Frequently Asked Questions

The LODHI-A is a semi-structured clinical interview guide for comprehensive adult ADHD assessment. Its full name — Longitudinally Oriented Diagnostic Historical Interview — ADHD — reflects its core methodology: tracing the developmental trajectory of symptoms across the patient's entire lifespan through naturalistic clinical conversation rather than criterion-by-criterion questioning. The instrument systematically screens for differential diagnoses, detects compensatory strategies that mask ADHD in high-functioning and historically underdiagnosed populations, and integrates cultural, gender-specific, and socioeconomic considerations throughout every module. It was developed by Shafi Lodhi, MD, a dual fellowship-trained forensic neuropsychiatrist, and is designed for use by licensed mental health professionals, including psychiatrists, primary care physicians, psychologists, psychiatric nurse practitioners, physician assistants, licensed clinical social workers (LCSWs), licensed professional counselors (LPCs), licensed mental health counselors (LMHCs), licensed professional clinical counselors (LPCCs), and other clinicians trained in diagnostic assessment.

The LODHI-A was developed by Shafi Lodhi, MD, a board-certified forensic neuropsychiatrist with dual fellowship training from Stanford in forensic psychiatry and neuropsychiatry. It was built in clinical practice over hundreds of patient encounters, not in a research laboratory, and every module exists to solve a diagnostic problem encountered with real patients.

The DIVA-5 is the most widely used structured diagnostic interview for adult ADHD internationally and is considered a gold standard in many settings. The LODHI-A differs in three fundamental ways. First, the DIVA-5 provides examples of each symptom for the patient to identify with — a recognition task. The LODHI-A never supplies examples; the patient must generate their own evidence of impairment — a recall task. Second, the DIVA-5 focuses exclusively on core ADHD symptoms and recommends a separate psychiatric assessment for co-occurring conditions. The LODHI-A embeds differential diagnostic screening throughout every module, maintaining a running differential updated continuously as information accrues. Third, the DIVA-5 is organized criterion by criterion. The LODHI-A is organized around the patient's narrative, and diagnostic criteria are evaluated through open-ended questioning and longitudinal cross-referencing as the story unfolds.

The ACE+ is a semi-structured diagnostic interview widely used in the UK NHS and internationally. It guides clinicians through DSM-5 or ICD-11 criteria, screens for co-existing conditions, and includes pre-assessment questionnaires. The LODHI-A differs in its underlying diagnostic logic: where the ACE+ organizes the interview around the criteria themselves, the LODHI-A organizes the interview around the patient's narrative and uses that narrative to evaluate whether criteria are met. The patient is never walked through the criteria directly. Evidence for or against each criterion emerges through open-ended questioning, patient-generated examples, and longitudinal cross-referencing. The LODHI-A also embeds cultural, gender-specific, and socioeconomic considerations throughout every module rather than addressing them in discrete sections.

The ASRS is a screening tool, not a diagnostic instrument. It identifies individuals who may warrant further evaluation by asking patients to rate symptom frequency on a Likert scale. The LODHI-A is the further evaluation — a comprehensive clinical interview that requires patients to provide concrete, specific examples of functional impairment across multiple life domains and developmental periods. The two instruments serve complementary rather than competing purposes, and many clinicians use the ASRS as a pre-screening measure before administering the LODHI-A.

Checklist-based assessments reformat DSM-5 criteria as questions and tally endorsed symptoms. A narrative-based assessment starts from the patient's own account of their life and evaluates whether diagnostic criteria are met through the evidence that emerges. In a checklist approach, the patient recognizes symptoms that have been described to them; in a narrative approach, the patient must produce their own evidence of impairment without being given the expected answers. The LODHI-A also embeds differential screening throughout the interview and systematically probes for the hidden effort behind apparently adequate functioning — two things a criterion-tallying approach is not structured to do.

