Is your brain constantly channel surfing? It’s an instant gratification world. You jump from song to song, photo to photo, convo to convo. Is this the new norm, or is it ADHD? Here’s a breakdown of ADHD rating scales to help you figure out what’s going on.
It’s a stereotype that only kids have ADHD. Rating scales are designed to evaluate and monitor symptoms across all ages. ADHD rating forms may be completed by:
- your child
The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) is the go-to classification of mental disorders. It’s used by most mental health professionals in the United States. ADHD rating scales ask questions based on the DSM-5’s definition of ADHD. Most tests are comprised of 18–90 questions.
The DSM-5 lists inattention, hyperactivity, and impulsivity as the key markers for ADHD. Some specific symptoms include:
- difficulty focusing
- lack of organizational skills
- poor attention
- struggling to be patient
- interrupting others
- inability to follow directions
- difficulty bringing a task to completion
Keep in mind…
ADHD rating scales don’t provide a diagnosis. You can’t self-diagnose ADHD, only a medical professional can.
ADHD tests take 5–20 minutes to complete. Phew! They can cost upwards of $150, but free self-testing versions can be found on the web. Just be sure the test you’re taking is validated and not composed on a personal website.
ADHD rating scales are broken into categories by age:
The DSM-5 states around 5 percent of American children have ADHD. According to the CDC, the rates might be higher based on community sample studies.
Some popular ADHD rating scales for kiddos ages 6–18 include the:
- Conners Comprehensive Behavior Rating Scale (CBRS) for ages 6–18
- Child Behavior Checklist (CBCL) for ages 6–18
- Swanson, Nolan, and Pelham-IV Questionnaire (SNAP-IV) for ages 6–18
- Conners Comprehensive Behavior Rating Scale (CBRS) for ages 6–18
Some forms ask questions differently based on sex. Studies show that girls with ADHD are predominantly inattentive and have poorer coping strategies when compared to boys with ADHD. Adolescent boys tend to be more hyperactive, and show more signs of physical aggression than girls.
Rating forms for adults include the:
- ADHD Rating Scale-IV (ADHD-RS-IV)
- Brown Attention-Deficit Disorder Symptom Assessment Scale (BADDS) for Adults
- Adult ADHD Self-Report Scale (ASRS v1.1)
- Adult ADHD Clinical Diagnostic Scale (ACDS) v1.2
The tests evaluate if symptoms add up to an actual ADHD diagnosis. Everyone has an off day once in a while, making it hard to concentrate. But when symptoms continue over a long period of time, it may be ADHD.
Rating scales focus on the following behaviors:
- Hyperactivity: Excessive talking, fidgeting, and restlessness
- Inattention: Inability to focus, forgetfulness, and “zoning out”
- Impulsivity: Acting without considering consequences or reactions
For children, school performance may be factored in. Children are tested based on their “on the go” actions (i.e. while in class or during playtime). Adults are rated on symptoms that pop up while inactive, and also their ability to maintain focus at work or school.
Responses are rated on a scale of 0–3 or 0–4 (depending on the test). Adult testing may have questions related to clinical history.
Some standard questions include:
- Do you interrupt others frequently?
- Are you easily distracted by others?
- Do you have a hard time remembering your schedule?
- Do you avoid wrapping up projects?
Every test has a unique way of scoring the probability of ADHD. Generally, higher scores equate to more intense symptoms. More on this in a second.
The CDC has a shortlist that covers the potential signs of ADHD. Kids have a different checklist than adults.
It’s always a good idea to have a parent, caregiver, or a teacher who knows your child fill out the checklist as well. If a child has scored 6 or more, it’s time to have them screened for ADHD by a doctor.
The Child Behavior Checklist (CBCL) screens for emotional, social, and behavioral abnormalities in children. It also covers symptoms of autism and depression.
The NICHQ (National Institute for Children’s Health Quality) Vanderbilt Assessment Scale Diagnostic Rating Scale is a popular choice for healthcare providers. The scale was designed for children ages 6–12, but other age groups may also use the test. There are additional forms for teachers and parents that screen for inattention.
The teacher assessment has a section devoted to learning disabilities. The parental version of the scale has a section for antisocial behavior and conduct disorders. After all, you know your kid best.
If you use the Vanderbilt Diagnostic Rating Scale, add all the numbers from your responses and divide it by the number of responses. For performance questions, a minimum score of 4 on two questions, or a score of 5 on one question point to ADHD. You can take the assessment every few months to monitor improvement.
The Conners CBRS was designed to assess children ages 6–18 for ADHD. It helps determine:
- ADHD is a concern for social and school performance
- if a student qualifies for special education
- what treatment plans may be most beneficial
- if treatment response is positive
Forms are available for the child, parents, and teachers. The short version has 25 questions. There’s a longer version of the assessment which is used to evaluate ADHD’s evolution over time. Scores of 60 and higher indicate ADHD.
The SNAP-IV rating scale tests for the frequency of ADHD symptoms. It has 18 questions in total. Nine questions test for impulsivity and hyperactivity and nine more test for inattention. Responses are scored on a scale of 0–3 (0 = never, 3 = very frequent). Once you’re done responding, add up your scores in each section. Then divide the sum by 9 to get an average.
The ratings vary based on who is answering the form. For hyperactivity and impulsiveness, the figure is 1.44 for parents and 1.78 for teachers. For inattentiveness, it’s 1.78 for parents and 2.56 for teachers.
ADHD may last your whole life. But like anything, it may change and greatly improve over time. The key to success is early action.
