Different rating scales assess ADHD by asking questions about behaviors, social life, and school or work. Each assigns points differently to determine the likelihood of ADHD.
Rating scales have long been used to help screen, evaluate, and monitor the symptoms of attention deficit hyperactivity disorder (ADHD) in children.
These are considered essential for diagnosing ADHD, especially in children. The questionnaires may be filled out by various people, from children to family and caregivers like teachers or healthcare professionals.
Generally, rating scales may be used to help evaluate or diagnose someone with ADHD, monitor progress, or get a bigger picture of someone’s behavior.
A typical rating scale will have 18 to 90 questions about the frequency of ADHD-related behaviors.
Questions are based on the definition of ADHD provided by the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Some examples of these behaviors include:
- having difficulty focusing, organizing, and paying attention
- having difficulty staying still
- squirming
- fidgeting
- having difficulty being patient
- being unable to wait your turn
- interrupting others
- having difficulty following through on instructions or tasks
Behaviors like squirming or inattention are common in healthy children, so scales usually ask about behaviors over the past 6 months.
Because the scales are subjective, having more than one person fill them out is best. Remember that these ADHD rating scales aren’t an official diagnosis, but they do help doctors provide one.
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ADHD rating scales are available for children, teenagers, and adults.
Questionnaires can take anywhere from 5 to 20 minutes to complete. You can find them online for free or sold at a cost and get them from your healthcare team.
While anyone can fill out a rating scale, only your doctor can accurately diagnose ADHD.
Common ADHD rating scales for children include the:
- Child Behavior Checklist (CBCL) for children 6 to 18 years old
- Conners-Wells’ Adolescent Self-Report Scale for teenagers
- National Institute for Children’s Health Quality (NICHQ) Vanderbilt Assessment Scale for children 6 to 12 years old
- Swanson, Nolan, and Pelham-IV Questionnaire (SNAP-IV) is for children 6 to 18 years old
- Conners Comprehensive Behavior Rating Scale (CBRS), which is for children ages 6 to 18
Some forms may separate questions based on sex. Boys and girls with ADHD tend to display different behaviors like being hyper versus being shy, respectively.
Typical questions and scoring system
Rating these behaviors can help measure inattention, hyperactivity, and impulsiveness.
Some rating scales, like the SNAP-IV, will also ask about classroom performance. The tests are designed to look for strong evidence of ADHD behaviors.
Some survey questions will include rating how often the person:
- avoids assignments or has trouble wrapping up details of a project
- interrupts
- is distracted by other things or people
- has trouble remembering appointments or obligations
For children, it will rate how often they act on the go. For adults, it will rate their difficulty unwinding or relaxing.
The adult rating scale may also include checklists, prompts, and questions about clinical history.
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. Some say that you need six counted behaviors to indicate ADHD while others ask you to add up scores. Read on to see how some common tests determine their results.
For children, there’s the CBCL. This checklist screens emotional, behavioral, and social problems. It covers many conditions, from autism to depression.
If someone shows six or more symptoms of inattention or hyperactivity, and impulsivity, they may have ADHD. Those symptoms must be considered inappropriate for the age and have been present for over six months.
If your child has scored 6 or more, bring the list to a doctor. Be sure to have another parent, teacher, or caregiver fill out the checklist too.
Many healthcare professionals use the NICHQ Vanderbilt Assessment Scale Diagnostic Rating Scale to help diagnose ADHD.
The scale is meant for children ages 6 to 12, but people in other age groups can use it, if applicable. Different forms are available for parents and teachers. Both forms screen for symptoms of ADHD and inattention.
The parent assessment scale has a separate section for conduct disorder or antisocial behavior, while the teacher assessment scale has an extra section on learning disabilities.
There must be six counted behaviors with a score of 2 or 3 out of the nine questions for inattention or hyperactivity to meet DSM-5’s criteria for ADHD.
For the performance questions, there must be a score of 4 or higher on two questions or a score of 5 on one question for the results to indicate ADHD.
If you’re using this test to track symptoms, add all the numbers from the responses and divide it by the number of responses. Compare the numbers from each assessment to monitor improvement.
The Conners CBRS is for assessing children ages 6 to 18. It’s specially formatted to help determine if:
- the student qualifies for inclusion or exclusion in special education
- the treatment or intervention is effective
- ADHD is a concern
- response to the treatment is positive
- what treatment plans may work best
Separate forms are available for parents, teachers, and the child. The short version is 25 questions and can take 5 minutes to an hour to complete. The long version is used for ADHD evaluation and monitoring progress over time. Scores above 60 indicate ADHD.
Your doctor will also convert those scores into percentile scores for comparison.
The SNAP-IV rating scale contains nine questions regarding inattention and nine regarding hyperactivity and impulsivity.
For each item, or behavior, you note the frequency from not at all to very much. These responses are ranked on a scale of 0 to 3.
Once you add up the scores for each section, you divide the number by 9 to determine an average.
From teachers, an average score on the Snap-IV scale above 2.56 regarding inattention and a score greater than 1.78 on hyperactivity-impulsivity questions would suggest a need for further investigation for ADHD.
ADHD may last for the rest of your child’s life, although most people report that symptoms improve as they age. The condition is manageable, however. Standard ADHD treatments involve one or more of the following:
- medication
- education
- therapy
- counseling
People with ADHD often take stimulant drugs like Adderall or Ritalin to balance the chemicals in their brains.
Your doctor can advise you on any possible side effects. They may also ask about any heart conditions or a family history of heart conditions before prescribing any medication.
For non-drug related treatments, a management plan might:
- include behavioral therapy, education, or coaching
- be based on the individual and their needs
- have goals and can be monitored
- involve family, friends, and healthcare professionals
Many healthcare professionals use ADHD rating scales to help form a diagnosis.
Since rating scales are subjective, it’s best to have people from different settings, like teachers or doctors, fill out the tests, too. If the scores indicate the likelihood of ADHD, bring your rating scale to a healthcare professional for a proper diagnosis.