Phillip Ruppert, PhD Assistant Professor Department of Psychiatry and Behavioral Neuroscience
Noam Grysman, MD Department of Psychiatry and Behavioral Neuroscience
George Grossberg, MD Samuel W. Fordyce Professor Director, Geriatric Psychiatry
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Saint Louis University School of Medicine St. Louis, Missouri
Disclosures The authors report no financial relationships with any companies whose products are mentioned in this article, or with manufacturers of competing products.
The key aspects of diagnosing ADHD are the interview based on DSM-5 criteria, exclusion of other diagnoses, and collateral information. Research has shown that clinical interviews and longitudinal family histories provide critical information that can differentiate ADHD from other psychiatric conditions.35 DSM-5 criteria are adjusted for adults: 5 out of 9 criteria for inattention and/or hyperactivity-impulsivity must be fulfilled, as opposed to 6 out of 9 in children age <17.21,31,36 However, no criteria are specific for older adults.37 Since the differential diagnosis involves multiple entities, it is important to follow DSM-5 criteria for ADHD, which include eliminating other conditions that can explain these symptoms.15 Additionally, in DSM-5, the age-of-onset threshold for ADHD diagnosis was increased from 7 and younger to 12 and younger, addressing criticism that the previous cutoff was too restrictive.24,31 The age of onset of childhood symptoms can be challenging to verify in older adults. Older patients can have unreliable memories and their childhood records are not always available.2,20 In this population, childhood symptoms are mainly underreported but sometimes overreported.10,38 However, to establish a diagnosis, the patient should have experienced some symptoms of the disorder within their first 50 years of life, including having impaired functionality in multiple settings.15,26 The goal is to establish the chronicity of this condition to distinguish it from other psychiatric conditions.22 Overall, using DSM-5 criteria without any modifications may lead to underdiagnosis of ADHD in adults.23 At this time, however, DSM-5 remains the main criteria used to make a diagnosis.
While tools to assist in screening and diagnosing ADHD have been validated in adults, none have been validated specifically for older adults.22 Structured diagnostic interviews to diagnose ADHD include39:
Adult ADHD Clinical Diagnostic Scale version 1.2
ADHD Lifespan Functioning interview
Conners’ Adult ADHD Diagnostic interview for DSM-IV
Diagnostic Interview for ADHD in Adults version 2.0
Structured Clinical Interview for DSM-5.
ADHD symptom measures that can be used for screening and to look at treatment response include39:
ADHD Rating Scale 5
Adult ADHD Self-Report Scale Symptom Checklist
Barkley Adult ADHD Rating Scale IV
Barkley Quick-Check for Adult ADHD Diagnosis
Young ADHD Questionnaire
RATE Scales.
Adult ADHD inventories consider problems that adults with ADHD face. These include39:
Brown Attention Deficit Disorders Scales—Adult version
