ALFI

MANUAL
THE ADHD LIFESPAN
FUNCTIONING INTERVIEW
MANUAL

Professor Susan Young

www.psychology-services.uk.com
 HOW TO USE THE ALFI MANUAL
The ADHD Lifespan Functioning Interview (ALFI) is a clinical interview developed to support a
diagnostic assessment of ADHD in adults. The ALFI should be used in conjunction with the ALFI
Manual, which provides information on how to administer and score the ALFI.

Users are guided to ask questions about ADHD symptoms, personal history, school history,
occupational history, antisocial behaviour, social functioning and presentation to services.
Aside from garnering helpful qualitative information to support a clinical assessment, ratings
are generated that can be used for research purposes. A version of ALFI that can be
administered at follow-up to assess clinical and functional outcomes is also available (ALFI-2).

This manual describes the principles of the ALFI interview, guidelines on how to score the
rating scales, and descriptions of situations commonly encountered. However, it is impossible
to cover all possible situations or dilemmas that individual interviewers may come across.
Whenever there is doubt about how to rate a particular behaviour, it is advisable to record
detailed information, discuss with colleagues and arrive at a shared decision.

For a comprehensive assessment of ADHD in adulthood it is recommended that the following

areas are evaluated: cognitive functioning, personality, mood and affect, core symptomology in
childhood and adulthood, and a birth/developmental history.

The manual and the interview schedule should be used together. Instructions regarding
questioning are primarily contained within the manual, although the interview schedule also
provides some guidance.

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 CONTENTS

PAGE

Introduction 3

Personal History 3

ADHD Checklist of Symptoms 4

School History 6

Occupational History 11

Antisocial Behaviour 15

Substance Use 22

Social Functioning 24

Presentation to Services 28

Interviewer Perception 29

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 INTRODUCTION
At the beginning of the interview the individual should be asked some general questions such
as why they are attending the clinic, what symptoms they have, how they view their
difficulties and problems and how these impact on their life. They should also be asked
about the strategies they adopt to cope with or compensate for their problems. It is
important to acknowledge the problems and difficulties the individual describes, and any
underlying distress they cause in order to put the individual at ease at this stage.

There is space provided on the introduction page to record general information relating to the
interview, including the date, name of interviewee, date of birth and space for a study or
research reference if applicable. Following this, blank space is provided for notes and
description of the problem.

PERSONAL HISTORY
The first section of the interview covers personal history. Interviewees are asked about their
current living arrangements. They are then asked about their family history, including
whether they are adopted, whether they have a twin and their ordinal birth position. Further
details are then requested about their family of origin and their family of creation, including
details of psychopathology. Blank spaces are provided for additional family members not
listed but considered relevant to the individual.

The questions within the personal history pages should be viewed as prompts for information
relating to the individuals family of origin and family of creation that may be of relevance to
their ADHD symptoms and assessment.

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 ADHD CHECKLIST OF SYMPTOMS

This section includes a checklist for ADHD symptoms according to ICD-10 and DSM-5 criteria
as defined by the World Health Organization1 and the American Psychiatric Association2
respectively.

Symptoms of inattention and hyperactivity/impulsivity are assessed using a range of 18

questions. The interviewer is required to ask the interviewee whether during the past 6 months
the interviewee has experienced any of the listed problems/symptoms. Each problem should
then be rated on frequency, with the options of never, sometimes or often. Rate never if the
problem has never occurred in the past 6 months. Rate sometimes if the problem has occurred
a few times in the past 6 months, with an average frequency of up to once a month. Rate often
if the problem has occurred very frequently in the past 6 months, on average over once a
month.

The DSM-5 diagnostic criteria are the most commonly used, which can be applied as follows:

To score the inattention items, the total number of responses in the 'Often' column should be
calculated. If the interviewee is 17 or older, 5 or more responses need to be recorded as ‘Often’
for Criterion A to be satisfied. If the interviewee is under 17 years old then 6 or more ‘Often’
responses are required for Criterion A to be satisfied. The interviewer should then highlight
whether Criterion A is satisfied or not, based on the above guidelines, by circling the
corresponding ‘yes’ or ‘no’.

To score the hyperactivity/impulsivity items, the total number of responses in the 'Often'
column should be calculated. If the interviewee is 17 or older, Criterion B is satisfied if 5 or
more responses are recorded as ‘Often’. If the interviewee is under 17 years old then 6 or more
‘Often’ responses are required for Criterion B to be satisfied. The interviewer should then
highlight whether Criterion B is satisfied or not, based on the above guidelines, by circling the
corresponding ‘yes’ or ‘no’.

Once both Criteria A and B, referring to the total number of 'Often' responses for each section,
have been completed, it can be worked out whether the overall screening symptom criteria
have been met:

 If ‘yes’ has been circled for Criterion A, the interviewee meets screening criterion for
Predominantly Inattentive Presentation.

 If ‘yes’ has been circled for Criterion B, the interviewee meets screening criterion for
Predominantly Hyperactive/Impulsive Presentation.

 If ‘yes’ has been circled for both Criteria A and B, the interviewee meets screening
criterion for Combined Presentation.

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Please note that this only provides screening criterion. To meet DSM-5 diagnostic criteria
further assessment is required to determine:

 onset of symptoms by age 12

 Symptoms must have persisted for at least six months to a degree that is inconsistent
with developmental level and that negatively impacts directly on social and
academic/occupational activities.

