ADHD Diagnosis in Adults

What Are ADHD Rating Scales?

Clinicians often use rating scales before diagnosing a patient with ADHD. Here, Dr. Russell Barkley shares how they work, why they’re valuable, and how they can benefit both children and adults.

Hand of teacher checking off "excellent" from options for ADHD rating scale test
Hand of teacher checking off "excellent" from options for ADHD rating scale test

Rating scales are used for assessing whether a patient meets the Diagnostic and Statistical Manual of Mental Disorders (DSM) criteria for a diagnosis of attention deficit hyperactivity disorder (ADHD). They allow the clinician to quantify behaviors that can’t be readily observed in the clinic — for example, how easily distracted a patient may be. The clinician wants to determine how a person’s symptoms compare with those in the rest of the population. There are scales for gauging ADHD symptoms, executive function, and so on.

How do ADHD rating scales work?

Most adult rating scales are self-report scale, filled out by the patient; others are administered by a clinician. The patient evaluates behaviors (“makes careless mistakes” or “talks excessively”) on a frequency basis: “never,” “rarely,” “sometimes,” “often,” “very often.”

Do rating scales work for children with ADHD?

Several studies show that children are not accurate reporters of their own ADHD symptoms. Although there are several scales for kids ages 12 and up, their responses are generally for clinical information, to find out how the child thinks about himself, rather than for diagnostic purposes. A more effective approach is to ask parents and two teachers — a math and an English teacher preferably — to fill out the scales.

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How long do ADHD rating scales take to fill out?

Typically, ratings scales ask about 18 behaviors and can be completed in five to 10 minutes.

Why are ADHD rating scales valuable?

They allow a clinician to assess behaviors over a long period of time. Most scales ask the patient to rate behaviors or symptoms based on the last six months. A clinician would have to live with his patient for that period to glean the information a rating scale provides.

Are ADHD rating scales tailored to the patient?

Absolutely. There are ratings scales that present norms for different ages, ethnic backgrounds, and regions of the country, as well as for both genders.

Should a clinician always use ADHD rating scales?

In most cases, yes. If a doctor doesn’t use one during an evaluation, the patient should know why. Clinicians are encouraged to use rating scales, even for diagnosing mood disorders or anxiety.

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