DIAGNOSIS AND TREATMENT FOR ADULTS
An ADHD assessment should always include a general mental health screening (to consider comorbidities and differential diagnoses). In addition to a diagnostic interview, CADDRA recommends tools such as the WSR II. This eToolkit contains an optional guided assessment tool, the CADDRA ADHD Assessment Form.
The step-by-step flowchart below applies after general mental health screening has been completed and ADHD is suspected. All the tools documented in this flowchart are free to download and use. Other assessment tools (e.g. Vanderbilt, Conners, Strengths and Difficulties Questionnaire – SDQ, Wender Utah Rating Scale) can be used in place of those proposed below. Further information on these steps can be found in Chapter 1, Canadian ADHD Practice Guidelines, 4th Edition.
ADHD SUSPECTED
STEP 1 - INITIAL INFORMATION GATHERING
FORMS FOR PATIENTS
- ASRS - Adult ADHD Self-Report Scale
Consider also using a functional impairment scale (e.g. WFIRS-S - Weiss Functional Impairment Rating Scale Self)
QUESTIONNAIRES FOR SOMEONE WHO KNOWS THE PATIENT WELL
(e.g. spouse, other)
- ASRS - Adult ADHD Self-Report Scale
FORMS FOR SOMEONE WHO KNEW THE PATIENT AS A CHILD (if possible)
STEP 2: MEDICAL REVIEW
EXCLUDE ANY MEDICAL CAUSES THAT CAN MIMIC OR AGGRAVATE ADHD
REVIEW NUTRITION AND LIFESTYLE HABITS:
Sleep, exercise, screen time, high-risk activities, substance use. sexual activity (if applicable), accidents
EVALUATE POTENTIAL CONTRAINDICATIONS TO ADHD MEDICATIONS
STEP 3: ADHD SPECIFIC INTERVIEW
DISCUSS PATIENT’S STRENGTHS AND OBSERVE PATIENT DURING INTERVIEW
REVIEW DEVELOPMENTAL HISTORY AND OBTAIN COLLATERAL INFORMATION FROM PARENTS/CLOSE RELATIVES
REVIEW THE QUESTIONNAIRES USED IN ASSESSMENT
CONSIDER CONTRIBUTIONS OF OTHER PSYCHIATRIC, PSYCHOSOCIAL FACTORS OR LEARNING DISORDERS TO THE PRESENTING SYMPTOMS
Consider specialist referral if necessary.
STEP 4: FEEDBACK & TREATMENT RECOMMENDATIONS
EDUCATION ON ADHD
(Continuing process)
Provide information and resources, including:
Links to useful websites:
- CADDAC (Canada: www.caddac.ca)
- PANDA (Quebec: www.associationpanda.qc.ca)
- CHADD (USA: www.chadd.org)
FEEDBACK ON DIAGNOSIS
Feedback to patient and family on ADHD symptoms & impairments
TREATMENT OPTIONS
Discuss and initiate treatment + adaptation measures (school/work accommodations, daily strategies)
FOLLOW-UP VISITS
- ADHD is a chronic disorder that needs long-term, regular follow-up, whether or not medication is prescribed.
- Follow-up will be more frequent when adjusting medications and during life transitions.
- Document changes over time with the rating scales that are most significant for the patient (e.g. ASRS, WFIRS-S).
Other forms to track changes:
The CADDRA PATIENT TRANSITION FORM can be used when a patient is transferring to new healthcare professionals, including pediatric patients to adult services. The JEROME DRIVING QUESTIONNAIRE can be used to assess driving.