1
. World Health Organization. (1992). International Statistical Classification of Diseases and
Related Health Problems (10th ed.). Geneva: World Health Organization.
2
. American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental
Disorders (5th ed.). Washington, DC: American Psychiatric Association.

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 SCHOOL HISTORY
In this section information relating to the individual’s school history should be explored,
relating to academic achievement, attitude and behaviour problems and the individual’s
interaction with peers and teachers. If individuals can provide objective reports of childhood
problems and behaviours (e.g. school reports, educational psychologist reports, Statement of
Special Educational Needs reports, probationer’s reports) then information from these
reports should be prioritised to make the ratings.

Initially individuals should be asked a few open ended questions about their perception of their
schooling history, and boxes are provided to note down their responses. These questions are
then followed by structured questions regarding specific aspects of their schooling.

1. SCHOOL TYPE

1 State
2 Public/private
3 Special

Rate state if the person went to a regular state-run school including comprehensive and
secondary modern schools. Rate public/private if the person went to a grammar or fee paying
school (including boarding school). Rate special if the person went to a remedial or special
school for children with learning and/or behavioural difficulties.

2. ACADEMIC PROBLEMS

0 No problems
1 Trivial
2 Definite but slight
3 Definite and marked

Rate no problems if the person reports not to have experienced any real difficulty in school
subjects. Rate trivial if the person reports to have been weak in some subjects but was able to
keep up with course work and had a conceptual understanding of the subject, such a person
would still be passing in the subject but not find it as easy compared to other subjects. Rate
definite but slight if the person reports to have experienced some difficulty in some subjects
compared to others and this cause him/her to struggle in this subject and fall behind in course
work or exams in these subjects. Rate definite and marked if the person was failing in subjects
to the extent that he/she needed remedial help and/or additional coaching provided by the
school.

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3. ATTITUDE PROBLEMS

0 No problems
1 Trivial
2 Definite but slight
3 Definite and marked

Rate no problems if the person reports that his/her parents did not get complaints about
his/her attitude at school. For example he/she did not routinely break school rules or refuse to
work. Rate trivial if the person reports that the school did periodically make complaints to
parents for reasons such as being talkative, not wearing school uniform, hair being too long.
Rate definite but slight if the teachers complained to parents about him/her working below
ability because of his/her attitude to work, e.g. not handing in homework or coursework on
time. Rate definite and marked if teachers had more serious complaints to make to parents
for reasons such as refusing to work, playing truant or deliberately behaving in a disruptive or
oppositional way.

4. BEHAVIOUR PROBLEMS

Tick whether there were specific complaints by teachers to parents regarding the child's
behaviour relating to disruptive behaviour in class; fighting; stealing and/or destroying things;
daydreaming; withdrawal; and playing the clown. The total number of items should also be
recorded in the box provided.

5. PEER PROBLEMS

This refers to how the person got along with other pupils. Tick whether the individual reports
he/she was bullied or excessively teased; bullied other children; was excluded from activities
by peers; did not mix with others at all; or did mix with others but was part of a "bad" crowd
frequently getting into trouble and mischief. The total number of ticked items should also be
recorded in the box provided.

6. TEACHER PROBLEMS

Tick how the person got along with his/her teachers at school, particularly with respect to
whether he/she disliked or deliberately set out to annoy teachers; felt he/she was disliked
and/or was victimised by teachers; was uncooperative with teachers by not doing what
he/she was told to do; or threatened and/or swore at teachers. The total number of items
should also be recorded in the box provided.

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7. TRUANCY

0 Never
1 Some lessons only
2 Whole days
3 Whole weeks

These periods are given as guidelines only and the interviewer needs to question the person
carefully and make sensible interpretations as to the amount of school missed overall. Rate
never if the person reported never to have truanted from school. Rate some lessons only if on
average in each year the person would miss lessons only, rather than being away from school
for whole days. If the person reports to have missed one or two days of school in his/her entire
school history then this should also be rated as some lessons only. Rate whole days if the
person would report to truant for one day at a time on a regular basis, this would include
missing up to three lessons a week or one whole day each month. Rate whole weeks for major
persistent truancy involving over one full day a week or 4 or more lessons per week on a
regular basis.

8. SCHOOL REFUSAL

0 Never
1 Days only
2 As long as one week
3 Periods longer than one week

These periods are given as guidelines only and the interviewer needs to question the person
carefully and make sensible interpretations as to the amount of school missed overall. School
refusal does not include children staying at home and pretending to parents that they are too
ill to attend school. School refusal is only rated in cases where the child categorically refused to
go to school to parents or guardians. Rate never if the person reported never to have refused
to go to school. Rate days only if on average in each year the person refused to go to school on
the occasional day, for example it may have been the child's birthday, or the child may only
have refused to attend school once or twice in their entire school history. Rate as long as one
week if the person would report to refuse to go to school for seven days in the academic year.
Rate whole weeks for major persistent school refusal resulting in the child regularly missing
over one week's schooling each academic year.

9. CONTACT WITH THE EDUCATION AUTHORITY

It should be noted whether the school made contact with the education authority because of
truancy or missing school.

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10. SUSPENSIONS/EXPULSIONS

0 Never
1 Suspended once
2 Suspended more than once
3 Any expulsion

The number of suspensions and expulsions from school should be recorded here, including
reasons for exclusion. Rate never if the person has never been expelled or suspended from
school. Rate suspended once if the person has been suspended from school on one occasion
only. Rate suspended more than once if the person has been suspended from school on more
than one occasions and rate any expulsion if the person has been expelled or asked to leave a
school on one or more occasions. The reason for suspensions and expulsions should be noted
in the space provided.