The LODHI-A is most valuable when the diagnostic question is genuinely uncertain. If the presentation is straightforward — clear childhood history, classic symptom profile, corroborating collateral — a criterion-structured instrument may be sufficient. The LODHI-A earns its administration time when the clinician is working with a patient whose coping infrastructure may be masking impairment, whose presentation overlaps significantly with anxiety, trauma, or other differential considerations, who arrives having already researched the diagnosis extensively, or whose cultural or developmental background makes a standard criterion walkthrough unreliable.

Yes. The LODHI-A is designed to function as a comprehensive standalone evaluation, but it integrates naturally into multi-method assessment workflows. Clinicians commonly pair it with the ASRS or Barkley scales as pre-screening measures, use the LODHI-A-COL collateral forms alongside other instruments, and incorporate neuropsychological testing data when available. The LODHI-A's narrative structure complements rather than duplicates the data produced by rating scales and criterion-structured interviews.

Licensed mental health professionals who conduct diagnostic evaluations: psychiatrists, primary care physicians, psychologists, psychiatric nurse practitioners, physician assistants, licensed clinical social workers (LCSWs), licensed professional counselors (LPCs), licensed mental health counselors (LMHCs), licensed professional clinical counselors (LPCCs), and other clinicians trained in diagnostic assessment, practicing within their scope. The instrument assumes clinical judgment in interpreting responses, probing for specificity, and maintaining a running differential diagnosis. It is not a self-administered questionnaire.

Administration time varies depending on clinician familiarity with the instrument and how many modules are covered in a given evaluation. Typical administrations run 120 to 180 minutes, often split across two to four sessions. Suggested session break points are built into the interview, and the number of sessions depends on clinical complexity and patient tolerance. The length is intentional: the extended format functions partly as a behavioral sample of sustained attention and provides the time necessary to trace symptom trajectories across developmental periods and probe beyond surface-level endorsements.

Yes. The LODHI-A includes a Telemedicine Adaptation Guide with specific modifications for remote assessment. Clinicians can observe facial expressions, upper body restlessness, speech patterns, narrative organization, and many other diagnostically informative behaviors through video platforms. The guide addresses what can and cannot be reliably observed remotely and provides adapted behavioral observation protocols.

Yes. The LODHI-A includes companion collateral informant forms (LODHI-A-COL) in two versions: one for a spouse or partner and one for a parent or family member. Collateral information strengthens the evaluation by providing independent corroboration of developmental history and current functioning, and is particularly valuable when the patient's self-report is limited by poor recall or lack of insight.

The interview opens with broad, open-ended questions about why the patient is seeking evaluation and why now — not with a symptom checklist. From there, the clinician follows the patient's narrative through developmental periods, using the module structure to ensure all diagnostic domains are covered while the conversation remains natural. When responses are vague, follow-up probes press for specificity. Differential diagnostic flags are attended to as they arise. The behavioral observation protocol runs concurrently — the clinician notes attention, restlessness, emotional regulation, and narrative organization in real time. By the end, the clinician has a longitudinal picture of functioning, a running differential updated throughout, and a body of patient-generated evidence. Patients consistently report that the experience feels like a genuine conversation about their life rather than a test.

High-functioning adults require an assessment that probes beneath surface-level outcomes to evaluate the cognitive effort required to achieve them. The LODHI-A was designed specifically for this population. Traditional instruments often miss high-functioning adults because their outcomes — degrees, careers, relationships — appear adequate, and criterion-verification formats do not ask what those outcomes cost. The LODHI-A reverses this by focusing on effort rather than achievement: the organizational systems, the reliance on others, the all-night sessions, and the trajectory of increasing strain that often brings these patients to evaluation.

This is one of the most common and clinically important challenges in adult ADHD assessment. The LODHI-A addresses it structurally: because the patient is never supplied with symptom descriptions or examples, pre-existing knowledge of DSM-5 criteria does not advantage the patient the way it would in a criterion-verification instrument. Vague or criteria-matching language triggers follow-up probes that press for the granular details that distinguish lived experience from adopted narrative. The longitudinal structure adds a further layer — a patient can rehearse a current symptom profile, but producing a consistent, detailed developmental trajectory across childhood, adolescence, and adulthood is substantially more difficult to fabricate.

