ebook_ADHD2019

The World Federation of ADHD Guide 55 There is no evidence that neuroimaging exams (e.g. MRI, SPECT, PET scans) or EEGs should be part of the routine clinical assessment of ADHD, although they might be useful in very specific cases for differential diagnosis. Again, ADHD, as all other mental disorders, is a disorder relying exclusively in clinical assessment. 2,4 It is appropriate and helpful for clinicians to be trained in the application and interpretation of commonly used scales for ADHD. Although there are numerous different instruments, we give preferences for those that are open-access. For chil- dren and adolescents, one option is the SNAP (Swanson 23 – version 4) – IV scale. Although there are some controversies about its psychometric properties in popu- lation samples, this scale is helpful for clinicians in: a initial screening of ADHD symptoms; b getting information from teachers on ADHD symptoms when a direct con- tact is not feasible; c monitoring trajectory of symptoms along the time or during treatment (see Figure 3.1). When using this kind of scale, it is always important to check for adequate and valid translations in your language. For adults, there is the Adult ADHD Self Report Scale (ASRS) that has two versions: a screener version developed by the World Health Organization (WHO) with six items that is suitable for primary care settings and for a quick screening of ADHD. 24 This version is has been translated in various languages. There is also a long version with the 18 DSM symptoms, probably more useful for specialized settings. 25 Both versions use wording more adequate for adults for assessing symp- toms. Recently, a short version adapted for DSM-5 was made available. 26 A valuable instrument for assessing the diagnosis of ADHD in adults is the DIVA 2.0. This is a semi-structured interview based on DSM-IV-TR that can be downloaded in many languages. 27 Finally, several apps are available that might help clinicians in assessing and monitoring ADHD. 28 In English, one of the most downloaded is the ADHD test (available at Google Play and Apple Store). In Portuguese, there is the FOCUS TDAH 29 that has both the SNAP-IV and ASRS scales included inside the app and a platform for psycho-education. Although these instruments are open-access, it is important to highlight that none of them has yet its real clinical utility confirmed in well-designed trials. DIFFERENTIAL DIAGNOSES A general physical examination is mandatory to exclude clinical conditions that might be causing the inattentive and/or hyperactive/impulsive symptoms. In this