Barkley’s Adult ADHD Checklist

Barkley’s Adult ADHD Checklist is an evidence based and scientifically valid, short screening for symptoms of Adult ADHD. It can be used to quickly and accurately screen a person for significant deficits which may lead to impairments, and could be helpful in predetermining the potential for Adult ADHD, so as to help indicate the need for a full diagnostic interview by a trained and certified mental health professional.

Adapted and edited by Peter Vang, ADDspeaker.org

Introduction

In a large-scale research project intended to identify the best items for the diagnosis of adult ADHD, Barkley and colleagues (2008) tested 99 new symptoms of ADHD, most of which were derived from either chart reviews of several hundred adults diagnosed with the disorder or rating scales and theories of executive functioning.

Eight were from the symptom list for oppositional defiant disorder (ODD). These items were evaluated using both large samples of clinic-referred adults diagnosed with ADHD (via DSM-IV), adults seen at the same clinic but not meeting criteria for the disorder, and a community sample of adults.

They were also evaluated in a study of children with ADHD who were followed to adulthood. Following the identification of the best item set from these 99 symptoms for discriminating between adults with ADHD and control groups, the resulting small set of items was then also tested against the DSM-IV 18-item set.

ASRS v.1.1: https://add.org/wp-content/uploads/2015/03/adhd-questionnaire-ASRS111.pdf

Results

The result was that of the nine items identified as being the most accurate at discriminating adults with ADHD, only three items were from DSM-IV and none were from the hyperactive–impulsive symptom list.

These items, shown in Table 2.2, are listed in descending order of discriminative accuracy. The final two items on this list, taken from DSM-IV, were retained but contributed just 1% more accuracy to the group discriminations.

Further analyses showed that a cutoff of 4 of the first seven items or six of the entire list of nine items would be useful for making a diagnosis of adult ADHD, and better at doing so than the DSM-IV.

Evidence

Other studies have also shown this reduced item set to be useful in identifying adult ADHD (Vergara-Moraques et al., 2011). Using this same original item set, Biederman and colleagues (Biederman et al., 2008) found that just eight items were as useful at identifying functional impairment in adults with ADHD as the entire item set, some of which overlap with those in Table 2.2. Later, Fedele, Hartung, Canu, and Wilkowski (2010) studied this same item pool for its utility in predicting impairment in ADHD in a large sample of college students and found that 17 items were sufficient to account for such impairment accurately.

Note that Barkley and colleagues (2008) developed their items from those that best discriminated between adults with ADHD and non-ADHD groups; that is a different undertaking than identifying items best at predicting functional impairment, as these latter two studies attempted to do.

So it is not surprising that the resulting reduced item sets found in these studies are not identical. All of this is to say that better items than those in DSM-5 exist as symptoms for diagnosing adults with ADHD, whether for discriminating them from other conditions or for predicting impairment.

Although this information was shared with the DSM-5 committee developing the criteria for ADHD, no new items were eventually included in the final DSM-5 for use with adults.

Questionnaire

References

Attention-Deficit Hyperactivity Disorder, Fourth Edition: A Handbook for Diagnosis and Treatment (2015), Russell A. Barkley, PhD., www.russellbarkley.org