Yes. Gender-specific probes are embedded throughout the interview, not isolated in a separate module. The LODHI-A is designed to detect the predominantly inattentive presentations, emotional dysregulation, and internalized symptoms that are more common in women and that have historically been dismissed as anxiety, depression, or hormonal fluctuations. It also addresses the socialized behavioral expectations that lead many women to develop coping architectures earlier and more extensively than their male counterparts.

Accurate cross-cultural ADHD assessment requires an instrument that accounts for how symptom expression, help-seeking behavior, educational history, and functional expectations differ across cultural contexts. The LODHI-A integrates these considerations throughout every module rather than treating culture as an add-on. It includes specific guidance for evaluating patients whose childhood schooling occurred in different countries, languages, or educational systems, and for distinguishing culturally normative behavior from pathological presentations. The instrument also addresses diagnostic challenges specific to immigrants and refugees, including the masking effects of language acquisition, acculturation stress, and survival-mode functioning.

ADHD and PTSD produce overlapping symptoms — attentional difficulty, executive dysfunction, emotional dysregulation, sleep disruption — and differentiating them requires longitudinal analysis, not just cross-sectional symptom counts. The LODHI-A embeds differential screening for trauma throughout the interview rather than confining it to a single question. The longitudinal trajectory is particularly informative: ADHD symptoms predate trauma exposure, while trauma-related attentional symptoms emerge after the traumatic event. The instrument is designed to identify cases where both conditions are present, and to detect patients who have been told their symptoms are "just trauma" without their neurodevelopmental condition being investigated.

The LODHI-A embeds systematic differential screening for anxiety and mood disorders throughout every module rather than deferring this to a separate evaluation. The symptom overlap is substantial: anxiety produces concentration difficulty and avoidance behaviors that resemble inattention; depression produces psychomotor retardation, poor motivation, and cognitive slowing that mimic executive dysfunction. The LODHI-A's longitudinal structure helps clarify the differential — ADHD is trait-like across the lifespan, while anxiety and depression are typically episodic with identifiable onset periods.

Conversational forensics is an interviewing methodology in which the diagnostic evaluation is conducted as a naturalistic clinical conversation while systematically gathering evidence for and against the diagnosis. In the LODHI-A, questions are designed to flow naturally and serve multiple simultaneous functions — building rapport, eliciting diagnostic data, identifying hidden effort, and surfacing differential considerations. The clinician follows the patient's narrative rather than reading from a checklist, but the conversation is structured so that all necessary diagnostic domains are covered and cross-referenced across developmental periods.

Temporal triangulation is the practice of evaluating symptom consistency across the lifespan by revisiting the same functional domains across childhood, adolescence, early adulthood, and current functioning. In the LODHI-A, this is built into the interview's structure — the clinician does not need to manually cross-reference, because the interview is designed so that the longitudinal pattern emerges as the patient narrates their history. A lifelong trajectory of impairment supports an ADHD diagnosis. Symptom onset in adulthood points toward a mimic condition.

The LODHI-A identifies compensation by probing for the effort and infrastructure behind apparently adequate functioning. Rather than asking a single question about coping strategies, the interview surfaces these patterns across every functional domain: external organizational systems, reliance on partners or assistants, avoidance of tasks that expose deficits, strategic career choices, and the cognitive load required to perform tasks that others complete automatically. This is diagnostically critical because the presence of extensive scaffolding explains why many adults appear to function well on outcome measures while approaching the point of collapse.

Yes. The LODHI-A screens for ADHD mimics and comorbidities continuously throughout the interview, not in a separate module. The instrument maintains a running differential that is updated as new information emerges. Conditions systematically evaluated include anxiety disorders, depression, bipolar disorder, PTSD and complex trauma, autism spectrum disorder, sleep disorders, substance use disorders, OCD, borderline personality disorder and other personality disorders, learning disabilities, burnout and performance-enhancement presentations, and medical conditions that can mimic ADHD.

