CAADID

Conners’ Adult ADHD Diagnostic Interview for DSM-IV™

An empirically-based interview that aids in the diagnostic process of ADHD

J. Epstein, Ph.D., D. E. Johnson, Ph.D., & C. K. Conners, Ph.D.

Part I: Self-report or clinician-completed questionnaire; Part II: Clinician-completed structured interview

Ages 18 and older

60–90 minutes administration time for Part I; 60 minutes for Part II

B Level User Qualification

©2001 MHS Inc.

 Jeff Epstein, Ph.D., Diane E. Johnson, Ph.D.,
& C. Keith Conners, Ph.D.

Aim Instrument
The CAADID addresses the demand for an empirically-based Part I of the CAADID is designed to collect information related
diagnostic interview necessary in the assessment of adults. It was to four patient-related areas: Demographic History,
developed primarily to help clinicians and researchers produce Developmental Course, ADHD Risk Factors, and Comorbidity
the categorical diagnosis of ADHD they require. The CAADID Screening Questions. The questions in Part I of the interview are
employs a language and format that is conducive to self-report presented primarily in a Yes/No answer format.
and it produces a comprehensive demographic and develop-
Part II of the interview examines if the patient meets the first four
mental history of the adult patient. In addition, it provides infor-
DSM-IV™ criteria in the diagnosis of ADHD (Criteria A–D). Criterion
mation to support a categorical diagnosis based upon DSM-IV™
E is addressed in Part I of the interview. Part II is divided into three
criteria for ADHD, during both adulthood and childhood. This is
sections. The first section assesses the presence of the DSM-IV™
important because ADHD is a persistent developmental disorder
Inattention symptoms followed by questions about onset of the
that begins in early childhood. Recent evidence suggests that
Inattention symptoms, and pervasiveness of the Inattention
50 to 65 percent of children diagnosed with ADHD continue to
symptoms. The second section assesses Hyperactive-Impulsive
demonstrate symptoms as they reach adulthood. To meet DSM-
symptoms. This is followed by a section that assesses impairment
IV™ criteria, it is necessary to determine that the adult patient
for the amalgam of Inattention and Hyperactive-Impulsive
had problems with ADHD when he or she was a child, specifi-
symptoms. A checklist is provided for recording behavioral
cally during the early elementary school years. The CAADID
observations of the patient, whether the patient exhibits behav-
measures a cross-section of ADHD-related symptoms and
iors that are either consistent of inconsistent with ADHD behav-
behaviors in adults. Meeting all these requirements, the CAADID
ioral patterns during the interview. A section at the end of the
is ideal for screening adults for ADHD.
interview provides space for the clinician to note these behav-
When assessing ADHD, a clinical interview is a primary method ioral characteristics, which can be useful information for report
of assessment and dimensional measures, such as rating scales, writing. Lastly, scoring algorithms are provided on a summary
are used to supplement these assessments. This categorical sheet that enables the summarizing and scoring of Part II.
interview, which is a part of the CAADID, can be used as part
The summary sheets with scoring algorithms of the CAADID Part
of a routine screening in a number of settings, such as outpa-
II form serve several purposes. First, they allow for the scoring of
tient clinics, residential treatment centers, prisons, psychiatric
Part II of the interview, which will help determine the presence
hospitals, and private practice offices. The CAADID may also
or absence of a DSM-IV™ diagnosis of ADHD. Second, they pro-
be used to monitor ADHD symptoms over the course of treat-
vide a synopsis of the data acquired from the interview. This
ment. It is also useful in research settings because it is scorable,
aspect is extremely helpful for summarizing the patient’s ADHD
provides categorical information helpful for defining research
characteristics, whether for a verbal summary or for report writ-
groups, and offers a variety of content that can be used for
ing. Third, they ensure that, when making an ADHD diagnosis,
qualitative analyses.
all five ADHD DSM-IV™ criteria are used.
User Qualifications
The CAADID Manual presents a discussion of the current issues
Administrators of the CAADID should have an understanding of
in the assessment of ADHD in adults and offers the ways in
the basic principles and limitations of psychological testing,
which the CAADID deals with these issues. These include:
especially the interpretation of results. B-level qualification
requires, as a minimum, that the user has completed courses in Overdiagnosis and misclassification when assessing adults for
tests and measurement at a university. A professional with ADHD
advanced training in psychological assessment and profes- • the interview has been designed to capture frequency
sionals from related disciplines that adhere to relevant profes- and severity of behaviors
sional standards must assume responsibility for the use, inter-
pretation, and communication of results. This person should Symptoms associated with other conditions, such as psychi-
possess an advanced degree in the social, medical, or behav- atric and/or medical conditions that may include attention or
ioral sciences such as a Ph.D., Ed.D., M.D., or M.A. organizational deficits
• embedded into the developmental history of the inter-
view is a brief comorbidity screen that briefly determines
if disorders other than ADHD, in particular depression,
 Conners’ Adult ADHD Diagnostic Interview for DSM-IV™

