History and exam
Key diagnostic factors
common
presence of risk factors
Risk factors include male sex, family history of ADHD, psychosocial adversity, and environmental factors.
onset prior to age 12 years
Several inattentive or hyperactive-impulsive symptoms must have been present prior to age 12 years. Hyperactive symptoms are typically most prominent at preschool age, with inattention becoming more prominent during elementary school.[1]
In addition to a self-report, a secondary report given by a parent to assess validity can be helpful in identifying age of onset.
past or present academic dysfunction
present or past occupational dysfunction
Multiple work placements, with evidence of work termination as a result of poor work performance and problems with authority.
familial and relationship dysfunction
Family rifts and multiple short sexual relationships.
drug and alcohol use disorders
Up to 23% of patients attending a substance use disorder clinic have attention deficit hyperactivity disorder (ADHD).[81] A history of amfetamine use giving an abnormal calming effect may be elicited. Depending on the substance used, the cautious use of long-acting stimulants is unlikely to exacerbate substance use disorders as the pharmacokinetic and dynamic properties do not lend themselves to misuse. Following stabilisation of the substance use disorder, treatment of the underlying ADHD may reduce addictive behaviour.[82][83]
thrill-seeking behaviour
Patients are prone to thrill-seeking actions.
driving accidents
Driving accidents are increased in young adults with attention deficit hyperactivity disorder as a result of being distracted, impulsive, and having an increased need for stimulation.[84] Road rage is more common.
unable to pay attention to details resulting in ‘careless’ mistakes at work, school, etc.
DSM-5-TR diagnostic criteria for inattention.[1]
has difficulty maintaining attention in tasks
DSM-5-TR diagnostic criteria for inattention.[1]
seems not to listen when being spoken to
DSM-5-TR diagnostic criteria for inattention.[1]
does not follow instructions and does not finish duties and assigned tasks (not due to misunderstanding or oppositional behaviour)
DSM-5-TR diagnostic criteria for inattention.[1]
has organisational difficulties
DSM-5-TR diagnostic criteria for inattention.[1]
avoids, dislikes, or is reluctant to engage in tasks that require maintaining mental effort
DSM-5-TR diagnostic criteria for inattention.[1]
frequently loses things needed for tasks or activities
DSM-5-TR diagnostic criteria for inattention.[1]
frequently forgetful in daily activities
DSM-5-TR diagnostic criteria for inattention.[1]
fidgets often with hands or feet and moves in seat
DSM-5-TR diagnostic criteria for hyperactivity and impulsivity.[1]
frequently leaves situations, rises from chair when remaining seated is expected
DSM-5-TR diagnostic criteria for hyperactivity and impulsivity.[1]
often feels restless
DSM-5-TR diagnostic criteria for hyperactivity and impulsivity.[1]
has difficulty engaging in leisure activities quietly
DSM-5-TR diagnostic criteria for hyperactivity and impulsivity.[1]
often 'on the go', acting as if 'driven by a motor'
DSM-5-TR diagnostic criteria for hyperactivity and impulsivity.[1]
often talks excessively
DSM-5-TR diagnostic criteria for hyperactivity and impulsivity.[1]
often interrupts with answers before questions have been completed
DSM-5-TR diagnostic criteria for hyperactivity and impulsivity.[1]
often has difficulty waiting for his/her turn (e.g., while waiting in line)
DSM-5-TR diagnostic criteria for hyperactivity and impulsivity.[1]
often interrupts or intrudes on others (e.g., interrupting conversations)
DSM-5-TR diagnostic criteria for hyperactivity and impulsivity.[1]
uncommon
increased criminal justice system involvement
Criminal justice system involvement is more common in adults with attention deficit hyperactivity disorder (ADHD) than a general population sample. People with ADHD are also more likely to be apprehended, convicted, and incarcerated.[85]
distracted easily by surroundings and external stimuli
DSM-5-TR diagnostic criteria for inattention.[1]
Other diagnostic factors
common
mild mood symptoms (dysphoria, mood lability, irritability, boredom)
May be an associated symptom.[45]
anxiety
May be an associated symptom.[33]
difficulty with peer interactions
May be an associated symptom.[45]
low self-esteem
May be an associated symptom, likely related to academic, peer, and personal difficulties.[86]
working memory (i.e., short-term memory) impairment
Associated sign on neuropsychological testing.[87]
processing speed impairment (i.e., the rate at which information is dealt with)
Associated sign on neuropsychological testing.[88]
Risk factors
strong
family history of ADHD
Family history is a strong determinant of attention deficit hyperactivity disorder (ADHD) with twin studies reporting about 70% to 80% heritability.[27] However, most of these twin studies have been conducted among children. Adult heritability studies are often retrospective and, therefore, less reliable. Studies that combine data across informants and those that use clinical diagnostic data find heritability estimates for adults in the same range (70% to 80%) as for children.[31] More replication is needed to determine the strength of this association in the adult ADHD population. Heritability in families with autism, dyslexia, and bipolar disorder is also increased.
male sex
A national survey for DSM-IV disorder prevalence identified 61.6% of adults with attention deficit hyperactivity disorder as men.[6] Among adults, the male-to-female ratio is reported to be approximately 3:2 and in other studies there is still male predominance.[6] Under-diagnosis in girls and women is considered likely, due to differences in presentation and under-recognition by healthcare professionals.[3]
weak
psychosocial adversity
obstetric complications in pregnancy or labour
Pregnancy and delivery complications such as toxaemia, eclampsia, poor maternal health, increasing maternal age, fetal postmaturity, duration of labour, fetal distress, low birth weight, and antepartum haemorrhage appear to confer a predisposition for attention deficit hyperactivity disorder.[67]
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