11. AGE ON LEAVING SCHOOL

The age the person officially left school should be recorded in the box provided. If this was
after completing GCSE’s or their equivalent then this will usually be 16 years. If this was after
completing ‘A’ levels at school then this will usually be 18 years. If the person left school after
taking GCSE’s (or their equivalent) and took ‘A’ levels at a college of further education, then the
actual age they left school should be recorded and not the age they finished the ‘A’ level course
at college. If a person was expelled or asked to leave prior to taking examinations, then the age
they left school should be recorded.

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12. FURTHER EDUCATION OR OCCUPATION ON LEAVING SCHOOL

0 Re-taking GCSE’s or other (school or college)

1 Preparing for ‘A’ levels (school or college)
2 Other full-time education
3 Vocational training
4 Apprenticeship
5 YTS scheme
6 Job
7 Unemployed

What the person did on leaving school should be recorded here. Rate re-taking GCSE’s if the
person returns to either school or college to re-take or do additional GCSE examinations (or
their equivalent). Rate ‘A’ levels if the person returns to school or goes to college to study ‘A’
levels. Rate other full-time education if the person goes to college or university or equivalent
to do other full-time education studies. This will include sandwich courses. Rate vocational
training if the person continues to do vocational training such as going into the forces, or
training to be a nurse (but not via a university course). Rate apprenticeship if the person
becomes an apprentice to a trade, such as carpenter or plumber. Rate Youth Training Scheme
[YTS] if the person joins a government sponsored training scheme or its equivalent. Rate job if
the person is in full-time constructive employment (or part-time employment and not on
income support). Rate unemployed if the person is not in constructive employment, regardless
of whether he/she is drawing unemployment benefit, income support or invalidity benefit.

A full list of qualifications obtained by the individual, both on leaving school and on
subsequent study, should be recorded in the box provided.

The interviewer should then discuss any full-time further education highlighted in the prior
question with the individual. A description of full-time further education should be
ascertained and notes detailed in the box provided. The interviewer should also enquire and
note whether an individual has failed to complete any of their further-education courses and,
if so, the reasons for dropping out of study, which can be detailed in the box provided.

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 OCCUPATIONAL HISTORY

Individuals should be questioned about the type of work they do and their employment
history. Specifically it is aimed to get an idea of individuals’ attitudes towards work, their
level of motivation and interest in their job and amount of effort they put into their work. If
dissatisfied with their job, then this should be explored as well as how they spend their time.
Individuals should also be questioned about whether they are actively seeking a job.
Questions should include their aims and ambitions for the future. If unemployed, they
should be asked about the jobs they had in the past.

13. CURRENT JOB

A description of the person's current employment status should be recorded. Unemployed

includes housewife or husband, people in prison, regional secure units or other institutions,
and those people unable to work through invalidity. Employed includes people in full-time and
part-time employment. If in part-time employment, and receiving benefits for low income,
then unemployed should be recorded (e.g. for individual’s working a few hours per week and
includes work not impacting on state benefits). Students are in full-time education.

14. DESCRIPTION OF CURRENT JOB

A detailed description of current employment, and the work this entails, should be described
and recorded in the box provided.

To score this item, the current job should be rated using the following categories, and then
recorded clearly at the end of the notes:-

777 people in full-time education (i.e. students) should be rated as “not applicable”
1 professional/managerial (business executives, lawyer, doctor)
2 vocational (teacher, nurse)
3 skilled non-manual (secretary, hairdresser)
4 skilled manual (carpenter, welder)
5 semi-skilled manual (general labourer, apprentice)
6 unskilled (shop assistant)
7 unemployed (houseperson, invalidity benefit, institution – such as prison or in a
regional secure unit).

People working or studying part-time, but still receiving state benefits, should be coded as
unemployed.

If employed, a record should be made of whether this work is full-time, part-time or other.

Questions should then be asked regarding the individual’s interest in their job and whether
they wish to stay in that job. Questions are provided as a framework for discussion, and space
is provided to note responses.

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15. TYPE OF OCCUPATION

The number of different types of full-time gainful employment should be recorded in the box
provided. Jobs such as drug dealing or helping out a friend on a street market would not be
included. The number of types of occupation are recorded, for example an individual may have
been a lorry driver, worked in retail sales as a shop assistant, worked as a buyer for a retail
store and been employed in a pub as bar staff. This would count as four different types of
employment. Where an individual has been employed in different types of retail sales, i.e. fast
food, supermarkets and chain stores, this would count as one type of employment. People
need to be questioned carefully about their types of employment as a carpenter, hod carrier
and scaffolder would for example count as three types of employment, whereas several
periods of employment in general building work would count as one.

16. NUMBER OF JOBS

The number of full time jobs in which the person has been employed since leaving school
should be recorded in the box provided. If an individual gives an estimated number then the
mid-point should be recorded. If this falls on a decimal number, then this should be rounded
up, e.g. 15-20 = 18.

17. LONGEST PERIOD EMPLOYED

The longest period a person was in full-time gainful employment should also be recorded in
months in the box provided. The mid-point should be taken for estimated periods. If this falls
on a decimal number, then this should be rounded up, e.g. 19-22 = 21.

