1. Questionnaires for ADHD diagnosis

Questionnaires are filled out by people with ADHD themselves and their caregivers (parents, teachers, friends).

Questionnaires are very subjective and involve the risk that the respondent’s personal opinion about ADHD itself influences the response scale. It can happen that parents reject the diagnosis of ADHD in principle, especially in their own child. Likewise, subjective ideas of people with ADHD (perhaps that they “want” a diagnosis in the hope of finding a solution to their suffering, perhaps that they reject a diagnosis because they fundamentally reject ADHD or to avoid stigmatization) or the change in assessment standards due to intensive prior employment can distort the results (bias).

For example, in tests of elimination diets for ADHD, the results of parent surveys are always far more positive than the results of objective tests.¹ As this occurs even in double-blind studies, there is a considerable bias on the part of parents to report the subjectively desired result (that ADHD can be treated with a diet rather than with critically considered medication).
However, it is also conceivable that the parents were already enthusiastic about the small improvements that an elimination diet can bring or that a placebo effect can have on the child with ADHD and were not even aware of the much better effect that could be achieved through medication or therapy, or at least were not aware of it at the time of the assessment.

Suitable questionnaires for ADHD are:

• 1. Clinical expert scales
• 2. Self-assessment questionnaires
• 3. External evaluation questionnaires

1. Clinical expert scales¶

Clinical expert scales:²

• Diagnostic checklist (ADHD-DC)
• IDA-R (Integrated Diagnosis of ADHD, revised version)
• Wender-Reimherr Interview (WRI)
• Conners Scales of Attention and Behavior - External Assessment (CAARS-O) ³

• Conners 3-Parent Short Form, C 3-P(S)⁴
• Conners 3-Teacher Short Form, C 3-T(S)⁴
• Conners Early Childhood.⁵
• Child Behavior Checklist, CBCL/1.5-5 (parent questionnaire on behavior)
  of preschool children between 1.5 and 5 years)⁶⁴
• Child Behavior Checklist, CBCL/6-18 (Parent Behavior Questionnaire)
  of children and young people from 4 to 18 years)⁷⁴
• Child and Adolescent Behavior Inventory (CABI)
  CABI is a parent questionnaire with 75 questions.
  CABI is more accurate than CBCL in relation to ADHD and anxiety, CBCL is more accurate in relation to conduct disorder (CD) and oppositional defiant disorder (ODD).⁸
• Teacher Rating Form (TFR 6-18)⁷⁴
• Parent/Teacher Questionaries (Conner)⁹
• Parent / teacher questionnaires¹⁰
• Quantitative Behavior Test (QbTest)
  70% accuracy in adults aged 55 to 79 years. In combination with self-reported ADHD symptom severity, 91% accuracy.¹¹¹²
• Assessment form for parents, teachers and educators (FBB-HKS)¹³
• Before School Functioning Questionnaire (BSFQ)¹⁴
• Parent Rating of Evening and Morning Behavior Scale, Revised (PREMB-R)¹⁴
• ADHD/ODDEFB: ADHD/ODD parent questionnaire. Steinhausen (2002)
• AD-H-D Test System: Attention and Hyperactivity Deficit Disorder Questionnaire Test. Sponsel (2002)
• CAPT: Continuous Attention Performance Test - German version. Nubel, Starzacher, Grohmann (2006)
• BADD: Brown Attention Deficit Disorders Scale, a self-completion questionnaire with 40 items to assess cognitive ADHD symptoms
• Q-ADHD-Child: a rating scale for childhood ADHD symptoms according to DSM-IV and ICD-10 criteria¹⁵

2. Self-assessment questionnaires¶

A meta-study of 9 ADHD questionnaires found that only 37% asked identical symptoms/behaviors.¹⁶ Most of the questionnaires for children were answered by parents, most of the questionnaires for adults were self-tests.
In questionnaires, a study showed considerable deviations in the assessments of parents, teachers and people with ADHD, with the exception of emotional dysregulation, all existing symptoms, but even more so the frequency of their occurrence.¹⁷
In the case of self-assessment questionnaires, response tendencies and unintentional misjudgments can influence the result.
Subjects who were asked to report their daily physical activity showed considerable deviations from the actigraphy measurement, even though they were aware of the actigraphy measurement.¹⁸
Children with ADHD performed worse on tests with a slow event rate, while their results on exciting, challenging tasks were comparable to those of people with ADHD.^{19 20} It is consistent with this that the test results of people with ADHD change when rewards are promised.²¹ This also indicates that it is not the ability to concentrate or inhibition that is impaired per se, but rather the insufficient activation by “normally interesting” stimuli that is the actual key.

Self-assessment questionnaires:²

• ADHD self-assessment scale (ADHD-SB)
• ADHD screening for adults (ADHD-E) (including severity of severity compared to standard values)
• Conners Scales of Attention and Behavior for Adults - Self-Assessment (CAARS-S)
• Cologne ADHD Test for Adults (KATE)
  • Folder with various tests and evaluation instructions
  • ASRS 1.1.
• Wender-Reimherr self-assessment (WR-SB)

• ASRS 1.1, ADHD screening of the WHO²²
  • 6-item short screening
  • 18-item long screening
  • The ASRS 1.1 rating scales have a very limited diagnostic value²³
  • The high negative predictive value is typical for a (non-diagnostic) screening instrument that must not overlook any possible case, with a low positive predictive value, according to which more than every second person is not diagnosed with ADHD.
  • For adults:²⁴
    • Sensitivity: 0.92
    • Specificity: 0.69
    • Positive predictive value: 0.48
    • Negative predictive value: 0.97
    • Average time to complete less than 1 minute
• Youth Self-Report, YSR/11-18 (questionnaire for young people)²⁵
• Behavioral symptoms were asked from 28% to 81% of the questions in the questionnaires
• Cognitive symptoms were addressed by 9% to 44% of the questions
• Emotional symptoms accounted for between 0% and 24% of the questions
• Physical symptoms were only asked about in 3 of the 9 instruments

Emotional dysregulation (also in ADHD) can be tested with the

• Reactivity, Intensity, Polarity and Stability questionnaire (RIPoSt-40)²⁶

3. External evaluation questionnaires¶

• Vanderbilt ADHD Diagnostic Parent Rating Scale