ABSTRACT

Introduction

Adult Attention Deficit/Hyperactivity Disorder (ADHD) is prone to misdiagnosis because its symptoms are subjective, share features with a broad range of mental, behavioral and physical disorders, and express themselves heterogeneously. Furthermore, Diagnostic and Statistical Manual of Mental Disorders (DSM) criteria for adult ADHD diagnosis remain underdeveloped, prompting a need for systematic and empirically-informed guidelines.

Method

This article presents a brief history of research on adult ADHD and reviews common sources of false positive and false negative diagnoses. A systematic, stepped diagnostic procedure is described that adheres to DSM guidelines and integrates the latest science on adult ADHD assessment and diagnosis.

Results

Seven steps are recommended: a structured diagnostic interview with the patient, collection of informant ratings, casting a wide net on symptoms using “or rule” to integrate informant reports, providing checks and balances on the “or rule” by enforcing the impairment criterion, chronicling a symptom timeline, ruling out alternative explanations for symptoms, and finalizing the diagnosis.

Conclusions

Based on the extant research, it is expected that the stepped diagnostic procedure will increase detection of malingering, improve diagnostic accuracy, and detect non-ADHD cases with subclinical difficulties or non-ADHD pathologies.

中文翻译：

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首次成人 ADHD 诊断的经验指导指南

摘要

介绍

成人注意力缺陷/多动障碍 (ADHD) 很容易被误诊，因为它的症状是主观的，与广泛的精神、行为和身体障碍具有共同的特征，并且表现出异质性。此外，成人 ADHD 诊断的精神疾病诊断和统计手册 (DSM) 标准仍然不完善，这促使需要系统和经验丰富的指南。

方法

本文简要介绍了成人 ADHD 的研究历史，并回顾了假阳性和假阴性诊断的常见来源。描述了一种系统的、阶梯式的诊断程序，它遵循 DSM 指南并整合了成人 ADHD 评估和诊断的最新科学。

结果

建议采取七个步骤：与患者进行结构化的诊断访谈，收集线人评级，使用“或规则”广泛收集症状以整合线人报告，通过执行损害标准对“或规则”进行制衡，记录症状时间表，排除症状的其他解释，并最终确定诊断。

结论

根据现有研究，预计阶梯诊断程序将增加对装病的检测，提高诊断准确性，并检测具有亚临床困难或非多动症病理的非多动症病例。