Last reviewed: 26 Dec 2021
Last updated: 11 May 2021



History and exam

Key diagnostic factors

  • presence of risk factors
  • onset prior to age 12 years
  • past or present academic dysfunction
  • present or past occupational dysfunction
  • familial and relationship dysfunction
  • drug and alcohol misuse
  • thrill-seeking behaviour
  • driving accidents
  • fails to pay attention to details and careless mistakes at work, school, etc.
  • has difficulty maintaining attention in tasks
  • seems not to listen when being spoken to
  • does not follow instructions and does not finish duties and assigned tasks (not due to misunderstanding or oppositional behaviour)
  • has organisational difficulties
  • avoids and/or dislikes tasks that require maintaining mental effort
  • frequently loses things needed for tasks or activities
  • frequently forgetful in daily tasks
  • fidgets often with hands or feet and moves in seat
  • frequently leaves situations, rises from chair when remaining seated is expected
  • often feels restless
  • has difficulty engaging in leisure activities quietly
  • often acts as though 'on the go
  • often talks excessively
  • often interrupts with answers before questions have been completed
  • often has difficulty waiting for his/her turn
  • often interrupts or intrudes on others (e.g., interrupting conversations)
  • increased criminality
  • distracted easily by surroundings and external stimuli

Risk factors

  • family history of ADHD
  • male sex
  • psychosocial adversity
  • other environmental factors

Diagnostic investigations

1st investigations to order

  • Conners Adult ADHD Rating Scale
  • Brown Attention Deficit Disorder Scale
  • World Health Organization Adult ADHD Self-Report Scale
  • Wender Utah Rating Scale
  • neuropsychological testing

Investigations to consider

  • urine drug screen
  • electroencephalogram
  • brain imaging (CT or MRI)
  • polysomnography
  • computer-based programme

Treatment algorithm



Marios Adamou, MD, MSc, LL.M, MA, MBA, PhD, FRCPsych, FFOM

Consultant Psychiatrist

South West Yorkshire NHS Partnership Foundation Trust

University of Huddersfield




MA is a member of the UK Adult ADHD Network (UKAAN) executive committee, Adult ADHD and Autism Service at South West Yorkshire Partnership NHS Foundation Trust, and a board member of the Wigan and Northumberland Clinical Commissioning Groups. MA has received a National Institute for Health Research (NIHR) grant for use of AI in diagnosis of attention deficit hyperactivity disorder.


Professor Marios Adamou would like to gratefully acknowledge Dr Bridget Craddock, Dr S. Nassir Ghaemi, and Dr Elizabeth A. Whitham, the previous contributors to this topic.


BC declares that she has no competing interests. SNG has received research grants from Pfizer, served on the speakers' bureaus of Astra Zeneca and Pfizer, and received honoraria from Bristol Myers Squibb. Neither SNG nor his family hold equity positions in pharmaceutical corporations. EAW declares that she has no competing interests.

Peer reviewers

Gianni Faedda, MD

Lucio Bini Mood Disorders Center

New York



GF has been reimbursed by Astra Zeneca, the manufacturer of Seroquel, for attending several conferences.

David W. Goodman, MD

Assistant Professor

Department of Psychiatry and Behavioral Sciences

Johns Hopkins School of Medicine




DWG has received research grants from Shire Pharmaceuticals. DWG has received speaking fees from Neuroscience Education Institute, Temple University, American Professional Society of ADHD and Related Disorders, Medscape, and WebMD. DWG has been a paid consultant to American Physician Institute for Advanced Professional Studies, Prescriber's Letter, Consumer Reports, Thomson Reuters, GuidePoint Global, Shire Pharmaceuticals, McNeil Pediatrics, Cephalon, Teva Pharmaceuticals, Lundbeck, Otsuka Pharmaceuticals, and Novartis.

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