18. PLANS FOR THE FUTURE

The interviewer should then ask the individual about their occupational plans for the future,
prompting a discussion and recording their responses in the space provided. This is to
investigate their plans for personal development, their current job satisfaction and their desire
to work.

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19. UNEMPLOYMENT

The number of periods of unemployment, for which an individual claimed unemployment

benefit, should be recorded in the box provided. Individuals who are unable to work due to
disability or invalidity (and who claim the appropriate respective benefit) should be included
e.g. a person who is unemployed due to having back problems, and who receives benefit for
these problems, should include this as a period of unemployment. The mid-point should be
taken for estimated periods. If this falls on a decimal number, then this should be rounded up,
e.g. 16-21 = 19.

The longest single period a person has been unemployed should be recorded in months in the
box provided. The mid-point should be taken for estimated periods. If this falls on a decimal
number, then this should be rounded up, e.g. 9-12 = 11.

20. CURRENT UNEMPLOYMENT

0 Unemployed
1 Disability/invalidity
2 Children
3 Institution

A description of the person’s reason for unemployment should be recorded. Rate unemployed
if a person has chosen to be unemployed or who has been unsuccessful in getting a full-time
job. Rate disability/invalidity if the person has some form of impairment which prevents them
from working. Rate children if the person is a housewife or husband and looks after children at
home. Rate institution if the person is unable to work because they are being held in prison or
a regional secure unit.
The interviewer then asks the individual what they do with their time whilst unemployed, with
a specific focus on whether they are undertaking constructive or non-constructive activities.
Space is provided to detail the individual's response.

It should then be enquired whether the individual is looking for a job, and either 'yes' or 'no'
circled. Space is provided in order to note down their additional comments regarding their
search for a job.

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21. OCCUPATION OF FAMILY MEMBERS

Individuals should be asked about the type of employment of family members, i.e. partner,
parents, and siblings. Individuals should be asked for the job title in addition to a general
description of what this work entails. For example, ‘working in the travel industry’ could be
managerial, skilled or unskilled work. It may help to ask about the education of the target
person e.g. someone working in the travel industry with a degree in marketing is more likely to
be in professional/managerial category. Similarly, self-employed people should be rated
according to the business they have and the type of work they do. Retired family members
should be coded for their prior occupational status. Unemployed includes categories of
housewife/husband, people claiming benefits as described previously, and individuals in
institutions such as regional secure units and prison establishments. Full-time students should
be coded as 777 (‘not applicable’). It is advised that interviewers make a note of the profession
of each family member during the interview, and then rate these occupations according to the
following categories after administration. Spaces for the addition of 'other' family members,
considered to be relevant, are provided.

777 Student
1 Professional/managerial
2 Vocational (teacher/nurse)
3 Skilled non-manual (secretary/hairdresser)
4 Skilled manual (carpenter/welder)
5 Semi-skilled manual
6 Unskilled (shop assistant)
7 Unemployed (house wife/husband, invalidity benefit, institution

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 ANTI-SOCIAL BEHAVIOUR
This section of the ALFI focuses on a developmental perspective of conduct and substance
abuse problems and provides three scales of anti-social behaviour:-

1) In childhood (defined as prior to 18 years of age)

2) in adulthood (defined from 18 years of age)
3) during the past year

If individuals have supplied objective reports relating to childhood conduct problems and/or
later anti-social behaviour then priority should be given to this source of information for
ratings (e.g. school reports, probationer reports, police/court reports).

Individuals are questioned about frequency and severity of antisocial behaviour in childhood
(prior to 18 years), in adulthood, and the past year. Questions relate to verbal and physical
aggression; use of a weapon, vandalism and fire-setting; theft (including shoplifting, joyriding,
breaking and entering); mental cruelty toward others; cruelty to animals; and trouble with the
police. Individuals are encouraged to describe specific incidents that come to mind and,
through discussion and probing, an estimate of the average frequency and severity of
behaviour in a typical year is made. Thus, ratings are made on four degrees of severity and
frequency, ‘0’ representing no problem behaviour, ‘1’ representing mild or infrequent
behaviour, ‘2’ representing marked and regular behaviour (once a month), ‘3’ representing
severe and repetitive problem behaviour (more than once a month).

Severity – the most severe episode or incident for the year or in an average, typical year are
recorded.

Frequency – the average number of episodes or incidents for the year or in an average, typical
year are recorded.

The interviewer rates the individual’s answers using an estimate of the average frequency and
severity of such behaviours. If incidence of behaviour varies, e.g. the person reports that they
fought on average once a month as a child of 6 years but only two or three times in a year as a
child of 13 years, then the most frequent incidence should be rated i.e. rate regular – on
average 1 x month for usual frequency, prior to 18 years of age. Details should be noted of
specific incidents mentioned in the boxes provided.

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Questioning can take the following format:-

“How many fights have you had in the past year?”. If the reply is “around seven” then this
would be coded as ‘2’ (regular, about 1 x month). If they replied “around four” then this would
be coded as ‘1’ (once or twice). The person is then asked “as an adult (since 18 years of age),
would you say you have been involved in about the same number of fights per
year?….more?….fewer?”. Thus, through discussion and probing, an estimate of frequency of
fights can be ascertained. For severity, the interviewer could say “Can you tell me about the
kind of fights you got into? Did you ever sustain any injury? Did you cause injury? Was it just
bruises and minor cuts to face and hands, or did the injury require visiting a doctor or hospital?
What is the worst outcome from a fight you can remember?

