Assessment and Treatment Monitoring Tools for Adult ADHD

Despite the evidence that ADHD is a distinct condition from other psychiatric and neurodevelopmental disorders that affect adults, it is a challenging one to assess because of its overlap with other conditions. It is fortunate that there are several evidence-supported pharmacologic and psychosocial treatments available to adult ADHD. However, accurate assessment and measurement strategies during treatment are needed to optimize outcomes. Even for clinicians who may not specialize in ADHD, screening tools are needed to determine if further evaluation or specialized treatment is indicated for patients suspected of having ADHD.

There are several options of various symptom measures, adult ADHD inventories that go beyond DSM symptomatology, and additional means for assessing executive functioning, impairment, and screening measures that are available to practicing clinicians who perform diagnostic evaluations and/or provide treatment. This blog will provide a general overview of essential topics that are covered in greater detail in a recently published article, including a review of a menu of specific assessment and tracking tools relevant for clinical practice.¹

Structured Diagnostic Interviews

            Although often associated with research, there are several structured diagnostic interviews that can be used to systematically guide the evaluation of ADHD in adults. All of them adhere to existing DSM criteria as well as assessing for age of onset, symptoms in multiple settings, and evidence of impairment. Even those developed during the advent of DSM-IV can be easily adapted to the changes in DSM-5 regarding age-of-onset criterion and reduced number of symptoms required for the diagnosis in adults.

ADHD Symptom Measures

            As with the structured interviews, there are multiple adult ADHD symptom checklists that can be used in the diagnostic evaluation as well as in monitoring treatment progress. Again, even those symptom measures published using DSM-IV criteria can be adapted to DSM-5. Several of the measures provided normative data with regarding the percentile rank of different scores, including symptom count and overall symptom rating scores.

Adult ADHD Inventories

            There are several adult ADHD inventories that often build on the foundation of the extant diagnostic criteria but cast a wider net in terms of other clinically-relevant manifestations of ADHD. These inventories are more likely to include items related to emotional regulation, issues related to organization and procrastination, which may offer a better means for tracking progress in terms of functioning in day-to-day life. These measures may be particularly relevant in tracking progress in psychosocial treatment, where functional impairments and the targets of treatment more than pure symptom improvement.

Executive Functioning Inventories

            Following up on the point made above about treatment promoting functional improvements, executive functioning inventories provide another useful means for assessing this aspect of the clinical presentation of adults with ADHD. It is most often issues related to poor time management, disorganization, and poor initiation and follow through on tasks that lead individuals to seek treatment. Emotional regulation issues are also captured in these scales and other executive functioning issues that are not represented in the official diagnostic criteria.

Functional Impairment/Quality of Life Inventories

            Many evaluations are asked to assess and address level of impairment, not to mention that evidence of impairment is one of the criteria for establishing whether symptoms reflect a diagnosable disorder. Although there are other ways to make the case for the existence of impairment, such as academic disruption or workplace evaluations, these measures provide another means to do so, as well as a way to track the effects of treatment on these life domains.           

Selecting and Using Interviews, Measures, and Inventories

            The primary guiding principle is that the clinical data gathered from these tools cannot be taken at face value and each must be considered as one component of the overall clinical picture, which includes a thorough clinical and developmental interview. A related principle is that these measures may be necessary for establishing a diagnosis of ADHD, but no one is sufficient. Many of the scales include observer rating forms which allows a means for collecting collateral data with which to make a diagnosis and/or assess treatment progress.

Summary

            The evaluation of ADHD requires a thorough evaluation of emergence and persistence of symptoms across time and establishing evidence of impairments, including gathering collateral data and ruling out other diagnoses. Similarly, because it is a neurodevelopmental disorder, treatment focuses on the effective management of symptoms and impairments and tracking progress is more challenging than a condition that is episodic. However, there are many useful clinical tools available to clinicians in practice that help improve diagnostic accuracy, assessment of treatment progress, and, ultimately, clinical outcomes.           

Reference

¹Ramsay, J. R. (2017). Assessment and monitoring of treatment response in adult ADHD patients: current perspectives. Neuropsychiatric Disease and Treatment, 13, 221-232. doi.org/10.2147/NDT.S104706