anxiety, and substance-related disorders, may be pre- All of the items in Part I of the CAADID have been numbered
sent; the medication history aids in identifying somatiza- to facilitate the cross-referencing of information. In Part II,
tion diagnoses and medical conditions instead of numbers, an alphabetical coding system has been
used which serves a similar purpose. Each part is designed to
Symptoms resulting from an adverse environment (e.g., chaot-
gather the information required for making a clinical determi-
ic families, ineffectual classrooms, or psychosocial stressors)
nation of the presence or absence of ADHD. Two options for
• the demographic and developmental history part of the
completing Parts I and II are suggested:
CAADID (Part I) has sections that assess psychosocial
stressors and their impact on the adult’s life; additional Option 1: Both parts of the CAADID are administered as a
questions in Part II are designed to assess symptom pres- clinical interview, but the interview is divided into two ses-
ence throughout the patient’s life in order to ensure that sions. Part I is administered during the first session and Part II
ADHD-like behavioral manifestations are not temporary, is administered during the second session.
situational, or reactive, but rather are stable behavioral
Option 2: Alternatively, the patient can be asked to com-
patterns that have occurred throughout the patient’s
plete Part I as a questionnaire on his or her own, prior to
entire life
meeting with the clinician. This greatly reduces the time
Reduced numbers of symptoms in adults required to administer the entire interview and allows the
• since no provision for different adult criteria is made in clinician to focus on those questions that were answered
DSM-IV™ currently, the CAADID manual offers suggestions affirmatively in Part I. (Based on a readability analysis, a
to reduce the potential underdiagnosis of Adult ADHD North American sixth-grade reading level has been deter-
mined for Part I of the CAADID). Part I of the interview should
Definition of symptoms through childhood behaviors
be reviewed with the patient in order to clarify and expand
• the CAADID uses DSM-IV™ language that effectively
on affirmative or unusual responses; then, Part II can be
translates into adult behavioral manifestations, symptom
administered to the patient.
criteria that are currently defined, for the most part, in
terms of childhood behaviors; in addition the CAADID The CAADID manual offers an introduction to ADHD in adults
contains lists of child and adult behaviors that would and detailed information on administration, scoring proce-
qualify as behavioral manifestations of each symptom, dures, and the interpretation and use of the CAADID results.
thereby helping clinicians to judge whether reported The background and development of the instrument are also
behaviors are consistent with each symptom provided. In addition, the manual presents three case studies
that may exemplify the interpretation of the CAADID and con-
Diagnostic prerequisite of childhood ADHD
cludes with comments about using the CAADID as part of a
• the CAADID has been developed so that there is a simul-
comprehensive, multimodal assessment of Adult ADHD.
taneous assessment of ADHD in adulthood and childhood
Development
The ability to track treatment progress has been built into the
Interest in the assessment of Adult ADHD has increased dra-
CAADID. It can be used as a repeated measure to follow
matically in recent years; however, there are current difficulties
patients’ progress. An Impairment section in the interview
in diagnosing Adult ADHD and limited data are available.
includes very specific impairment ratings. These impairment
Consequently, there has been a pressing need for empirically-
ratings can be used in a manner similar to typical Clinical
based structured interviews that aid the process of diagnosis.
Global Impressions (CGI) commonly used in clinical and
The CAADID will help to fill this void. It was piloted in the Duke
research settings, but with the CAADID’s precision and speci-
University ADHD clinic with adult patients.
ficity. Completion of these impairment ratings at regular inter-
vals will inform clinicians about patients’ treatment responses It is hoped that users of the CAADID will provide useful feed-
and can help guide treatment decisions. back that will help in the further evolution and refinement of
this new tool to the authors via MHS or to the MHS Research
Format and Development department. Such feedback will greatly
The CAADID is administered using the CAADID interview forms.
assist the further development of the CAADID, aimed at pro-
The forms include all the necessary information for administer-
viding clinicians with a diagnostic tool of maximum reliability,
ing and scoring.
validity, and relevance.
Complements for the CAADID
BarOn Emotional Quotient-Inventory™ (BarOn EQ-i®)
Carroll Depression Scales–Revised (CDS–R)
Computer-Assisted SCID–Clinician Version (CAS–CV) for Windows™
Conners’ Adult ADHD History Form
Conners’ Adult ADHD Rating Scales (CAARS)
Conners’ Continuous Performance Test II (CPT II) for Windows™
Holden Psychological Screening Inventory (HPSI)
SCID Screen Patient Questionnaire (SSPQ) for Windows™
Social Adjustment Scale–Self-Report (SAS–SR)
State-Trait Anxiety Inventory (STAI) for Windows™
Symptom Assessment–45 Questionnaire (SA–45)

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HC 01 08 Printed in Canada