22. CRUELTY TO ANIMALS

Severity

0 None
1 Minor (no injury)
2 Marked (some injury)
3 Severe (serious injury)

Rate none if the person reports no cruelty to animals. Rate minor (no injury) if the person
reports a single incident in which the person has caused some, but not serious, hurt or injury to
an animal through, for example, unintentional, excessive use of force. Rate marked (some
injury) if the person reports deriving pleasure from tormenting or hurting animals in such a way
as to cause minor, but definite, pain or distress to an animal. Rate severe (serious injury) only
for those cases in which the person reports gaining malicious and sadistic pleasure from
inflicting pain and suffering on animals.

Frequency

0 Not at all
1 Once or twice
2 Regular, on average 1 x month
3 Regular, more than once a month

The average frequency of cruelty to animals is recorded. For example, if the person reports
being cruel to an animal on average more than once a month as a child of 8 years, but only two
or three times a year as a child of 16 years, rate the overall frequency for prior to 18 years as
regular, more than once a month. Rate not at all if the person reports not to have engaged in
any cruelty to animals. Rate once or twice if the person reports isolated incidents of cruelty.
Rate regular, on average 1 x month if the person indicates that they have been cruel to animal
approximately once a month. Rate regular, more than once a month if the person admits to
acts of cruelty at least once a month in the past year, prior to 18 years of age and post 18 years
of age.

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23. VERBAL AGGRESSION

0 None
1 1 or 2 isolated episodes
2 3 or more episodes
3 At least monthly

Episodes of verbal aggression in which the person has engaged in serious arguments with
people should be rated in this section. Examples might include occasions in which the person
was abusive or threatening towards another person. Shouting, abuse and/or threatening
behaviours must involve loss of temper and not be in the context of joking or bantering. Rate
none if the person indicates that they have not engaged in any verbal aggression in the last
year, during childhood or in adulthood. Rate 1 or 2 isolated episodes where the person reports
isolated incidents occurring in the last year, during childhood or in adulthood. Rate 3 or more
episodes if the person indicates that they have engaged in such acts on three or more separate
occasions. Rate at least monthly if the frequency reached this level on average for the whole of
the past year, prior to 18 years of age and post 18 years of age.

The interviewer should then enquire who these arguments are usually with, and record this in
the space provided.

24. PHYSICAL AGGRESSION

Episodes of physical aggression outside the home i.e. not family members, should be recorded
according to their usual severity and frequency. Details of specific incidents reported should be
noted in the box provided. It may be helpful to note aggressive acts toward family members
but these should not be included in the rating system.

Severity

0 No fighting
1 Defence only
2 Mild (no injury caused)
3 Severe (injury caused)

Rate no fighting if the person reports that they have not engaged in any physical
aggression/fighting with another person outside the home. Rate defence only if the person
reports that they have pushed, hit, seized or held another person in the context of defending
themselves from attack by another. Rate mild (no injury caused) if the person indicates that
they have engaged in some form of fighting – such as pushing, hitting or seizing another – but
not with intent to harm and no injury to another person was caused other than minor bruising.
Rate severe (injury caused) if the person reports that they fought with another person, with
the intent to harm or otherwise injure, and injury was subsequently inflicted on the other
person and that required treatment.

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Frequency

0 Not at all
1 Once or twice
2 Regular, on average 1 x month
3 Regular, more than once a month

The average frequency of physical aggression is recorded. So, for example, if the person
reports fighting on average once a month as a child of 8 years but only two or three times a
year as a child of 16 years, rate the overall frequency for prior to 18 years as regular, more
than once a month. Rate not at all if the person reports not to have engaged in any physical
aggression in the past year, prior to 18 years of age or post-18 years of age. Rate one or twice
if the person reports isolated incidents of physical aggression. Rate regular, on average 1 x
month if the person indicates that they have engaged in acts of physical aggression once a
month. Rate regular, more than once a month if the person reports incidences of physical
aggression occurring at least once a month in the past year, prior to 18 years of age and post
18 years of age.

Individuals should then be asked about their use of weapons and whether they carry on
around. Notes regarding key incidences should be made in the box provided.

0 None
1 Carries weapon, never used
2 Only used to threaten
3 Used weapon in fight

Rate none if, over the past year, prior to 18 years or post 18 years, the person has never used a
weapon to hurt, or to threaten someone or to defend themselves in a fight. Rate carries a
weapon, never used it if the person has ever carried some kind of a weapon on their person,
like a knife, with the intent of using it to threaten or to harm someone “if necessary”. Rate
only used to threaten if the person reports carrying weapon in order to threaten, scare or
otherwise intimidate another person but has never used it. Rate used weapon if the person
has used a weapon in a fight; either a weapon carried for this purpose, like a knife, or a
weapon that comes to hand (like a piece of wood, a baseball-bat or a stone) on at least one
occasion.

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25. VANDALISM

Severity

0 No vandalism
1 Minor (little damage)
2 Major (serious damage)
3 Fire setting

This scale is concerned with episodes of vandalism (including graffiti) and/or fire-setting. Rate
none if the person reports never having engaged in vandalism in the past year, prior to 18
years of age and post 18 years of age. Rate minor (little damage) if the person reports having
engaged in some destructive acts. These might include damaging fences or hedges, letting
down people’s tyres, knocking over estate agents boards and a whole range of minor vandalism
and trouble-making of a kind often seeming to arise from persistent boredom and as a by-
product of irresponsible behaviour or other activities. Rate major (serious damage) if the
person reports having engaged in more serious acts of vandalism, such as window breaking,
scratching cars, breaking car windscreens or other acts of deliberate destruction. Rate fire-
setting if the person indicates episodes of fire-setting, regardless of whether these episodes
resulted in serious damage, in the past year, prior to 18 years and post 18 years of age.

