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
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.
Diagnostic Interview for ADHD in Adults 2.0 (DIVA 2.0), in: Kooij, JJS. Adult
ADHD. Diagnostic assessment and treatment. Springer, 2012.
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.
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