The DIVA is divided into three parts that are each applied to both childhood and adulthood:
(1) The criteria for Attention Deficit (A1)
(2) The criteria for Hyperactivity-Impulsivity (A2)
(3) The Age of Onset and Impairment accounted for by ADHD symptoms
Start with the first set of DSM-IV criteria for attention deficit (A1), followed by the second set of criteria for hyperactivity/impulsivity (A2). Ask about each of the 18 criteria in turn. For each item take the following approach: First ask about adulthood (symptoms present in the last 6-months or more) and then ask about the same symptom in childhood (symptoms between the ages of 5 to 12 years).
Read each question fully and ask the person being interviewed whether they recognize this problem and to provide examples. Patients will often give the same examples as those provided in the DIVA, which can then be ticked off as present. If they do not recognize the symptoms or you are not sure if their response is specific to the item in question, then use the examples, asking about each example in turn.
For a problem behavior or symptom to be scored as present, the problem should occur more frequently or at a more severe level than is usual in an age and IQ matched peer group, or to be closely associated with impairments. Tick off each of the examples that are described by the patient. If alternative examples that fit the criteria are given, make a note of these under “other”. To score an item as present it is not necessary to score all the examples as present, rather the aim is for the investigator to obtain a clear picture of the presence or absence of each criterion.
For each criterion, ask whether the partner or family member agrees with this or can give further examples of problems that relate to each item. As a rule, the partner would report on adulthood and the family member (usually parent or older relative) on childhood. The clinician has to use clinical judgement in order to determine the most accurate answer. If the answers conflict with one another, the rule of thumb is that the patient is usually the best informant.7
The information received from the partner and family is mainly intended to supplement the information obtained from the patient and to obtain an accurate account of both current and childhood behavior; the informant information is particularly useful for childhood since many patients have difficulty recalling their own behavior retrospectively. Many people have a good recall for behavior from around the age of 10-12 years of age, but have difficulty remembering the pre-school years.
For each criterion, the researcher should make a decision about the presence or absence in both stages of life, taking into account the information from all the parties involved. If collateral information cannot be obtained, the diagnosis should be based on the patient’s recall alone. If school reports are available, these can help to give an idea of the symptoms that were noticed in the classroom during childhood and can be used to support the diagnosis. Symptoms are considered to be clinically relevant if they occurred to a more severe degree and/or more frequently than in the peer group or if they were impairing to the individual.
Age of onset and impairment
The third section on Age of Onset and Impairment accounted for by the symptoms is an essential part of the diagnostic criteria. Find out whether the patient has always had the symptoms and, if so, whether any symptoms were present before the 7th year of age. If the symptoms did not commence until later in life, record the age of onset. Then ask about the examples for the different situations in which impairment can occur, first in adulthood then in childhood. Place a tick next to the examples that the patient recognizes and indicate whether the impairment is reported for two or more domains of functioning. For the disorder to be present, it should cause impairment in at least two situations, such as work and education; relationships and family life; social contacts; free time and hobbies; self-confidence and self-image, and be at least moderately impairing.
Summary of symptoms
In the Summary of Symptoms of Attention Deficit (A) and Hyperactivity-Impulsivity (HI), indicate which of the 18 symptom criteria are present in both stages of life; and sum the number of criteria for inattention and hyperactivity/impulsivity separately. Finally, indicate on the Score Form whether six or more criteria are scored for each of the symptom domains of Attention Deficit (A) and Hyperactivity-Impulsivity (HI).
For each domain, indicate whether there was evidence of a lifelong persistent course for the symptoms, whether the symptoms were associated with impairment, whether impairment occurred in at least two situations, and whether the symptoms might be better explained by another psychiatric disorder. Indicate the degree to which the collateral information, and if applicable school reports, support the diagnosis. Finally, conclude whether the diagnosis of ADHD can be made and which subtype (with DSM-IV code) applies.
1. Diagnostic Interview for ADHD in Adults 2.0 (DIVA 2.0), in: Kooij, JJS. Adult ADHD. Diagnostic assessment and treatment. Springer, 2012.
2. Kooij JJS, Francken MH: Diagnostisch Interview Voor ADHD (DIVA) bij volwassenen. Online available at www.kenniscentrumadhdbijvolwassenen.nl, 2007 and published in English in reference 1.
3. American Psychiatric Association (APA): Diagnostic and Statistical Manual of Mental Disorders, Text Revision, Fourth Edition. Washington DC, 2000.
4. Applegate B, Lahey BB, Hart EL, Biederman J, Hynd GW, Barkley RA, Ollendick T, Frick PJ, Greenhill L, McBurnett K, Newcorn JH, Kerdyk L, Garfinkel B, Waldman I, Shaffer D: Validity of the age-of-onset criterion for ADHD: a report from the DSM-IV field trials. J Am Acad Child .Adolesc Psychiatry 1997; 36(9):1211-21.
5. Barkley RA, Biederman J: Toward a broader definition of the age-of-onset criterion for attention-deficit hyperactivity disorder. J Am Acad Child Adolesc Psychiatry 1997; 36(9):1204-10.
6. Faraone SV, Biederman J, Spencer T, Mick E, Murray K, Petty C, Adamson JJ, Monuteaux MC: Diagnosing adult attention deficit hyperactivity disorder: are late onset and subthreshold diagnoses valid? Am J Psychiatry 2006;163(10):1720-9.
7. Kooij JJS, Boonstra AM, Willemsen-Swinkels SHN, Bekker EM, De Noord I, Buitelaar JL: Reliability, validity, and utility of instruments for self-report and informant report regarding symptoms of Attention-Deficit/Hyperactivity Disorder (ADHD) in adult patients. J Atten Disorders 2008; 11(4):445-458.