DIVA 2.0 - how to use
According to the
DSM-IV-TR, ascertaining the diagnosis of ADHD in adults involves determining
the presence of ADHD symptoms during both childhood and adulthood.
The main requirements for the diagnosis are that the onset of ADHD symptoms
occurred during childhood and that this was followed by a lifelong persistence
of the characteristic symptoms to the time of the current evaluation. The
symptoms need to be associated with significant clinical or psychosocial
impairments that affect the individual in two or more life situations.3
In order to simplify the evaluation of each of the 18 symptom criteria
for ADHD, in childhood and adulthood, the interview provides a list of concrete
and realistic examples, for both current and retrospective (childhood)
behavior. The examples are based on the common descriptions provided by adult
patients in clinical practice. Examples are also provided of the types of
impairments that are commonly associated with the symptoms in five areas of
everyday life: work and education; relationships and family life; social
contacts; free time and hobbies; self-confidence and self-image.
Because ADHD in adults is a lifelong condition that starts in childhood,
it is necessary to evaluate the symptoms, course and level of associated
impairment in childhood, using a retrospective interview for childhood behaviors.
Whenever possible the information should be gathered from the patient and
supplemented by information from informants that knew the person as a child
(usually parents or close relatives). The DIVA usually takes around 1 to 1,5
hours to complete.
The DIVA only asks
about the core symptoms of ADHD required to make the DSM-IV diagnosis of ADHD,
and does not ask about other co-occurring psychiatric symptoms, syndromes or
disorders. However comorbidity is commonly seen in both children and adults
with ADHD, in around 75% of cases. For this reason, it is important to complete
a general psychiatric assessment to enquire about commonly co-occurring
symptoms, syndromes and disorders. The most common mental health problems that
accompany ADHD include anxiety, depression, bipolar disorder, substance abuse
disorders and addiction, sleep problems and personality disorders, and all
these should be investigated. This is needed to understand the full range of
symptoms experienced by the individual with ADHD; and also for the differential
diagnosis, to exclude other major psychiatric disorders as the primary cause of
‘ADHD symptoms’ in adults.