Frequency

0 Not at all
1 Once or twice
2 Regular, on average 1 x month
3 Regular, more than once a month

The average frequency of vandalism is recorded. So, for example, if the person reports
committing acts of vandalism or fire-setting on average once a month as a child of 8 years, but
only two or three times a year as a child of 16 years, rate the overall frequency for prior to 18
years as regular, more than once a month. Rate not at all if the person reports not to have
engaged in any vandalism. Rate once or twice if the person reports isolated incidents of
vandalism. Rate regular, on average 1 x month if the person indicates that they have engaged
in acts of vandalism once a month. Rate regular, more than once a month if the person
reports committing acts of vandalism at least once a month or more in the past year, prior to
18 years of age and post 18 years of age.

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26. THEFT

Severity

0 None
1 Minor (value <£20)
2 Marked (value of £20-£100)
3 Major (value >£100, break-in, joy riding)

This scale is concerned with episodes of theft, including shoplifting, burglary and joy riding.
Rate none if the person reports never having engaged in theft in the past year, prior to 18
years of age and post 18 years of age. Rate minor (value <£20) if the person reports having
engaged in minor theft or shoplifting of items with a value of up to £20. Rate marked (value of
£20-£100) if the person reports having engaged in more serious acts of theft, stealing items
ranging from £20 to £100 in value. Rate major (value>£100, break-in, joy riding) if the person
indicates having engaged in stealing items with a value of over £100, or have taken part in
break-ins or occasions of joy riding in the past year, prior to 18 years and post 18 years of age.

Frequency

0 Not at all
1 Once or twice
2 Regular, on average 1 x month
3 Regular, on average more than once a month

Rate none if the person reports that they have never engaged in shoplifting, joy-riding or
break-ins, in the past year, prior to 18 years of age and post 18 years of age. Rate once or twice
if the person reports isolated incidents of shoplifting, joyriding or break-ins (including derelict
or otherwise unoccupied property). It should also be noted that many children engage in some
petty pilfering (for example, sweets from the local shop) during childhood and so the
interviewer should question the person closely regarding episodes of shop-lifting prior to 18
years of age. Rate regular, on average 1 x month if the person reports shoplifting, joy-riding or
break-ins in on average once a month. Rate regular, on average more than once a month, if
the person reports regularly shoplifting, joy-riding or breaking into property at least once a
month in the past year, prior to 18 years of age or post-18 years of age.

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27. POLICE INVOLVEMENT

This scale is concerned with both the frequency and nature of police contact the person has
experienced – in the previous year, prior to 18 years of age and post 18 years of age. Details
should be noted of any specific incidents reported by the person and outcome of police
involvement in the space provided.

Severity

0 No involvement
1 Mild (e.g. petty offences)
2 Marked (questioned, cautioned)
3 Severe (charged)

Rate none if the person reports having had no contact with the police in the previous year,
prior to 18 years of age or post 18 years of age. Rate mild (petty offences) if the person
reports occasional incidents such as speeding offences. Rate marked (questioned, cautioned)
if the person has had police contact resulting in them being questioned or cautioned about an
offence (whether petty or serious), even if they were not subsequently charged. Rate severe
(charged) if the person reports police contact that has resulted in charges being brought
against them (regardless of the nature of the offence).

Frequency

0 Not at all
1 Once or twice
2 Regular, on average 1 x month
3 Regular, more than once a month

Rate not at all if the person reports never having any police contact in the previous year, prior
to 18 years of age or post 18 years of age. Rate once or twice if the person reports that they
have had occasional contact with the police (regardless of the nature of the offence and
including being questioned by the police). Rate regular, on average 1 x month if the person
reports regular contact with the police, regardless of whether this is for serious or petty
offences. Rate regular, more than once a month if the person reports contact with the police
occurring several times a month, regardless of the nature of the offences.

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 SUBSTANCE USE
28. ALCOHOL

Initially the interviewer should open up a discussion about alcohol consumption and
experience. Individuals should be asked whether they drink alcohol, whether they get drunk,
how often they get drunk and whether they have had any bad experiences related to drinking.
These questions are provided on the ALFI and space is provided to note the individual’s
response.

Individuals are then asked to quantify their alcohol consumption. This should be measured by
the sum total of units of alcohol consumed in the past week. One unit is one glass of wine,
one measure of spirits or a half pint of beer or lager. A box is provided for this total number to
be recorded in. The mid-point should be taken for estimated ranges of units. If this falls on a
decimal number, then this should be rounded up, e.g. 5-10= 8.

29. ILLICIT SUBSTANCE USE

Cannabis
Cocaine (including crack cocaine)
Heroin
Speed/Amphetamine
Glue & Solvents
LSD
Ecstasy
Other

The above list of common drugs is provided, and individuals should be asked if they have ever
used any of those listed. A tick should be placed on the dotted line next to each substance they
have used (regardless of whether this was experimental or regular use). ‘Other’ may include
drugs such as magic mushrooms, morphine, amyl nitrate, or any prescribed medication used as
a drug of abuse, and the specific 'other' drug they used should be noted in the space provided.

