How to Assess Inattentive Symptoms in Adults With ADHD
How should clinicians evaluate adults for ADHD when inattentive symptoms are more prominent than hyperactive or impulsive symptoms?
Adults with attention-deficit/hyperactivity disorder often present with distractibility and sustained attention problems rather than overt hyperactivity. This guide applies to adult ADHD evaluations and helps clinicians focus the history on the symptom pattern most commonly reported in clinically referred adults.
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Ask directly about current DSM-IV ADHD symptoms
Base the evaluation on clinical history and systematic questioning about DSM-IV ADHD symptoms. In this study, adult ADHD diagnoses and subtypes were determined from structured diagnostic interviews using current symptoms, and diagnoses were assigned for both lifetime and current past-month time points.
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Prioritize the inattentive symptom cluster
Question inattentive symptoms carefully because they were the most frequently endorsed symptoms in adults with ADHD. Overall, 93% of adults had either the predominately inattentive or combined subtype, indicating that inattention was a dominant feature of adult presentation.
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Probe the most commonly endorsed inattentive complaints
Specifically ask about being easily distracted, difficulty sustaining attention, and difficulty with sustained mental effort. These were the most commonly reported inattentive symptoms in the sample and are the symptoms most likely to surface when adults with ADHD describe their current difficulties.
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Do not rely on overt hyperactivity to identify cases
Hyperactive and impulsive symptoms were less frequently endorsed overall than inattentive symptoms. If you ask only about visible restlessness or other hyperactive behaviors, you may miss the more typical adult ADHD presentation described in this article.
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Classify the current subtype from the symptom pattern
After reviewing current DSM-IV symptoms, determine whether the presentation is combined, inattentive only, or hyperactive/impulsive only. In this clinically referred adult sample, 62% had the combined subtype, 31% had the inattentive subtype, and 7% had the hyperactive/impulsive subtype.
Clinical Considerations
- The findings may not generalize to all adults with ADHD because the sample was derived in part from clinically referred and nonreferred populations.
- The study assessed adults who met 6 of 9 child-based ADHD diagnostic criteria, so the sample may represent a more severe adult ADHD group.
- Some symptom reporting relied on retrospective recall of past symptoms, which may limit accuracy.
Bottom Line
When evaluating adult ADHD, deliberately ask about distractibility, sustained attention, and sustained mental effort because inattention is the dominant adult presentation.
