ADHD Screening

For children and young people:

• The Swanson, Nolan, and Pelham Rating Scale (SNAP-IV) is widely used and measures the core symptoms of ADHD.
• The Vanderbilt ADHD Diagnostic Rating Scale (VADRS) is an assessment tool specifically designed to evaluate symptoms of Attention-Deficit/Hyperactivity Disorder (ADHD) in children and adolescents
• The Conners Comprehensive Behaviour Rating Scale (CBRS), and the Strengths and Difficulties Questionnaire are useful adjuncts.

For adults:

The Adult ADHD Self-Report Scale (ASRS-v1.1) is an instrument representing similar criteria to those in the DSM-V. Six of the 18 questions were found to be the most predictive of symptoms consistent with ADHD. These six questions are the basis for the ASRS v1.1 Screener and are also Part A of the Symptom Checklist. Part B of the Symptom Checklist contains the remaining twelve questions.

Patients who may be at risk include those who were born prematurely, in whom behavioural concerns have been raised or observed, in whom there is evidence of adverse childhood events, substance misuse and/or dependency, and those with a family history of speech/language delay and/or other developmental/ behavioural concerns.

Factors that may raise suspicion of neurodivergence in a patient presenting to frontline services include:

• A family history of neurodivergence¹.
• Observable symptoms like inattention, hyperactivity or impulsivity, lack of eye contact.
• Behavioural observations like repeated late or missed appointments, literal interpretation of rules.
• Patient or parental reports of concerns regarding difficulties in daily functioning, often related to emotional regulation challenges.
• Educational or occupational issues such as academic or occupational underachievement, frequent job changes, or difficulties in job performance due to lack of organisational skills, difficulties with time management.
• Social communication difficulties, such as struggles with inter-personal relationships, or struggles with hierarchical organisations.
• ‘Functional’ diagnoses such as chronic pain² and fibromyalgia³.
• Poor response to talking therapies and/or multiple antidepressants or antipsychotics.
• Unexplained anxiety, suicidal ideation.

ADHD is under-recognised in women and girls, and they are more likely to have un-diagnosed ADHD and to receive an incorrect diagnosis of another mental health or neurodevelopmental condition.

References

1. NICE CKS. Attention deficit hyperactivity disorder: diagnosis and management. Aug 2023.
2. ICD-11.Attention deficit hyperactivity disorder. 2022.
3. Hamed AM, Kauer AJ, Stevens HE. Why the Diagnosis of Attention Deficit Hyperactivity Disorder Matters. Front Psychiatry. 2015 Nov 26;6:168.