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Severity

0 None
1 Mild (no impairment)
2 Marked (some impairment)
3 Severe (major impairment)

Rate none if the person indicates they have never taken any illicit drugs, even experimenting, in
the past year, prior to 18 years of age or post 18 years of age. Rate mild (no impairment) if the
person reports occasionally taking drugs, or experimented with them, but suffers no obvious
impairment. Rate marked (some impairment) if the person reports taking any drugs that cause
them to be in some way either cognitively or physically impaired (e.g. taking days off sick from
work; poor concentration; spending a disproportionate time in bed). Rate severe (major
impairment) if the person reports suffering major impairment (either cognitive or physical)
including, for example, withdrawal symptoms or dependency. Impairment is defined as causing
personal, social and/or occupational handicap. In such cases an individual may not be able to
engage in normal daytime activities, they may have poor motivation and need to take drugs to
function normally.

Frequency

0 Not at all
1 Once or twice (gave up)
2 Intermittent (will try again)
3 Regular user

Rate not at all if the person reports never having taken any illicit drugs in the past year, prior to
18 years of age or post 18 years of age. Rate once or twice (gave up) if the person reports
having experimented with some drugs, perhaps as a youngster, but did not continue (because
they didn’t like the effect etc.). Rate intermittent (will try again) if the person reports
occasional drug use that is ongoing but not regular. Rate regular user if the person reports
regularly using drugs e.g. on a monthly basis, regardless of whether they report suffering
impairment or not.

If an individual has reported any use of illicit substances, they should be further questioned
regarding the age at which they first consumed an illicit substance, and the reasons why they
first started. The interviewer should ascertain the progression of the individual’s drug use,
noting any change in frequency, type of substance, and poly-use. Examples of the extent to
which associated impairment has occurred and the peak impairment should be explored and
recorded.

For those individuals still taking drugs, it is important for the interviewer to ask why and
identify any personal maintenance factors underlying this behaviour. Maintenance factors may
include enjoyment, raising confidence, self-medication, peer pressure and socialising, as well as
dependency, and identifying the underlying reason for both starting and maintaining drug use
is of importance.

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 SOCIAL FUNCTIONING
This section is concerned with the person's social functioning. The individual should be asked
about how they like to spend their spare time and with whom, and what their preferred
leisure activity is.

The friendship section focuses on the nature of the person’s friendships, and their ability to
make and sustain friendships. Family members (e.g. cousins, siblings) are NOT included in
this section. Some information relating to childhood friendships may have already been
explored within the section relating to school history and it should be noted if a person
reports that they found it difficult to make friends at school but experience no such problems
in adulthood. Conversely, the opposite may also be true. The person should therefore be
questioned closely as to the precise nature and developmental course of their friendships.

The intimate relationships section deals with the person’s romantic and sexual relationships
with other people. A tendency toward disorganisation, poor motivation and aggressive
impulsive behaviour is likely to negatively impact on family dynamics and the aim of this
section is to assess the impact of the individual’s difficulties/problems on their intimate
relationships. For example, an individual may have a consistent pattern of dysfunctional
intimate relationships. This could be for many reasons - relationships may be volatile; a
person may become violent and flash in and out of mood states; the individual may have low
self-esteem, and lack confidence. It is interesting to know who usually ends the relationships
and whether these are mutually negotiated. They may engage in a frequent number of
intense relationships that break down after a few weeks’ duration.

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30. ACTIVITIES

The interviewer should ask questions about how they spend their leisure time, and what their
favourite pastime is, with space provided for notes. The individual should be asked who they
usually spend their spare time with, and are provided with the following options:

0 Alone
1 Family (including cohabiting partners)
2 Friends (including non-cohabiting girlfriends/boyfriends)
3 Acquaintances

Rate none if the person reports that they spend most of their spare time alone. Rate family if
the person indicates that they spend most of their spare time with cohabiting partners and/or
other family members. Rate friends if the person indicates that they spend most of their spare
time with friends (including girlfriend/boyfriend with whom they do not cohabit) and rate
acquaintances if the person reports that they spend time with people whom they know but do
not regard as close friends, such as social events with a football team, team sports, meeting
people at the local pub but with whom they have made no prior arrangement to meet.

Have a hobby YES/NO

Take part in sport YES/NO
Play a musical instrument YES/NO
Belong to any clubs YES/NO
Attend sports events YES/NO
Visit theatres, museums, concerts YES/NO
Listen to music YES/NO
Other YES/NO

The individual should then be asked about their involvement in the above list of activities, as
presented on the ALFI, identifying whether they do or do not engage in such activities and
circling the appropriate response. Activities should only be included that are engaged in
regularly, defined as at least once a month. Space is provided after each activity and details
should be noted of particular hobbies, activities and interests in which the person regularly
participates. It is intended to ascertain whether individuals engage in constructive leisure
activities (e.g. sports, club memberships) as opposed to non-constructive activities (e.g.
watching television, staying at home listening to music). It is also of interest and should be
noted whether they mix with others or tend to engage in lone pursuits (e.g. listening to music
alone, playing solitaire). Some interests could be either social or lone pursuits, such as
horseriding or playing golf, as these can be performed in a group setting and/or with individual
friends. They can also be solo interests. 'Other' might include activities such as gardening,
playing on a computer (‘surfing the net’ etc.), which should be specified. The total number of
activities the individual engages in on a regular basis should also be recorded in the box
provided.

