1. Questionnaires for ADHD diagnosis

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

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
  • 2.1. Self-assessment questionnaires for diagnostics
  • 2.2. Screening
• 3. External evaluation questionnaires
• 4. Questionnaires for the retrospective identification of ADHD in childhood

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 Childhood⁵

• Quantitative Behavior Test (QbTest)⁶⁷

  • To be completed by diagnostician or parents
  • 70 % accuracy in adults aged 55 to 79 years
  • In combination with the self-reported severity of ADHD symptoms 91 % accuracy

• Before School Functioning Questionnaire (BSFQ)⁸

• AD-H-D Test System: Attention and Hyperactivity Deficit Disorder Questionnaire Test{Sponsel, 2002}}

• CAPT: Continuous Attention Performance Test - German version⁹

• Adult ADHD-RS-IV* with Adult Prompts

2. Self-assessment questionnaires¶

A meta-study of 9 ADHD questionnaires found that only 37% asked identical symptoms/behaviors.¹⁰ 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 differences in the assessments of parents, teachers and people with ADHD, with the exception of emotional dysregulation, in all existing symptoms, but even more so in the frequency of their occurrence.¹¹
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.¹²
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 who were not affected.^{13 14} It is consistent with this that the results of tests with people with ADHD change when rewards are promised.¹⁵ 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.

• 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 surveyed at all in 3 out of 9 instruments

2.1. Self-assessment questionnaires for diagnostics¶

Self-assessment questionnaires:²

• ADHD self-assessment scale (ADHD-SB)
• ADHD screening for adults (ADHD-E) (including severity of severity compared to standard values)

• BADD: Brown Attention Deficit Disorders Scale, a self-completion questionnaire with 40 items to assess cognitive ADHD symptoms
  Emotional dysregulation (also in ADHD) can be tested with the

• 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.

• Reactivity, Intensity, Polarity and Stability questionnaire (RIPoSt-40)¹⁶

• Wender-Reimherr self-assessment (WR-SB)

• Youth Self-Report, YSR/11-18 (questionnaire for young people)¹⁷

2.2. Screening¶

• ASRS 1.1.
  • ADHD screening by the WHO¹⁸
  • 6-item short screening
  • 18-item long screening
  • The ASRS 1.1 rating scales have a very limited diagnostic value¹⁹
  • 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, meaning that more than every second person with a positive ASRS is not diagnosed with ADHD
  • For adults:²⁰
    • Sensitivity: 0.92
    • Specificity: 0.69
    • Positive predictive value: 0.48
    • Negative predictive value: 0.97
    • Average time to complete less than 1 minute

3. External evaluation questionnaires¶

• ADHD/ODDEFB: ADHD/ODD parent questionnaire²¹
• Assessment form for parents, teachers and educators (FBB-HKS)²²
• Child Behavior Checklist, CBCL/1.5-5
  • Parent questionnaire on the behavior of preschool children between 1.5 and 5 years of age²³⁴
• Child Behavior Checklist, CBCL/6-18
  • Parent questionnaire on the behavior of children and adolescents aged 4 to 18²⁴⁴
• Child and Adolescent Behavior Inventory (CABI)
  • 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 behavior (ODD)²⁵
• Parent/Teacher Questionaries (Conner)²⁶
• Parent Rating of Evening and Morning Behavior Scale, Revised (PREMB-R)⁸
• Quantitative Behavior Test (QbTest)⁶⁷
  • To be completed by diagnostician or parents
  • 70 % accuracy in adults aged 55 to 79 years
  • In combination with the self-reported severity of ADHD symptoms 91 % accuracy
• Teacher Rating Form (TFR 6-18)²⁴⁴
• Vanderbilt ADHD Diagnostic Parent Rating Scale

4. Questionnaires for the retrospective identification of ADHD in childhood¶

• WURS-K
• WURS 25
  • Sensitivity of only 27.7 %²⁷
  • Specificity 90.3 %²⁷
  • Sensitivity of 60.7 % compared to the ASRS 1.1.²⁷ (which has very limited diagnostic value as a screening instrument)
  • Specificity of 60.8 % compared to ASRS 1.1²⁷
• Q-ADHD-Child: a rating scale for childhood ADHD symptoms according to DSM-IV and ICD-10 criteria²⁸