ADHD Rating Scales

Attention deficit hyperactivity disorder rating scales are structured questionnaires that measure the frequency of inattentive, hyperactive and impulsive behaviours. They are completed by parents, teachers, the patient, or a combination.

Examples include the Conners scales, the Vanderbilt scales, SNAP-IV, and the Adult ADHD Self-Report Scale. They support diagnosis and monitoring but do not diagnose the disorder alone.

Usage. They are used in the evaluation of children and adults with attention, activity or behavioural concerns, and to monitor response to treatment.

Indications. Suspected attention deficit hyperactivity disorder, school or work difficulty, and monitoring of treatment response.

Preparation and technique. Multiple informants complete the scales, because symptoms must be present in more than one setting. For children, parent and teacher versions are used. For adults, a self-report scale is used, with collateral information when possible.

Contraindications and precautions. Scales are interpreted with caution in children with other developmental conditions, in those with anxiety or mood disorder, and in those with sleep problems.

Interpretation.

• Scores are compared with age- and sex specific norms, and elevated scores support further assessment.
• A diagnosis requires symptoms that began in childhood, are present in two or more settings, and cause impairment.
• The adult self-report screener uses a short set of items, and a positive screen is 4 or more positive items out of 6.
• Change in scores over time is used to monitor treatment response.

Causes of raised scores. Attention deficit hyperactivity disorder, anxiety, depression, learning disorder, autism spectrum disorder, sleep disorder, hearing or vision problems, and environmental stress.

Critical values and findings needing immediate action. Thoughts of self-harm, aggression with risk to others, or a sudden change in behaviour require immediate clinical assessment.

Limitations and artefacts. Scales are subjective, and different informants often disagree. Scores can be affected by rater bias and by other conditions. The scale is not diagnostic.

Follow up tests. A full clinical assessment, developmental and psychiatric history, assessment for coexisting conditions, hearing and vision screening, and cardiovascular assessment before stimulant treatment.

Special groups. Preschool children are assessed with caution, because overactivity is common. Girls and adults are more often missed. Adults need retrospective childhood history to confirm onset.