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31. FRIENDSHIPS

The individual should be asked whether they have any friends they meet regularly, and
whether this has changed over time, in order to ascertain whether their ADHD symptoms are
impacting this area of their life. The individual should also be asked about the number of
friends they have and this should be recorded in the box provided. This refers to how many
close friends the person has and with whom they are in regular contact. Family members (e.g.
cousins, siblings) are not included. Regular contact is defined as either telephone contact or
face-to-face meetings on at least a monthly basis. Friendships that are generated and
maintained only via electronic sources are not included, e.g. a friend made on the internet and
with whom they are in daily contact but with whom they have never met. In cases when
individuals give a high number of close friends (say 15-20), the interviewer should probe for
further information to assess the quality of these relationships e.g. a person may be
nominating members of a football team as all close friends because he plays with them once a
week. The interviewer should then probe for how much contact there is with team players
outside of the weekly game in order to differentiate between acquaintances and close friends.
If the person insists that they are all close friends then it is the interviewee’s rating that is
recorded. If the person claims to have no close friends, reasons why should be examined to
establish whether the individual is a loner by choice or because he has difficulty sustaining
friendships.

The interviewer should also establish the degree to which the person easily makes friends and
falls out with friends. In this way, the interviewer aims to ascertain turnover of friendships and
whether a person finds it hard to make friends in the first place, or whether a person finds this
aspect easy but finds it hard to maintain reciprocal friendships. For example, does the person
readily make friends but seem unable to sustain friendships over any period of time. If so,
why? Why do friendships end? Is it because their friends move on, breaking the friendship? Is
it because of their behaviour toward other people?

The interviewer then asks whether the person has any long-standing friends. It is important
that the longest-standing friend is nominated from the number of friends the person is in
regular contact with (i.e. the first question). Thus, a friend of 20 years, with whom the person
meets infrequently, is not included here. For example, the interviewer may ask “How many
friends do you consider yourself to have, with whom you are in regular contact, you may meet
or speak with on the phone, at least monthly”…..this would be followed by….“Of those friends,
who is the longest-standing friend? How long have you been friends for?”.

The interviewer should then establish what the individual does when seeing their friends. This
is useful to understand the type of individuals being classed as friends and highlight any
potential influences they have on the individuals behaviour.

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32. INTIMATE RELATIONSHIPS

Intimate relationships include any romantic and/or sexual relationships the individual has. The
person should be questioned about how many significant or important relationships they have
had (other than family members or platonic friends). It is important to emphasise that this is
their perception of ‘significant’ and not a temporal measure. For example, the person may
consider a relatively intense, but short-term, relationship to have been significant. The number
of significant relationships should be recorded in the box provided, and then additional
information regarding the duration of each relationship, and the reason they broke down
should also be discussed, clarified and noted in the boxes provided.

The interviewer should ask at what age the person became sexually active. Individuals,
especially girls, may have engaged in intimate relationships at a young age (say 12/13 years)
and continue to behave in a promiscuous way in an attempt to make friends and attract the
interest of others. A lack of confidence in relationships may alternatively be expressed as
avoiding intimate and sexual relationships – they may not commence sexual relationships until
they are in young adulthood, say in their mid-twenties. The person should be asked whether
they have a current partner, spouse, girlfriend or boyfriend and, if so, whether they are
satisfied with this relationship. This may be a sensitive area and the interviewer should
carefully explore with the person sources of dissatisfaction.

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 PRESENTATION TO SERVICES

This section focuses on the individual’s presentation to clinical and education services since
childhood. Information should be elicited from referral notes, as well as direct questioning of
the person.

Details are recorded for extra professional teaching provided by the school and/or extra
private professional teaching paid for by parents. For each, the number of subjects should be
recorded, as well as the number of episodes of teaching e.g. reading (age 7 years), maths (age
10 years), English (age 10 years), maths (age 15 years). The number of interventions involving
an educational psychologist should also be recorded (including privately requested
assessments).

Whether an individual has had contact with child guidance clinics should be detailed, as well as
contact with social services (either as a child and/or as an adult).

A person is asked on how many occasions they have visited their NHS GP for non-physical
reasons, such as stress, anxiety, depression. Also included here are times they may have
visited their GP for physical reasons, e.g. migraine, fatigue, and been told by the GP that the
underlying problem is due to psychological problems (e.g. stress, anxiety, depression). Each
separate episode is recorded and not the actual number of appointments per episode.

Non-physical contacts with hospital or community services should be recorded, such as

referrals to psychiatric/psychology services (either primary or tertiary referrals). Thus for every
contact recorded here, one contact is potentially recorded in the prior GP section (e.g. four GP
referrals to hospital and/or community psychiatric services should be also recorded as four GP
presentations). Private GP referrals to psychiatric/psychology services should also be included
here. Treatment in primary care is also included here.

Consultation with a private practitioner refers to visits to professionals that are not referred by
GP or tertiary services. These include private psychotherapy and counselling sessions that are
funded by the individual. Also included are visits to allergists, homeopathists, acupuncturists,
Chinese herbalists, cranial osteopaths etc.

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 INTERVIEWER PERCEPTION
The purpose of this section is to provide a checklist of problem areas for the interviewer to
consider. This is intended to help clarify the interviewer’s thoughts about the individual and
it is not therefore part of the interview per se, although it is based on information elicited
during the course of the interview. Items should be ticked according to whether, in the
interviewer’s personal view, they may apply to the person concerned. Possible comorbidities
are listed for consideration.

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