Interviewing Adolescents and Adults

When I assess an older adolescent or adult, I invite them to have a parent, spouse, or close friend join in at least a portion of their clinical interview. This is not essential, but it may provide helpful information and an additional perspective. Of course, it may not be possible or desirable to involve a parent in the evaluation. The parent may be unavailable due to long distance, ill health, or death. For adults, a parent may have little relevant information about the patient's current and recent abilities. In this situation the patient may choose to invite a close friend or relative.

Sometimes clinicians become too cautious about making a diagnosis of ADHD in adults because the data are essentially self-reported. They feel that some "hard evidence" must be provided, such as old report cards with some teacher comments about learning or behavior problems, or direct testimony from a parent or childhood friend. They feel that self-reporting is "too subjective." It is certainly possible for the self-report to be biased or deceptive, but most skilled clinicians are able to sort this out in a comprehensive clinical interview. Diagnostic decisions in many other fields of medicine are made based primarily on self-reporting. For example, there is no laboratory test or diagnostic instrument that can measure pain, so self-reported information about the location, intensity, and timing of pain may be crucial for diagnostic decision-making in medicine, especially when there are few other clues on which to base a diagnostic or treatment decision.

Indeed, self-reported information about mental processes and cognitive functioning should play a central role in assessment of symptoms of ADHD, particularly for adults. Patricia Murphy and Russell Schachar (2000) reported studies showing that adults can give a true account of their childhood and current symptoms of ADHD. And it makes sense that assessment for this disorder should not be an adversarial process in which patients are required to prove that they meet diagnostic requirements while the clinician functions as a "devil's advocate," arguing that they do not. I believe that an evaluation for ADHD should be collaborative, with the patient being encouraged to describe the problems that have caused him to seek treatment, and the clinician inquiring for examples and additional information to understand the context in which these difficulties exist and the factors that may be causing them.

In evaluating for ADHD, I always consider and carefully weigh alternative diagnostic hypotheses for the patient's problems. Not everyone who thinks they have ADHD does, in fact, have it. But usually people who seek evaluation and treatment, especially those who self-refer as older adolescents or adults, come because they are suffering from some significant difficulties for which they need help. The evaluator should be a sensitive and compassionate listener who uses clinical skills to elicit relevant information from the patient and then uses diagnostic abilities to identify underlying causes, to provide a plan for effective treatment, and to guide the implementation, monitoring, and refinement of that treatment plan.

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