ADHD Evaluation Tool: Health Provider Version (Assessment)

This tool can be used as an aid to assist in the diagnosis of ADHD. The tool is meant to be completed after the clinician has finished an assessment of the young person including information obtained from a responsible family member or responsible adult who knows the youth well whenever possible. Once the tool is completed the clinician should review the DSM V criteria for ADHD and ensure that all criteria are fulfilled prior to making a diagnosis.

First, select a number 1, 2, or 3 that best describes the young person as they USUALLY are. Then, once you have done that, if the score is 3 ("very often" box) please decide if, in your opinion, the young person shows that characteristic “Clearly more than other young people at this age”. Thus, some items may have two check marks in their rows and some items may have only one.

For scoring, please see below.

Note: not all young people who demonstrate symptoms of ADHD have ADHD.

Name*

First NameLast Name

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Date of Birth*

Date

Email

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a. Often fails to give close attention to details or makes careless mistakes in schoolwork, at work, or during other activities (e.g., overlooks or misses details, work is inaccurate)

b. Often has difficulty sustaining attention in tasks or play activities (e.g., has difficulty remaining focused during lectures, conversations, or lengthy reading)

c. Often does not seem to listen when spoken to directly (e.g., mind seems elsewhere, even in the absence of any obvious distraction)

d. Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (e.g., starts tasks but quickly loses focus and is easily sidetracked)

e. Often has difficulty organizing tasks and activities (e.g., difficulty managing sequential tasks; difficulty keeping materials and belongings in order; messy, disorganized work; has poor time management; fails to meet deadlines)

f. Often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (e.g., school work or homework; for older adolescents and adults, preparing reports, completing reports, reviewing lengthy papers)

g. Often loses things necessary for tasks or activities (e.g., school materials, pencils, books, tools, wallets, keys, paperwork, eyeglasses, mobile telephones)

h. Is often easily distracted by extraneous stimuli (for older adolescents and adults, may include unrelated thoughts)

i. Is often forgetful in daily activities (e.g., doing chores, running errands; for older adolescents and adults, returning calls, paying bills, keeping appointments)

Totals:

A total of 6 or more selections of "(4) Clearly more than other young people at this age" is suggestive of a diagnosis of ADHD inattention type. Proceed to the hyperactivity/impulsivity scale.

a. Often fidgets with or taps hands or feet or squirms in seat

b. Often leaves seat in situations when remaining seated is expected (e.g., leaves his or her place in the classroom, in the office or other workplace, or in other situations that require remaining in place)

c. Often runs about or climbs in situations where it is inappropriate. (Note: In adolescents or adults, may be limited to feeling restless)

d. Often unable to play or engage in leisure activities quietly

e. Is often “on the go,” acting as if “driven by a motor” (e.g., is unable to be or uncomfortable being still for extended time, as in restaurants, meetings; may be experienced by others as being restless or difficult to keep up with)

f. Often talks excessively

g. Often blurts out an answer before a question has been completed (e.g., completes people’s sentences; cannot wait for turn in conversation)

h. Often has difficulty waiting his or her turn (e.g., while waiting in line)

i. Often interrupts or intrudes on others (e.g., butts into conversations, games, or activities; may start using other people’s things without asking or receiving permission; for adolescents and adults, may intrude into or take over what others are doing)

Totals:

A total of 6 or more selections of "(4) Clearly more than other young people at this age" is suggestive of a diagnosis of ADHD; hyperactivity/impulsivity component.

Proceed to the logic model:

Logic Model

A) Did you select "(4) Clearly more than other young people at this age" 6 or more times in the Inattention section? Yes No
B) Did you select "(4) Clearly more than other young people at this age" 6 or more times in the Hyperactivity/impulsivity section? Yes No

If yes to component A or B above, proceed to confirm diagnosis using DSM V criteria (DSM V – 2013) pages 59‐65.

Do not use the following DSM V options for your primary health care diagnosis: Other Specified Attention-Deficit/Hyperactivity Disorder; Unspecified Attention Deficit Hyperactivity Disorder.

Always consider the possibility of a specific learning disorder and arrange the necessary academic evaluation if your diagnosis for ADHD is confirmed.

In addition to being used as a diagnostic aid, this tool can be used as a severity measure to monitor treatment response. Once a diagnosis of ADHD has been made, the total score of the tool (add all the boxes together in A plus B) is calculated. The minimal score that can be obtained is 19 and the maximum score is 57. Improvement is demonstrated by a decrease in total scores over time.

ADHD Evaluation Tool: Health Provider Version (Assessment)

Inattention Item

Hyperactivity/Impulsivity items