ADHD Evaluation in Adults

Initial Screening Approach

The American Academy of Pediatrics recommends beginning with the Adult ADHD Self-Report Scale (ASRS) as the initial screening tool, then confirming diagnosis using DSM-5 criteria requiring documentation of symptoms causing impairment in at least two settings, with evidence of symptom onset before age 12 1
The ASRS Part A serves as the initial screen; if positive, proceed to Part B for comprehensive symptom assessment, as suggested by the American Academy of Pediatrics 1

The American Academy of Pediatrics states that to establish a diagnosis of ADHD, five or more symptoms of inattention and/or hyperactivity-impulsivity must persist for at least 6 months, with symptom onset before age 12, and impairment in at least two settings, as outlined in the DSM-5 criteria 1, 2
The DSM-5 criteria require symptoms to directly cause functional impairment and not be better explained by another mental disorder, according to the American Academy of Pediatrics 2
The American Academy of Pediatrics recommends documenting symptom onset before age 12 by obtaining childhood report cards, speaking with parents, or reviewing documented history 3

The American Academy of Pediatrics suggests obtaining reports from someone who knows the patient well, such as a spouse, parent, or close friend, by having them complete the ASRS with the patient in mind 1
The American Academy of Pediatrics recommends using the Weiss Functional Impairment Rating Scale-Self (WFIRS-S) to measure ADHD-specific impairment in daily functioning 1

The American Academy of Pediatrics recommends screening for depression and anxiety disorders, as symptoms overlap substantially with ADHD inattention, and substance use disorders, as they can mimic or mask ADHD symptoms 3, 5
The American Academy of Pediatrics suggests screening for bipolar disorder, as stimulants can precipitate manic episodes if misdiagnosed, and personality disorders, particularly borderline and antisocial patterns, although this is not exclusively cited 6
The American Academy of Pediatrics recommends ruling out sleep disorders, such as sleep apnea and insomnia, which can cause daytime inattention and fatigue, and other medical conditions that may mimic ADHD symptoms 5

The American Academy of Pediatrics recommends documenting specific DSM-5 symptoms present, age of onset with supporting evidence from childhood, settings where impairment occurs with concrete examples, degree of functional impairment in work, relationships, and daily activities, comorbid conditions identified or ruled out, and collateral information sources and their observations 1, 2, 3, 4

The American Academy of Pediatrics suggests considering referral to psychiatry for diagnostic uncertainty after comprehensive evaluation, multiple comorbid psychiatric conditions requiring complex medication management, treatment-resistant cases or previous medication failures, active suicidal ideation or severe mood symptoms, and active substance use disorder requiring specialized treatment 5, 6, 7