Some treatment options are:
- behavior therapy (BT)
- social skills training
- parenting skills training
- support groups
- central nervous system stimulants (CNS)
- nonstimulant medications
Central nervous system (CNS) stimulants are often prescribed to treat ADHD. They work by increasing dopamine and norepinephrine in the brain. Basically, the chemicals work to improve concentration and focus. Popular CNS stimulant drugs include:
- methylphenidate (Ritalin, Concerta, Metadate, Daytrana)
- amphetamine-based stimulants (Adderall, Dextrostat, Dexedrine)
- dextromethamphetamine (Desoxyn)
- dextromethylphenidate (Focalin)
Certain nonstimulant medications containing norepinephrine can also be prescribed for those with ADHD. Norepinephrine may help with attention and memory. These non-stimulant treatments include:
- antidepressants like bupropion (Wellbutrin)
- atomoxetine (Strattera)
Medications may work better when combined with other treatments. Or maybe meds just aren’t your thing. There are plenty of non-drug options to help you achieve long term success.
Psychotherapy can help a child or adult living with ADHD to:
- improve relationships with peers and authority figures
- open up about their feelings
- explore better ways to stay organized
- work through disruptive behaviors
- learn to relate more to other people’s needs
Behavior therapy (BT) helps to monitor behavioral patterns. A positive outcome would include:
- developing strategies on how to behave in certain situations
- discovering why certain negative behaviors become a pattern
- learning to “play well” with others
Though it continues to be debated in the scientific community, a healthy diet may help promote better concentration in those with ADHD. Avoid certain food additives, which might lead to hyperactivity. These include:
- FD&C Red No. 40 (allura red)
- FD&C Yellow No. 6 (sunset yellow)
- FD&C Yellow No. 5 (tartrazine)
- D&C Yellow No. 10 (quinoline yellow)
- sodium benzoate
Most of these additives are found in processed foods, fruit juices, carbonated sodas, icing, candy, cakes, salad dressing, cereals, and granola bars. As if worrying about mercury poisoning wasn’t enough, smoked haddock is often colored using D&C Yellow No. 10. Yikes.
Swap those processed foods for healthy fats. Studies have shown that omega-3 fatty acids may help improve concentration in children and adolescents with ADHD.
Excess energy is a big problem for those with ADHD. Research indicates just 20 minutes of outdoor activity can greatly benefit children with ADHD. Fun in the sun can help burn off that hyperactivity, and nature is best when it comes to finding that state of natural calm.
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Over the years, ADHD has become a throwaway term for when you lose your focus. But ADHD is a dynamic disorder with real life challenges. Taking an ADHD rating scale is a great first step toward finding focus in life.
When your T-score is less than 60, it usually means you don't have ADHD. A score higher than 60 may indicate ADHD. And a T-score higher than 70 means your ADHD symptoms are more serious. The Conners scale is only one test to diagnose ADHD.
On the ADHD-RS-5 scale, the individual rates the frequency of each symptom or behavior over the preceding week on a 4-point Likert scale ranging from 0 (no or rare symptoms) to 3 (severe or frequent symptoms). The sum of scores for the 18 items provides the total score (ranging between 0 and 54).
The Conners Abbreviated Symptom Questionnaire may be the most effective diagnostic tool for ADHD because of its brevity and high diagnostic accuracy, and the CBCL-AP could be used for more comprehensive assessments.
The “gold standard” for ADHD diagnosis includes a comprehensive clinical history and examination, rating scales, direct behavioral observations, neuropsychological testing, and objective, comparative analysis of different drug effects.
Rating scales will ask you to score behaviors, typically on a point scale of 0-3 or 4. Usually, 0 means never, and 3 or 4 means very often and the higher the score, the more severe the symptom. Each test has a different way of adding up the scores to determine the likelihood of ADHD.
The ADHD Rating Scale-IV is completed independently by the parent and scored by a clinician. The scale consists of 2 subscales: inattention (9 items) and hyperactivity-impulsivity (9 items). If 3 or more items are skipped, the clinician should use extreme caution in interpreting the scale.
Clinicians can designate the severity of ADHD as “mild,” “moderate” or “severe” under the criteria in the DSM-5.
People with strong hyperactive symptoms can talk and talk, or jump in when other people are speaking — unaware that they've cut someone else off or unable to help themselves. They might fidget, unable to control the urge to move their bodies.
The ADHD RS-IV with adult prompts is an 18 item scale based on the DSM IV TR criteria for ADHD that provides a rating of the severity symptoms. Scoring is based on a 4 point Likert-type severity scale where 0 = none, 1 = mild, 2 = moderate, and 3 = severe.
ADHD cannot be diagnosed accurately just from brief office observations or simply by talking to the person. The person may not always exhibit the symptoms of ADHD during the office visit, and the diagnostician needs to take a thorough history of the individual's life.
If you are concerned about whether a child might have ADHD, the first step is to talk with a healthcare provider to find out if the symptoms fit the diagnosis. The diagnosis can be made by a mental health professional, like a psychologist or psychiatrist, or by a primary care provider, like a pediatrician.
- Inattention: Short attention span for age (difficulty sustaining attention) Difficulty listening to others. ...
- Impulsivity: Often interrupts others. ...
- Hyperactivity: Seems to be in constant motion; runs or climbs, at times with no apparent goal except motion.
A widely used screening instrument for identifying adult ADHD is the Adult ADHD Self-Report Scale, version 1.1 (ASRS-v1. 1). Using a total score of ≥4 on the six-item Part A section of the scale as the threshold to indicate a positive screening test, the developers of the ASRS-v1.
- Disorganization and problems prioritizing.
- Poor time management skills.
- Problems focusing on a task.
- Trouble multitasking.
- Excessive activity or restlessness.
- Poor planning.
- Low frustration tolerance.