The LODHI-A has not undergone formal psychometric validation. No claims of inter-rater reliability, sensitivity, or specificity are made or implied. Preliminary studies to validate the instrument psychometrically are currently underway, and this page will be updated as that research is completed. The LODHI-A is grounded in established diagnostic principles that are individually well-supported in the clinical literature: open-ended elicitation rather than criterion verification, longitudinal symptom analysis, systematic differential screening, and compensation detection. It was developed in clinical practice by a board-certified forensic neuropsychiatrist over hundreds of patient encounters, with every module designed to solve a real diagnostic problem. Clinicians should evaluate the LODHI-A's methodology and clinical utility within the context of their own practice and patient population.

The LODHI-A's methodology draws on well-established principles in clinical assessment. Open-ended elicitation — requiring patients to generate their own evidence of impairment rather than endorsing supplied descriptions — is a core technique in forensic psychiatric interviewing and is widely recognized as producing more diagnostically valid data than recognition-based questioning. Longitudinal symptom tracking is considered essential for ADHD diagnosis given the DSM-5 requirement of childhood onset and pervasive impairment. Systematic differential screening throughout the interview, rather than as a separate step, reflects best practices in complex diagnostic evaluation. Published psychometric data specific to the LODHI-A are forthcoming.

No formal certification or proprietary training is required. The LODHI-A guide can be downloaded and deployed by any licensed clinician with diagnostic evaluation experience, and it includes detailed guidance on methodology, clinical approach principles, and module-by-module objectives. Clinicians familiarize themselves with the framework and then conduct the interview in their own clinical voice; the LODHI-A is a guide, not a script. Optional in-depth training is available for clinicians who want to develop proficiency beyond the written guide, focusing on the conversational forensics methodology, running differential mechanics, compensation detection, and case-based differential work. A founding cohort is currently being assembled and CME accreditation is in progress; see the Training page to apply.

The LODHI-A ships as two companion documents. The full Clinical Interview Guide includes all nine modules with opening prompts, follow-up probes, concrete example requests, clinical notes, compensation detectors, cultural considerations, gender-specific probes, and the full appendix set (Clinical Formulation Framework, Comorbidity Decision Matrix, Compensation Assessment Rubric, Differential Diagnosis Decision Tree, Cultural Considerations Checklist, and Documentation Template). The Question Sheet is a stripped-down, chairside companion containing only the interview prompts, designed to be used during an actual evaluation without clinical commentary in the way. Also included are the LODHI-A-COL collateral informant forms (spouse/partner and parent/family versions), a behavioral observation protocol, a running differential tracking sheet, and a telemedicine adaptation guide.

The LODHI-A is free for licensed clinicians to use in their clinical practice. Submit your details through the request access form on the homepage, and the full instrument is emailed to you directly as downloadable PDFs: the Clinical Interview Guide (the full methodology and module reference), the Question Sheet (a chairside companion with just the prompts), the LODHI-A-COL collateral informant forms, and the telemedicine adaptation guide. Access is offered on a self-attestation basis — like other clinical interviews, the LODHI-A is intended for licensed clinicians practicing within their scope. Reproduction for distribution, modification, redistribution, incorporation into institutional protocols, commercial use, and published research require prior written permission from the author.

Yes. While the LODHI-A can be deployed without formal certification, an in-depth training program is open to clinicians who want to develop deeper proficiency in the conversational forensics methodology, running differential mechanics, compensation detection, executive function assessment, and case-based differential work. A founding cohort is currently being assembled, and CME accreditation is in progress. See the Training page to apply.

A digital administration and scoring platform is under development, including automated scoring, severity visualization, longitudinal tracking across visits, and EHR-exportable reports. Clinicians who have requested access to the paper instrument will be notified when the digital platform enters private beta.

Institutional implementation packages are available for health systems, residency programs, and group practices. These include bulk clinician training, customized scoring templates, quality assurance protocols, and ongoing consultation. Submit your details through the request access form on the homepage and we will follow up directly to discuss institutional needs.