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. |