MOXO Test: International validation study
Partners: Multi center study Hadassah University Medical Center, Radboud University Medical Center, Nijmegen, Netherlands.
Researchers: Dr. I. Berger, Prof. J. Buitelaar, Dr. N. Rommelse, Dr. H.Kasuto, J.Van der Meer
Status: Preliminary results

הכותב: איתמר פסקל, פסיכולוג קליני

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