Adult ADHD assessment: An integrated clinical-forensic perspective.

Abstract

Initial diagnoses of ADHD in adulthood have increased tremendously in recent years. Making such diagnoses accurately is challenging because ADHD is a childhood-onset disorder and because many adults have an incentive for obtaining a diagnosis (e.g., access to stimulant medication or disability accommodations). Certain elements of a forensic perspective can lead to more accurate ADHD diagnoses in adults and targeted treatment for clients who genuinely need it, and more appropriate alternative clinical responses to those who do not. This article describes the research base for integrating forensic principles into clinical assessments of adults presenting with ADHD-related concerns, and provides a scientific model for such assessments, from referral through conclusions. Public Significance StatementThis article presents a practical model for increasing the accuracy of ADHD diagnoses in adults. Making more accurate diagnoses not only increases the efficient use of treatment resources, but also reduces unnecessary problems such as medication side effects and stigma from a diagnostic label.

Profiles of Diagnosed and Undiagnosed College Students Meeting ADHD Symptom Criteria

“…First, diagnosticians and treatment professionals should seek to obtain records from prior evaluations to rule out the chance that a student is misrecalling or misinterpreting the results of those evaluations (and thus their diagnostic status). Second, as others (Lovett & Davis, 2017; Sibley, Mitchell, & Becker, 2016) have emphasized, ADHD evaluations in adulthood, like those in childhood, should emphasize collateral reports from third-party informants who know the client well, to confirm and complement self-reports, which may overestimate or underestimate true levels of symptoms and impairment. Third, a prior diagnosis of ADHD is not a reason to abbreviate a new evaluation protocol; evaluations done to “update” an ADHD diagnosis must be full, comprehensive evaluations conducted without assuming that the earlier diagnosis (even if it is accurate) still accurately applies to the client, given rates of remission and our findings of over half of students with a prior (reported) diagnosis failing to meet current symptom thresholds.…”

“…In many cases, the student does not have documentation of a childhood diagnosis, K-12 school records that demonstrate presence of symptoms and impairment, or a history of treatment (e.g., medication, behavioral interventions, or academic assistance). The research and clinical literature is replete with criticism for diagnoses based largely on self-reported complaints with little or no corroboration (e.g., Lovett & Davis, 2017; Musso & Gouvier, 2014; Nelson, Whipple, Lindstrom, & Foels, 2019). This is particularly true when incentives such as medication or disability accommodations are contingent on the diagnosis, as is often the case with ADHD (Harrison, Edwards, & Parker, 2007; Sollman, Ranseen, & Berry, 2010).…”

A Place for Psychological Testing in the Assessment of Adult ADHD

“…For example, a thoroughly outlined diagnosis and assessment of childhood ADHD via medical records may be all that is needed to meet the DSM-5 criteria for childhood onset, while a poorly documented ADHD diagnosis in childhood may require additional sources of information. Finally, although often time-consuming, the most thorough approach is to gather multiple collateral reports and to compare these reports against academic or medical records (Lovett and Davis, 2017). J Health Serv Psychol (2020) 46:119-131…”

Assessing Adults for ADHD: A Systematic, Evidence-Based Protocol

“…The model described in this article is inspired by both traditional clinical and forensic approaches to evaluation (Lovett & Davis, 2017). Recent research on adult ADHD (e.g., Cepeda et al, 2015;Marshall, Hoelzle, Heyerdahl, & Nelson, 2016) has also informed our thinking.…”