4. Clinical interviews for ADHD diagnosis

Author: Ulrich Brennecke
Review: Dipl.-Psych. Waldemar Zdero (08/2024)

Interviews are questionnaires that are completed by the doctor/therapist conducting the interview. These are usually based very closely on the DSM criteria.¹ This narrows down the diagnosis in an unpleasant way, as the DSM and ICD only use a very narrow catalog of symptoms.

Open-ended questions such as “Can you give me an example?” or “Can you give me an example from your everyday life?” are more informative than examples given to the patient to choose from and reduce the likelihood that patients who tend to agree with doctors or who are interested in the diagnosis for other reasons will be misdiagnosed with ADHD by constantly answering in the affirmative (the most serious-sounding answer)²
ADHD-affected adults may answer “yes” or “always” to ongoing immediate responses to the most severe symptoms. If attention problems result from other causes, people with ADHD seem to think longer about whether they are experiencing the symptom and may ask for clarification²
For patients who are unsure of themselves, it can be helpful to ask how their partner or friends would answer these questions for the patient. Most patients with ADHD are very aware of the feedback they have received from their family and close friends.²

• 1. Clinical interviews with test subjects
• 2. Clinical interviews with third parties about test subjects
• 3. Clinical interviews by age group
  • 3.1. Observation tools for preschool children
  • 3.2. Interviews / instruments with schoolchildren / adolescents
• 3.3. Interviews / instruments for adults
  • 3.1. Tests for ADHD symptoms in adulthood
• 4. Live interviews compared to video testing

1. Clinical interviews with test subjects¶

Clinical expert scales:⁷

• IDA-R (Integrated Diagnostics of Adult ADHD, revised version)
  • Standardized diagnostic guide that draws on existing instruments⁸
  • Step 1: ASRS as screening
  • Step 2: ADHD symptoms in childhood
    • Unlike WURS-k, uses not only self-reporting, but also third-party anamnestic information
    • IDA is based on the 5 ADHD core symptom items of the WURS-k with the highest discriminatory power (between 0.52 and 0.60):
      • Concentration problems
      • Fidgety/nervous
      • Loss of self-control
      • Low stamina
      • Inattentive/dreamy
    • Characteristics that indicate frequently occurring oppositional and emotional disorders in children and that show high discriminatory power values (0.53 to 0.61) are recorded by IDA but not included in the evaluation
      • Strong mood swings/moody
      • Disobedient/rebellious/rebellious
      • Tendency to be or act unreasonably
    • Cutoff⁸
      • At 6 or higher: specificity of 85 % (15 % are detected although not given) and sensitivity of 91 % (9 % are incorrectly not detected) (recommended; is nevertheless stricter than WURS-K with more incorrect non-detection of child ADHD symptoms)
      • At 7 or higher: specificity at over 99 % (1 % are detected although not given), sensitivity at 79 % (21 % are incorrectly not detected)
  • 3. Step: Diagnosis of acute symptoms according to DSM / ICD
    • Semi-standardized interview
    • Finding symptoms
    • Identification of restrictions in several areas of life

• AD-H-D test system: Attention and hyperactivity deficit disorder questionnaire test⁹
• Barkley Adult ADHD Rating Scale (BAARS-IV) against Diagnostic Interview for ADHD in Adults 2.0 (DIVA-2) in n = 390 male prison inmates in England¹⁰
  • Sensitivity: 37.9 %
  • Specificity: 96.3 %
• Before School Functioning Questionnaire (BSFQ)¹¹
• Clinical Assessment of Attention Deficit-Adult¹²
  • NI scale, cut-off 51: sensitivity 30 %, specificity 90 %
  • IF scale, cut-off 4: sensitivity 18 %, specificity 90 %
  • PI scale, cut-off 27: sensitivity 36 %, specificity 90 %
• Conners 3-Parent Short Form, C 3-P(S)¹³
• Conners 3-Teacher Short Form, C 3-T(S)¹³
• Conners Early Childhood¹⁴

• Diagnostic checklist (ADHD-DC) for adults¹⁵

• Diagnostic Interview for ADHD in Adults 2.0 (DIVA-2)
• DIVA 5
  • Validity Korean version:¹⁶
    • Diagnostic accuracy: 92 %
    • Sensitivity: 91.30 %
    • Specificity: from 93.62 %
• Mini-International Neuropsychiatric Interview (MINI-Plus): ADHD module
  • Validity in patients with substance use disorders (SUD) compared to the Conners’ Adult ADHD Diagnostic Interview for DSM-IV (CAADID):¹⁷
    • Sensitivity: 74 %
    • Specificity 91 %
    • Positive predictive value: 60 %
    • Negative predictive value 96 %
    • Kappa: 0.60
• Vineland Adaptive Behavior Scales, Second Edition¹⁸
  • The combination of four item subgroups (listening and paying attention, expressing complex ideas, social communication and following instructions) classified children with ADHD with
    • Sensitivity: 87.5 %
    • Specificity: 87.5 %
  • Only reading skills, writing skills and time and data distinguished children with specific learning disabilities from controls

• Wender-Reimherr Interview (WRI)
  Mixture of neuropsychological test and external assessment scales:

• Quantitative Behavior Test (QbTest); manufacturer: qbtech¹⁹²⁰²¹
  • A combination of CPT and motion analysis using an infrared measuring system²²
  • 70% accuracy in adults aged 55 to 79 years
  • In combination with the self-reported severity of ADHD symptoms 91 % accuracy
  • Two versions:
    • QbTest
      • Children aged 7 to 12 years
      • Simple target recognition task (“Go/No-Go”); each time a circle appears on the screen, the respondent should press a hand-responder button, but not react if a cross appears in front of the circle. Similar to the Conners CPT due to the inhibitory component
    • QbTest+
      • From 12 years
      • Working memory component, similar to the A-X CPT. Subjects observe blue and red squares and circles appearing one after the other. They are asked to react when two consecutive symbols match in color and shape.
      • Physical activity component during the CPT is measured with an infrared camera that measures the movement of a reflector in the center of the subject’s forehead

