Adhd19 Algorithm
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Zayana4Adhd19 Algorithm
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Zayana4Adult ADHD Assessment and Diagnosis Approach
It is suggested that the diagnosis of adult ADHD requires 2-3 visits.
Assessment of ADHD is not a clinical emergency and requires enough time
to gather necessary evidence for the diagnosis.
Suspect ADHD
Self-referral
Adult patient referred for assessment of potential ADHD
Re-assessment of adult patient previously diagnosed with ADHD in childhood
First Visit
• Standard mental health assessment
• Review current symptoms*
• Assess current symptom using a brief validated tool*
• Assess functional impairment at home, work, school and in relation-
ships*
• Identify comorbidities*
• Perform screening for substance use*
• Exclude other disorders
• Assess physical health Consider Referral*: Consider referral to a psychiatrist
• Gather/review additional information in the following several presentations and co-
• Request past medical records and complete medical history
conditions:
• Request childhood and developmental history*
• Identify informants and obtain consent to contact them to collect • Extreme or severe dysfunction
information*
• Schedule a second visit, preferably include an informant who can • Suicidal or homicidal ideations
corroborate symptoms • Substance use or dependence
• Psychosis
• Extreme psychosocial stressors or present trau-
matic events
Second Visit (in 2-4 weeks) • Previous treatment failures
• Review gathered information and assessment results
• Atypical presentation – if presentation as brand
new symptoms this is not ADHD, even if not diag-
• Interview for corroboration of childhood symptoms nosed as a child the symptoms must concur
• Interview for corroboration of current symptoms and disfunction
• Consider severity of impairment
• Meets DSM-5 criteria for ADHD diagnosis*
• Confirm and document diagnosis
Third Visit
• Explain diagnosis*
• Discuss treatment options, risks and benefits*; shared decision-making
• Consider non-pharmacological management*
• Initiate treatment if recommended*
• Discuss need for treatment monitoring
• Educate patient on their responsibilities in managing their condition
and self-management strategies
Follow-up Visits
• New diagnosis, uncontrolled symptoms or change in medication – within 30 days; monthly until functionality is significantly improved;
every 3-6 months once stabilized
• Review symptoms and functional abilities, including diurnal variations in symptoms
• Review impressions of informants
• Monitor for drug adverse effects*
• Monitor for adherence to therapy
• Monitor vital signs (weight, blood pressure and heart rate)
• Monitor for signs of misuse/abuse/diversion
• Adjust therapy as needed
• Assist with additional management strategies for psychological, behavioral, occupation and educational needs (e.g., skill-building
trainings, psycho-education, parenting, vocational and/or educational accommodation)*
* = Resource available in this Toolkit; this approach is suggested as a general guidance only and is modifiable to fit local context;
second and third visits can be combined if enough evidence to diagnose ADHD and initiate treatment
Copyright © 2019 American Academy of Family Physicians. All rights reserved
Authors: Loskutova N, Callen E, Lutgen C; 2019, AAFP National Research Network
Updated August 30, 2019