Diagnosing Attention-Deficit/Hyperactivity Disorder (ADHD) in young adults: A qualitative review of the utility of assessment measures and recommendations for improving the diagnostic process


Paul Marshall, Dep. of Psychiatry, Hennepin Healthcare Systems, Minneapolis, USA
James Hoelzle, Dep. of Psychology, Marquette University, Milwaukee, USA
Molly Nikolas, Dep. of Psychological and Brain Sciences, University of Iowa, Iowa City, USA


2021, VOL. 35, NO. 1, 165–198


Objective: Identify assessment measures that augment the clinical interview and improve the diagnostic accuracy of adult ADHD assessment. Method: The sometimes limited research literatures concerning the diagnostic efficacies of the clinical interview, standard and novel ADHD behavior rating scales, performance and symptom validity testing, and cognitive tests are critically reviewed. Results: Based on this qualitative review, both clinical interviews alone and ADHD behavior rating scales alone have adequate sensitivity but poor specificity in diagnosing ADHD. Response validity and symptom validity tests have reasonably good sensitivity and very good specificity in detecting invalid symptom presentation. Cognitive test batteries have inadequate sensitivity and specificity in identifying ADHD. Using cognitive tests in conjunction with behavior rating scales significantly improves the specificity of an assessment battery. Executive function behavior rating scales and functional pairment rating scales are unlikely to improve the diagnostic accuracy of ADHD assessment. Conclusions: Based on this review, key clinical interview questions, behavior rating scales, symptom validity tests, and cognitive tests that have promise to enhance current assessment practices are recommended. These are the authors’ personal opinions, not consensus standards, or guidelines promulgated by any organization. These measures are incorporated in a practical, somewhat abbreviated, battery that has the potential to improve clinicians’ ability to diagnose adult ADHD.

KEYWORDS: ADHD; adult; diagnosis; assessment; neuropsychological testing