ADHD Assessment Methods

As psychiatrists, we emphasize that ADHD diagnosis does not rely on a single test. Instead, it requires detailed clinical evaluation. Guided by diagnostic criteria, we carefully determine whether a patient meets the standards for ADHD.

I. Self-Assessment Tools

Self-assessment tools are often the first step in ADHD evaluation. They help patients, parents, and teachers gain preliminary insights into symptom presentation. While these tools cannot replace professional diagnosis, they provide valuable clues that indicate whether further clinical assessment is needed.

1. Adult ADHD Self-Report Scale (ASRS v1.1)

• • Developed by the World Health Organization (WHO) and Harvard University.
  • Contains 18 questions covering two major symptom domains: inattention and hyperactivity/impulsivity.
  • Designed for adults, offering quick screening for ADHD risk.
  • Clinical value: Provides initial self-awareness. If results suggest high risk, we recommend professional evaluation by a psychiatrist or clinical psychologist.

2. Conners’ Rating Scales

• • Widely used in Hong Kong, completed by parents and teachers.
  • Evaluates children’s behavior at home and school.
  • Covers inattention, hyperactivity, and impulsivity.
  • Clinical value: Reflects cross-setting symptom presentation.

3. Vanderbilt ADHD Diagnostic Rating Scale

• • Suitable for children aged 6–12.
  • Covers ADHD symptoms, academic performance, and comorbidities such as anxiety and depression.
  • Commonly used in primary care and school mental health screening.
  • Clinical value: Allows simultaneous observation of ADHD and other psychological difficulties.

4. SWAN Rating Scale (Strengths and Weaknesses of ADHD Symptoms and Normal Behaviour)

• • Suitable for children and adolescents aged 6–18.
  • Bidirectional assessment: Records both strengths and weaknesses (e.g., good attention span or strong self-control in certain contexts).
  • Continuous 7-point scale: Captures nuanced behavioral differences rather than simple yes/no symptoms.
  • Reduced bias: Avoids focusing only on deficits, presenting a more balanced behavioral profile.
  • Clinical value: Enables comprehensive understanding of a child’s behavioral characteristics and supports positive intervention strategies.

II. Clinical Rating Scales and Tests

Conners Continuous Performance Test (CPT-3)

• Age range: Suitable for children aged 8+, adolescents, and adults.
• Format: Computerized test requiring responses to target stimuli while suppressing responses to non-target stimuli over time.
• Purpose: Evaluates sustained attention, response inhibition, reaction speed, and consistency.
• Clinical value: Provides objective data to complement subjective observations, and helps distinguish ADHD from other attention difficulties such as anxiety or fatigue.

TEA-Ch (Test of Everyday Attention for Children)

• Age range: 6–16 years old.
• Format: Simulates everyday scenarios to assess selective attention, sustained attention, and divided attention.
• Clinical value: Offers analysis of attentional patterns in ADHD patients.

WISC-IV (Wechsler Intelligence Scale for Children, Fourth Edition, Hong Kong Version)

• Age range: 6–16 years old.
• Purpose: The most widely used IQ test for children worldwide, measuring intellectual functioning and cognitive abilities.
• Index scores:

• • Verbal Comprehension Index (VCI) – language reasoning and expression.
  • Perceptual Reasoning Index (PRI) – visual-spatial reasoning and non-verbal problem solving.
  • Working Memory Index (WMI) – short-term memory, attention, and information processing.
  • Processing Speed Index (PSI) – speed and efficiency in completing tasks.

• WISC-IV is not an ADHD diagnostic tool.
• Clinical value: Provides a reference for cognitive functioning, helping psychiatrists and psychologists better understand a patient’s learning and thinking patterns.

III. Professional Interviews and Clinical Diagnostic Process

Psychiatrists conduct structured interviews and clinical observations to gain a comprehensive understanding of the patient’s symptoms.

Key areas of focus:

• Symptom history: onset, duration, and frequency.
• Cross-setting presentation: symptoms at home, school, or workplace.
• Functional impact: effects on academics, work, relationships, and daily management.
• Family history: ADHD or other psychiatric conditions in relatives.
• Comorbidities: anxiety, depression, learning disorders, or other psychological conditions.
• Life events: exposure to major stressors or trauma.

Mental Status Examination (MSE):

• Appearance and behavior.
• Cognitive function.
• Emotional expression.
• Thought content.

IV. Rule Out Comorbid Conditions

ADHD frequently co-occurs with other psychiatric or medical conditions, so careful differential diagnosis is essential:

• Anxiety disorders / Depression.
• Autism Spectrum Disorder (ASD).
• Learning disorders.