ADHD

Diagnostic evaluation

{ADHD evaluation}

PRESENTING COMPLAINTS OR ISSUES
Patient history: 
1. Symptoms of hyperactivity and impulsivity:
[-] excessive fidgetiness (eg, tapping the hands or feet, squirming in seat)
[-] difficulty remaining seated when sitting is required (eg, at school, work, etc)
[-] feelings of restlessness (in adolescents) or inappropriate running around or climbing in younger children
[-] difficulty playing quietly
[-] difficult to keep up with, seeming to always be "on the go"
[-] excessive talking
[-] difficulty waiting for turns
[-] blurting out answers too quickly
[-] interruption or intrusion of others
 
2. Symptoms of inattention: 
[-] failure to provide close attention to detail, careless mistakes
[-] difficulty maintaining attention in play, school, or home activities
[-] seems not to listen, even when directly addressed
[-] fails to follow through (eg, homework, chores, etc)
[-] difficulty organising tasks, activities, and belongings
[-] avoids tasks that require consistent mental effort
[-] loses objects required for tasks or activities (eg, school books, sports equipment, etc)
[-] easily distracted by irrelevant stimuli
[-] forgetfulness in routine activities (eg, homework, chores, etc)

3. Symptom development:
Age of onset:

4. Context - settings in which symptoms are present:
[-] home 
[-] school/work 
[-] social settings (friends/relatives)
[-] other settings
Details:

5. Evidence symptoms interfere with, or reduce the quality of function in settings (see below^):
a) Social: 
-

b) School/work: 
-

6. Past mental health history: 
[-] anxiety
[-] depression
[-] mania
[-] psychosis
[-] substance use/abuse
[-] eating disorder
Details: 
-

7. Medical history:
[-] epilepsy
[-] hyperthyroidism
[-] cardiovascular disease
[-] childhood developmental delay (eg milestones)
Details: 
-

8. ADHD Medication History:
Stimulants: 
[-] methylphenidate 
[-] amphetamine 
Non-stimulants: 
[-] viloxazine 
[-] atomoxetine 
[-] bupropion 
[-] guanfacine 
[-] amantadine 
Details: 
-

9. Collateral information:
a) School reports^: 
-

b) Parental information^: 
-

c) Work history^: 
-

[Mental state observations]

{abnormalities}
[-] appearance
[-] behaviour
[-] motor activity
[-] speech
[-] mood (patient - subjective)
[-] affect (examiner - observations)
[-] thought processes
[-] thought content
[-] perceptions
[-] cognition
[-] orientation
[-] attention/concentration
[-] memory
[-] abstract reasoning
[-] insight
[-] judgement
[-] numeric skills
[-] construction and spatial skills
[-] abstract thinking

Comments:

[Vital signs]

HR (bpm): 
  Heart rhythm: 
  BP seated (mmHg): 
  BP standing (mmHg): 
  BP lying (mmHg):

PHYSICAL EXAMINATION
Relevant examination findings: {abnormalities}
[-] chest deformity/asymmetry
[-] chest scars
[-] raised JVP (>3 cm above sternal angle at 45 deg.)
[-] heart murmur/s:

[12-lead resting ECG]

Findings:
[+] normal, [-] abnormal {normal ranges}
[+] Rate {60-100/min} 
[+] Rhythm {sinus} 
[+] PR interval {120-200 ms} 
[+] QRS axis {-30 to +90 degrees} 
[+] QRS duration {< 120 ms} 
[+] ST segments {isoelectric} 
[+] T wave morphology 
[+] Corrected QT interval

ASSESSMENT
Diagnostic criteria:
The American Psychiatric Association has defined consensus criteria for the diagnosis of ADHD, which are published in the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5).

For children <17 years, the DSM-5 diagnosis of ADHD requires:
[-] 6+ symptoms of hyperactivity and impulsivity or 6+ symptoms of inattention.

For adolescents 17+ years and adults:
[-] 5+ symptoms of hyperactivity and impulsivity or 5+ symptoms of inattention.

In addition, the following conditions must be met:

[-] Several inattentive or hyperactive-impulsive symptoms were present before age 12 years.
[-] Several symptoms are present in two or more settings (eg, at home, school or work; with friends or relatives; in other activities).

[-] There is clear evidence that the symptoms interfere with, or reduce the quality of, social, school, or work functioning.

[-] The symptoms do not happen only during the course of schizophrenia or another psychotic disorder. The symptoms are not better explained by another mental disorder (e.g. Mood Disorder, Anxiety Disorder, Dissociative Disorder, or a Personality Disorder).

Diagnostic comments:
-

MANAGEMENT PLAN
Referrals:
-

Information and advice given:
-

Medication:
-

FOLLOW-UP
Outstanding issues:
-

Next appointment:
-

ADHD Screening Tools and Forms (Downloads)

Child forms

Adult forms

External links

None