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Difficulties with Assessment of ADHD in Adults
The June 1997 issue of Comprehensive Psychiatry included an article titled "Adult attention deficit hyperactivity disorder: Assessment guidelines based on clinical presentation to a specialty clinic" that highlights the difficulties and problems associated with "self-diagnosis" of adult ADHD.
The authors report on 143 adults between the ages of 18 and 64 who requested that they be evaluated for ADHD at a specialty clinic. Of these 143 individuals, all of whom believed that they had ADHD, 46 met diagnostic criteria for ADHD, 46 clearly did not meet criteria, and 51 had ADHD like features but did not meet criteria either because there was no history of childhood onset and/or because of complicating psychiatric disorders or substance abuse. Members of the 3 groups were similar in demographics, psychiatric symptom severity, and functional impairment.
Compared to patients not meeting diagnostic criteria for ADHD, those adults with ADHD had more frequent histories of learning disabilities in childhood, poorer reading scores on a standardized test of reading achievement, poorer scores on a laboratory test of sustained attention, and higher scores on a ADHD rating scale that has been developed specifically for adults. The rating scale used for adults was developed by Dr. Paul Wender from the University of Utah and looks specifically at 5 types of types of symptoms: emotional lability, emotional over activity, disorganization, impulsivity, and inability to complete tasks.
It is important to stress that ADHD is a disorder that requires a childhood onset. An key consideration in making this diagnosis in adults is thus to determine that an adult did actually have ADHD in childhood. This can be difficult to do, and a comprehensive evaluation can require direct input from an adult's parents as well as an examination of old school records. There are many other reasons why an adult can experience difficulties with concentration and can feel fidgety and impulsive, but unless these difficulties were also evident in childhood, the explanation for current problems can not be ADHD.
The results of this study suggest that many adults who experience symptoms that make them feel they have ADHD are unlikely to have this disorder. In my opinion evaluating adults for ADHD is actually more difficult than evaluating children, because obtaining the information about childhood history is often quite difficult. Finding a practitioner who has specific expertise in adult ADHD is strongly recommended for individuals who wish to learn whether difficulties they experience are the result of ADHD. Self-diagnosis using "ADHD tests" floating around on the Internet is not a good substitute for a thorough evaluation.
Note: This article originally appeared in Attention Research Update, an online newsletter written by Dr. David Rabiner, a Duke University psychologist and former member of CHADD's Professional Advisory Board. You can learn more about Attention Research Update and sign up for a free subscription at www.helpforadd.com.