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Steps to the Clinical Diagnosis of ADHD
        Is there history of medical complications in pregnancy (maternal smoking, alcohol
        consumption, low birth weight, etc.)?
                                                       ⇩
        Was the patient adopted? Is there a family history for ADHD (80% genetic)?
                                                       ⇩
        Is there evidence for childhood onset of impairing symptoms of hyperactivity, impulsivity
        and distractibility (early school records document comments such as “poor attention span,
        does not apply himself, could do better…”)?
                                                       ⇩
        Is there longitudinal persistence of symptoms into adolescence and adulthood
        (underachievement in high school, family dysfunction, etc.)?
                                                       ⇩
        Does the patient cross-sectionally endorse symptoms of ADHD (on SNAP, Conners
        scales)?
                                                       ⇩
        As a consequence of the ADHD symptoms, do they demonstrate impairments in multiple
        domains (educational, social, home life)?
                                                       ⇩
        Rule out underlying medical disorder (e.g., seizure disorder, traumatic brain injury, sleep
        disorder)
Murphy KR, Gordon M, Assessment of Adults With ADHD, from the text Attention-Deficit Hyperactivity Disorder, A Handbook for Diagnosis and Treatment,
                                                                                                                                                 Treatment,
2006 by Russell A. Barkley
Practice Guidelines for the Psychiatric Evaluation of Adults, Second Edition; Supplement to the American Journal of Psychiatry, Vol. 163, No. 6, June 2006.
APA, DSM-IV-TR, 2000
Making a Diagnosis of Adult ADHD
 • 80% genetic                                                                           Cross-sectional
 • Adoption                                                                      endorsement of adult rating
 • Maternal smoking/drinking                                                     scales. Collateral history¹.
                                               Clear persistence of                   Identifying comorbid
                                                   unremitting                    conditions (mood, anxiety
            Childhood onset                        symptoms.                           disorders, learning
           of DSM-IV criteria                       Secondary                             disabilities).
            School records                        impairment in                  Rule out other neurological
        (“Underachievement”,                   academic, cognitive,                disorder (sleep disorder,
         “inconsistent effort”,                  social and family                  frontal lobe syndrome,
              “distractible”)                      functioning                          seizure disorder)
TIMELINE

               Latency                          Adolescence                                  Adulthood

            A persistent longitudinal pattern of impairing symptoms

1 Practice Guidelines for the Psychiatric Evaluation of Adults, Second Edition; Supplement to the American
  Journal of Psychiatry, Vol. 163, No. 6, June 2006.                                                       Bilkey, 2008

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Diagnosis slides

  • 1. Steps to the Clinical Diagnosis of ADHD Is there history of medical complications in pregnancy (maternal smoking, alcohol consumption, low birth weight, etc.)? ⇩ Was the patient adopted? Is there a family history for ADHD (80% genetic)? ⇩ Is there evidence for childhood onset of impairing symptoms of hyperactivity, impulsivity and distractibility (early school records document comments such as “poor attention span, does not apply himself, could do better…”)? ⇩ Is there longitudinal persistence of symptoms into adolescence and adulthood (underachievement in high school, family dysfunction, etc.)? ⇩ Does the patient cross-sectionally endorse symptoms of ADHD (on SNAP, Conners scales)? ⇩ As a consequence of the ADHD symptoms, do they demonstrate impairments in multiple domains (educational, social, home life)? ⇩ Rule out underlying medical disorder (e.g., seizure disorder, traumatic brain injury, sleep disorder) Murphy KR, Gordon M, Assessment of Adults With ADHD, from the text Attention-Deficit Hyperactivity Disorder, A Handbook for Diagnosis and Treatment, Treatment, 2006 by Russell A. Barkley Practice Guidelines for the Psychiatric Evaluation of Adults, Second Edition; Supplement to the American Journal of Psychiatry, Vol. 163, No. 6, June 2006. APA, DSM-IV-TR, 2000
  • 2. Making a Diagnosis of Adult ADHD • 80% genetic Cross-sectional • Adoption endorsement of adult rating • Maternal smoking/drinking scales. Collateral history¹. Clear persistence of Identifying comorbid unremitting conditions (mood, anxiety Childhood onset symptoms. disorders, learning of DSM-IV criteria Secondary disabilities). School records impairment in Rule out other neurological (“Underachievement”, academic, cognitive, disorder (sleep disorder, “inconsistent effort”, social and family frontal lobe syndrome, “distractible”) functioning seizure disorder) TIMELINE Latency Adolescence Adulthood A persistent longitudinal pattern of impairing symptoms 1 Practice Guidelines for the Psychiatric Evaluation of Adults, Second Edition; Supplement to the American Journal of Psychiatry, Vol. 163, No. 6, June 2006. Bilkey, 2008