2. Clinical interviews with third parties about test subjects¶

3. Clinical interviews by age group¶

3.1. Observation tools for preschool children¶

• Behavior Rating Inventory of Executive Function in Preschool (BRIEF-P)²⁵

3.2. Interviews / instruments with schoolchildren / adolescents¶

• Diagnostic Interview Schedule for Children (DISC-IV)²⁶
  Recording period 6 months
• Diagnostic Interview for Children and Adolescents (DICA-R)²⁷
• Child and Adolescent Psychiatric Assessment (CAPA)²⁸
  Recording period 6 months
• Schedule for Affective Disorders and Schizophrenia for School-Age Children (K-SADS)²⁹
• Childrens Interview for Psychiatric Syndromes (ChIPS)³⁰
• Swanson, Nolan and Pelham-IV (SNAP IV)
  • 26 items across 18 ADHD and 9 ODD symptom criteria, based on DSM IV.
    Free of charge for clinical use.³¹ Only available in English.³²
• Scale for recording current symptoms of attention deficit/hyperactivity disorder and oppositional defiant disorder according to DSM IV (ADHD-ODD scale)³³
  • According to Kiddie-Sads-Present and Lifetime Version, K-SADS-PL
• DIVA is also suitable for diagnosing adolescents aged 12 to 17. See below.

3.3. Interviews / instruments for adults¶

3.1. Tests for ADHD symptoms in adulthood¶

• Diagnostic Interview for ADHD in adults (DIVA)³⁴
  • Current: DIVA 5
    • DIVA 5 is not yet medically validated in the German translation
    • Diagnoses that use DIVA 5 alone therefore lead to recourse risks for doctors and psychologists when billing health insurance companies for treatments based on them
  • Time required: 1 - 1.5 hours
  • Download for 10 € possible³⁵
    • However, the DIVA 5 evaluation differentiates according to age:
      • Children between 5 and 12 years: ADHD (+), if:
        • at least 6 symptoms either
          • Of inattention (6 in total) or
          • Hyperactivity/impulsivity (6 in total) or
          • Of both inattention and hyperactivity/impulsivity (12 in total) are present.
      • Adolescents between the ages of 12 and 17: ADHD (+) if
        • At least 6 symptoms either
          • Of inattention (6 in total) or
          • Hyperactivity/impulsivity (6 in total) or
          • Of both inattention and hyperactivity/impulsivity (12 in total).
        • And in addition at least 3 symptoms (of these or others) occurred before the age of 12 years
      • Adults: ADHD (+), if
        • At least 3 symptoms of inattention or hyperactivity/impulsivity before the age of 12 years
        • And additionally at least 5 symptoms of either inattention (5 in total) or hyperactivity/impulsivity (5 in total) or both (10 in total)
• Homburg ADHD Scales for Adults (HASE)
  HASE consists of five individual procedures³⁶³⁷
  • Wender Utah Rating Scale - German short form (WURS-K)
    • Objective: retrospective diagnosis of childhood ADHD-HI symptoms³⁸
      • Problematic:
        • Refers to ages 8 to 10 years. Must be adapted to the age of 6 to 11 years.
        • Questions are artificially changed so that it remains chargeable. However, this has actually made it worse.
        • Inattention is poorly assessed, ADHD-I in girls and boys is often overlooked.
        • AUC only 86 %:
      • Better alternative: WURS-25: Comprehensive, 96 % AUC, free of charge
    • Method: Self-assessment
    • Time required: 10 - 15 min.
  • ADHD self-assessment scale (ADHD-SB)
    • Objective: To measure the 18 diagnostic criteria of DSM-IV and ICD-10.
    • Method: Self-assessment
      -Time required: 10 - 15 min.
  • ADHD Diagnostic Checklist (ADHD-DC)
    • External assessment scale for experts based on DSM-IV and ICD-10 criteria
    • Method: External assessment
    • Time required: 10 - 15 min.
  • Wender Reimherr Interview (WRI)
    • structured interview with 28 psychopathological characteristics that are particularly important for the diagnosis of ADHD in adults
    • Wender-Reimherr interview is criticized for underestimating the symptoms of the predominantly inattentive presentation form (ADHD-I)³⁹
    • Method: Interview
    • Time required: 25 - 35 min.
  • Wender-Reimherr self-assessment for adult ADHD (WR-SB)
    • new self-assessment scale for ADHD in adults
    • Method: Self-assessment
    • Time required: 30 - 45 min.
• Integrated Diagnosis of ADHD in Adults“ (IDA-R) test system⁴⁰
  IDA-R summarizes relevant self-assessment and external assessment instruments to enable a time-efficient and reliable diagnosis based on the current DSM standard. It is available as a print and online version.
  IDA-R consists of a training video and 3 tests:
  • ASRS of the WHO (not actually a diagnostic tool, but a screening tool with 6 questions)
  • Validated short form of the Wender-Utah Rating Scale (WURS-K) for the retrospective assessment of ADHD symptoms in childhood (see above for problems) and
  • A diagnostic interview based on the latest DSM criteria to assess the current symptoms
  • Available free of charge from Medice (manufacturer of Medikinet) for doctors and psychotherapists

4. Live interviews compared to video testing¶

Live interviews and video interviews showed no differences in the results.⁴¹