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Table 3 Enhancing ADHD diagnostic assessment in females: consensus recommendations

From: Females with ADHD: An expert consensus statement taking a lifespan approach providing guidance for the identification and treatment of attention-deficit/ hyperactivity disorder in girls and women

Rating scales, a clinical interview and an observational assessment.
Rating scales
• Norms from predominantly male or mixed-sex samples may disadvantage female patients. Rating scales providing female norms (see Table 4) may provide cut-offs more sensitive to female presentation.
• Where female norms are not available, greater emphasis on collateral information is required (e.g. parental and school reports).
• Findings should be interpreted cautiously. Rigid adherence to cut-offs may lead to a high proportion of false positives and negatives.
Clinical interview
• Assessors should bear in mind that family members may also have ADHD which may affect their judgment of ‘typical’ behaviour.
• Small modifications to symptoms may help to capture more female-centric behaviour (see topic for examples).
• Assessors should examine factors that may mask or moderate behaviour in different settings, e.g. compensatory strategies or accommodations at home or school (both functional and dysfunctional).
• Age-appropriate, common co-occurring conditions in females with ADHD should be explored, including ASD, tics, mood disorders, anxiety, eating disorders, fibromyalgia and chronic fatigue syndrome.
• A risk assessment and consideration of future challenges (e.g. personal, clinical, educational, social-relational and psychosexual) is required.
Collateral information
• School reports may comment more on attentional problems (daydreaming, distracted, disorganised, lacking in motivation and effort) or interpersonal relationship problems in girls with ADHD.
• Objective neuropsychological test results are not specific markers of ADHD but may provide useful supplementary clinical information. The QB scales have female-specific normative data and may therefore be more sensitive.