Quality standards for Adult Attention Deficit Hyperactivity Disorder (ADHD) services

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Criteria number Description Type (Essential or Optional)
One Information about the professional(s) who undertook the assessment, their role, training, professional registration, and experience in ADHD. Optional
Two A statement about the duration of the assessment. We consider anything less than 2-3 hours of direct clinical contact as an indicator of a poor-quality assessment. This would be the minimum time expected for a simple case with no significant comorbidity and very clear evidence of ADHD conducted by an experienced clinician. For more complex cases or those conducted by less experienced clinicians we would expect longer durations. This duration does not need to take place in a single appointment. Optional
Three A clear outline of the assessment process and where information was gathered. Typically, information from multiple sources, across different settings and direct observation / assessment with the person being assessed. Essential
Four Evidence from third party informants (corroborative information). Commentary must be provided where sources of information do not align, and an explanation given as to why one source is preferred over another. Where a diagnosis has been made in the absence of third-party information, clear justification for having concluded in this way. Essential
Five The report should include all the sections of a standard psychiatric history; reason for referral, history of present symptoms (including of mental disorders), personal history, family history, social history, past medical and psychiatric history, forensic history, history of substance misuse and risk assessment. The sections should include adequate clinical information in the form of narrative no tick boxes or short sections. Essential
Six Diagnostic reports should include a detailed account of each of the individual symptoms identified. Essential
Seven Clear evidence should be provided that a semi-structured interview format has been followed in the evaluation of ADHD symptom criteria. The Diagnostic Interview for Adult (DIVA), Conners’ Adult ADHD Diagnostic Interview (CAADID), or ADHD Child Evaluation for Adults (ACE+) provide an acceptable structure for this purpose. Optional
Eight The semi-structured interview for ADHD should be conducted directly with the patient (not sent out beforehand to be completed by the patient). This is important as the examples given by patients need to be probed by the clinician to be certain they reflect the ADHD symptom being scored. This is done by the clinician evaluating the patients account of their subjective experience and behaviour in real life situations. This is the same process as a mental state examination used as the basis for diagnostic assessments in adult mental health. Open-ended questions should be asked to allow for as many “spontaneous” answers on which clinical opinions should be based. Essential
Nine Scores from semi-structured interviews and self-report and informant questionnaires should be included in reports, but with a comprehensive accompanying narrative that has sufficient detail to substantiate the scores provided. Essential
Ten The accompanying narrative should include examples of details pertinent to the expression of ADHD symptoms in an individual’s life history and cover the context within which they occur. In other words, provide examples based on real situations in daily life. Essential
Eleven Reference to Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) and International Classification of Diseases, 11th revision (ICD-11) criteria for diagnosis and information provided to evidence how symptom thresholds are met, with examples. This includes symptoms being present in two or more settings (pervasive), of extended duration (persistent) and having specific and significant impact on the life of the person being assessed (problematic). Essential
Twelve Evidence to confirm that complex factors / differential / co-existing diagnoses have been explored (details of past mental health history, issues with learning or other possible neurodevelopmental conditions, past trauma). Essential
Thirteen A ‘formulation’ of how the presence of any additional complexity and comorbid diagnoses fit with the diagnosis of ADHD. Essential