Articles
Essays on adult ADHD assessment from the developer of the LODHI-A: differential diagnosis, high-functioning presentations, the evidence problems of retrospective history, and the craft of the diagnostic interview.
The Recognition Problem: Why ADHD Checklists Ask the Wrong Kind of Question
The central problem with ADHD symptom checklists is that they supply the patient with the answers. A criterion read aloud asks the patient only to recognize themselves in a description — and that is a far easier test to pass than being asked to produce the evidence yourself.
Read the essay → Clinical InterviewingThe "Why Now?" Question
The most diagnostically informative question in an adult ADHD evaluation is not on any symptom checklist. It is "why now?" — and the answer usually tells you more than the symptom inventory that follows.
Read the essay → Clinical MethodEvaluating the Patient Who Arrives With the Diagnosis
A patient who already knows the DSM-5 criteria can endorse every one of them honestly, which means your checklist has stopped measuring anything. The evaluation has to move from confirming symptoms to reconstructing a life.
Read the essay → Compensation DetectionThe High-Functioning Patient: What Does It Cost You to Achieve It?
Outcome measures — degrees, careers, marriages — conceal impairment when intelligence and effort are paying for them. Assessing a high-functioning adult means measuring the cost of the performance rather than admiring the performance itself.
Read the essay → Sex DifferencesWhy ADHD Assessment Keeps Missing Women
ADHD is underdiagnosed in women because the diagnosis depends on a childhood record of visible disruption, and girls are socialized to produce a quiet one. The symptoms don't disappear; they turn inward, and the chart calls them anxiety.
Read the essay → Differential DiagnosisADHD or Anxiety: Reading the Shape of the History
Anxiety and ADHD produce nearly identical complaints in adults. The differential rarely turns on which symptoms are present; it turns on when they started, whether there were ever good years, and what the mind is doing at the moment attention fails.
Read the essay → Differential DiagnosisADHD and Trauma: The Same Surface, Two Different Histories
ADHD and trauma-related disorders overlap on nearly every observable symptom. What separates them is not symptom content but temporal structure — which makes the longitudinal history, not the symptom checklist, the differentiating instrument.
Read the essay → Developmental HistoryReconstructing Childhood
DSM-5 requires that several ADHD symptoms were present before age 12. In an adult evaluation, that criterion cannot be observed — only reconstructed. Which makes it a problem of evidence quality, not a memory quiz.
Read the essay → Assessment MethodHow Long Should an Adult ADHD Evaluation Take?
A comprehensive adult ADHD evaluation that can withstand scrutiny typically requires two to three hours of direct clinical time, and it is usually better delivered across more than one session than compressed into a single sitting.
Read the essay → Remote AssessmentAssessing Adult ADHD Over Telemedicine: What the Camera Keeps and What It Loses
Adult ADHD can be diagnosed over telemedicine, and a careful video evaluation is not a lesser diagnosis with an asterisk. What separates a real remote assessment from a prescription mill is rigor, not resolution.
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