ADHD Evaluation Form for Adults for Mental Health Professionals (PDF & Word Doc)

Diagnosing ADHD in adults requires more than a symptom checklist — it requires establishing childhood onset, ruling out overlapping conditions, documenting functional impairment across multiple settings, and weighing compensatory strategies that often mask symptoms until adult demands outpace them. A structured evaluation template helps clinicians work through each DSM-5-TR criterion systematically while building a defensible diagnostic record.

TherapyByPro’s ADHD Evaluation Form for Adults is a comprehensive, clinician-developed diagnostic evaluation document designed for psychiatrists, psychiatric nurse practitioners, and other mental health professionals conducting adult ADHD assessments. The template guides clinicians through patient and encounter information, presenting symptoms, a full DSM-5-TR inattentive and hyperactive-impulsive symptom review, childhood symptom history, developmental and occupational history, executive functioning and emotional regulation, functional impairment across settings, medical and substance history, standardized screening instruments, differential diagnosis, risk assessment, a DSM-5-TR criteria checklist and diagnostic formulation, and treatment and follow-up recommendations.

The evaluation opens with evaluation context and referral information, then moves through presenting symptoms and clinical concerns before a detailed DSM-5-TR inattentive symptom table — documenting each of the nine Criterion A1 symptoms across current, worst-ever, and childhood presentation with frequency and severity ratings. A parallel table addresses the nine hyperactive-impulsive symptoms, with adult-specific framing such as subjective restlessness rather than overt hyperactivity, and calculates the DSM-5-TR presentation type based on symptom counts.

A dedicated childhood symptom history section addresses Criterion B, documenting the source and confidence of childhood evidence and common reasons diagnosis is delayed in adulthood — including high academic performance, symptoms misattributed to anxiety or depression, and structured environments that compensated for impairment. Developmental, educational, and occupational history sections document school performance and accommodations, job tenure patterns, and specific ADHD-related occupational difficulties, while an executive functioning assessment rates thirteen domains including working memory, time management, and emotional regulation, with dedicated fields for rejection sensitive dysphoria and hyperfocus.

Functional impairment is documented across ten life domains to support DSM-5-TR Criteria C and D, followed by medical, psychiatric, and substance history, current medications and a detailed prior ADHD medication trial table, a mental status examination, and a standardized screening instrument table covering the ASRS v1.1, Brown ADD Rating Scales, Conners’ Adult ADHD Rating Scales, Wender Utah Rating Scale, and comorbidity screeners. A structured differential diagnosis table addresses psychiatric and medical conditions that can mimic or co-occur with ADHD, followed by risk assessment, a DSM-5-TR criteria checklist with diagnostic formulation, and treatment recommendations covering stimulant diversion risk, contraindications, and non-pharmacological interventions.

What Is Included in This Adult ADHD Evaluation

This comprehensive evaluation includes documentation commonly used when conducting a diagnostic evaluation for adult ADHD:

• Patient and Encounter Information: Evaluation context, referral source, reason for evaluation, and prior ADHD evaluation and treatment history.
• Presenting Symptoms: Primary symptoms in the patient’s own words, age of onset, course, severity, and affected life domains.
• DSM-5-TR Inattentive and Hyperactive-Impulsive Symptom Review: All 18 Criterion A symptoms rated across current, worst-ever, and childhood presentation with frequency and severity.
• Childhood Symptom History: Documentation of Criterion B evidence, sources, confidence level, and reasons diagnosis may have been delayed.
• Developmental, Educational, and Occupational History: School performance and accommodations by level, and a detailed occupational history with job tenure and difficulty patterns.
• Executive Functioning and Emotional Regulation: A thirteen-domain executive function rating, rejection sensitive dysphoria, hyperfocus, and compensatory strategy documentation.
• Functional Impairment Across Settings: A ten-domain table documenting Criteria C and D across work, academic, relationship, and daily living settings.
• Medical, Psychiatric, and Substance History: Medical conditions, sleep assessment, comorbid psychiatric conditions, and substance use screening.
• Current Medications and Prior ADHD Treatment Trials: A detailed medication trial table documenting response, side effects, and reason for discontinuation.
• Mental Status Examination and Standardized Screening: A focused MSE and a tracking table for ASRS v1.1, CAARS, Brown ADD Scales, WURS, BDEFS, and comorbidity screeners.
• Differential Diagnosis: A structured table addressing psychiatric and medical conditions that mimic or co-occur with ADHD.
• Risk Assessment: Suicidal and homicidal ideation screening and ADHD-specific risk factors such as driving safety and impulsive financial decisions.
• DSM-5-TR Criteria Checklist and Diagnostic Formulation: A criterion-by-criterion checklist, presentation subtype, severity specifier, and narrative diagnostic formulation.
• Treatment and Follow-Up Recommendations: Stimulant diversion risk and contraindication assessment, pharmacological and non-pharmacological recommendations, and follow-up planning.

How This Adult ADHD Evaluation Functions in Practice

This evaluation is designed to be completed during an initial or re-evaluation diagnostic assessment for adult ADHD, providing a structured framework for working through each DSM-5-TR diagnostic criterion.

• Diagnostic Workup: Structures the collection of current, childhood, and functional evidence needed to support or rule out an ADHD diagnosis.
• Differential and Comorbidity Assessment: Guides clinicians through conditions that mimic ADHD and comorbidities that should be diagnosed alongside it rather than used to exclude it.
• Stimulant Prescribing Safety: Documents diversion risk factors and contraindications before medication recommendations are finalized.
• Disability and Accommodation Documentation: Supports documentation for workplace or academic accommodation requests when clinically indicated.

Documentation Features

• Designed specifically for psychiatrists, psychiatric nurse practitioners, and mental health professionals evaluating adult ADHD.
• Structured around all six DSM-5-TR diagnostic criteria (A through E) for ADHD.
• Includes detailed symptom-by-symptom tables for both inattentive and hyperactive-impulsive presentations.
• Provides a thirteen-domain executive functioning assessment and compensatory strategy documentation.
• Includes a standardized screening instrument tracker and a detailed prior medication trial table.
• Documents stimulant diversion risk and contraindications to support safe prescribing decisions.
• Includes clinician and supervisor signature and attestation sections.

Practical Integration Notes

This evaluation is intended to be completed by the evaluating clinician based on direct clinical interview, review of available records, and standardized measures. It is a clinical assessment tool and not a substitute for standardized neuropsychological testing. Clinicians should supplement documented responses with collateral information where available and customize sections to reflect their practice setting, patient population, and applicable state and licensing board requirements. The completed evaluation should be maintained as part of the patient’s clinical record in accordance with HIPAA and applicable documentation standards.

References

• American Psychiatric Association. (2022). Diagnostic and Statistical Manual of Mental Disorders (5th ed., text rev.). Resource
• Kessler, R. C., et al. (2005). The World Health Organization Adult ADHD Self-Report Scale (ASRS): A short screening scale for use in the general population. Psychological Medicine, 35(2), 245–256. Resource
• Kooij, S. J. J., et al. (2010). European consensus statement on diagnosis and treatment of adult ADHD: The European Network Adult ADHD. BMC Psychiatry, 10, 67. Resource
• Kroenke, K., Spitzer, R. L., & Williams, J. B. (2001). The PHQ-9: Validity of a brief depression severity measure. Journal of General Internal Medicine, 16(9), 606–613. Resource
• Spitzer, R. L., Kroenke, K., Williams, J. B., & Löwe, B. (2006). A brief measure for assessing generalized anxiety disorder: The GAD-7. Archives of Internal Medicine, 166(10), 1092–1097. Resource