Diagnostic Interview For ADHD in Adults (DIVA) : English
Diagnostic Interview For ADHD in Adults (DIVA) : English
Diagnostic Interview For ADHD in Adults (DIVA) : English
DIVA 2.0
in adults (DIVA)
diagnostic interview
for ADHD J.J.S. Kooij, MD, PhD & M.H. Francken, MSc
in adults 2010, DIVA Foundation, The Netherlands
Colophon Introduction
The Diagnostic Interview for According to the DSM-IV, ascertaining the diagnosis of ADHD in adults
ADHD in adults (DIVA) is a involves determining the presence of ADHD symptoms during both childhood
publication of the DIVA and adulthood.
Foundation, The Hague,
The Netherlands, August The main requirements for the diagnosis are that the onset of ADHD symp-
2010. The original English toms occurred during childhood and that this was followed by a lifelong
translation by Vertaalbureau persistence of the characteristic symptoms to the time of the current evalua-
Boot was supported by tion. The symptoms need to be associated with significant clinical or psycho-
Janssen-Cilag B.V. Back- social impairments that affect the individual in two or more life situations1.
translation into Dutch by Because ADHD in adults is a lifelong condition that starts in childhood, it is
Sietske Helder. Revison by necessary to evaluate the symptoms, course and level of associated impair-
dr. J.J.S. Kooij, DIVA ment in childhood, using a retrospective interview for childhood behaviours.
Foundation and Prof. Philip Whenever possible the information should be gathered from the patient and
Asherson, Institute of supplemented by information from informants that knew the person as a child
Psychiatry, London. (usually parents or close relatives)2.
Reprinted with permission The Diagnostic Interview for ADHD in Adults (DIVA)
from the Diagnostic and The DIVA is based on the DSM-IV criteria and is the first structured Dutch
Statistical Manual of Mental interview for ADHD in adults. The DIVA has been developed by J.J.S. Kooij
Disorders, Text Revision, and M.H. Francken and is the successor of the earlier Semi-Structured
Fourth Edition (Copyright Interview for ADHD in adults2,3.
2000). American Psychiatric
Association. In order to simplify the evaluation of each of the 18 symptom criteria for
ADHD, in childhood and adulthood, the interview provides a list of concrete
This publication has been and realistic examples, for both current and retrospective (childhood) behav-
put together with care. iour. The examples are based on the common descriptions provided by adult
However, over the course of patients in clinical practice. Examples are also provided of the types of
time, parts of this publication impairments that are commonly associated with the symptoms in five areas of
might change. For that everyday life: work and education; relationships and family life; social con-
reason, no rights may be tacts; free time and hobbies; self-confidence and self-image.
derived from this publica-
tion. For more information Whenever possible the DIVA should be completed with adults in the presence
and future updates of the of a partner and/or family member, to enable retrospective and collateral
DIVA please visit information to be ascertained at the same time. The DIVA usually takes
www.divacenter.eu. around one and a half hours to complete.
The DIVA only asks about the core symptoms of ADHD required to make the
DSM-IV diagnosis of ADHD, and does not ask about other co-occurring
psychiatric symptoms, syndromes or disorders. However comorbidity is
commonly seen in both children and adults with ADHD, in around 75% of
cases. For this reason, it is important to complete a general psychiatric
assessment to enquire about commonly co-occurring symptoms, syndromes
and disorders. The most common mental health problems that accompany
ADHD include anxiety, depression, bipolar disorder, substance abuse disor-
ders and addiction, sleep problems and personality disorders, and all these
should be investigated. This is needed to understand the full range of symp-
toms experienced by the individual with ADHD; and also for the differential
diagnosis, to exclude other major psychiatric disorders as the primary cause
of ‘ADHD symptoms’ in adults2.
The DIVA is divided into three parts that are each applied around the age of 10-12 years of age, but have difficulty
to both childhood and adulthood: for the pre-school years.
(1) The criteria for Attention Deficit (A1)
(2) The criteria for Hyperactivity-Impulsivity (A2) For each criterion, the researcher should make a decision
(3) The Age of Onset and Impairment accounted for by about the presence or absence in both stages of life,
ADHD symptoms taking into account the information from all the parties
involved. If collateral information cannot be obtained, the
Start with the first set of DSM-IV criteria for attention deficit diagnosis should be based on the patient’s recall alone. If
(A1), followed by the second set of criteria for hyperactiv- school reports are available, these can help to give an
ity/impulsivity (A2). Ask about each of the 18 criteria in idea of the symptoms that were noticed in the classroom
turn. For each item take the following approach: during childhood and can be used to support the diagno-
sis. Symptoms are considered to be clinically relevant if
First ask about adulthood (symptoms present in the last they occurred to a more severe degree and/or more
6-months or more) and then ask about the same symptom frequently than in the peer group or if they were impairing
in childhood (symptoms between the ages of 5 to 12 to the individual.
years)4-6. Read each question fully and ask the person
being interviewed whether they recognise this problem Age of onset and impairment
and to provide examples. Patients will often give the same The third section on Age of Onset and Impairment ac-
examples as those provided in the DIVA, which can then counted for by the symptoms is an essential part of the
be ticked off as present. If they do not recognise the diagnostic criteria. Find out whether the patient has always
symptoms or you are not sure if their response is specific had the symptoms and, if so, whether any symptoms were
to the item in question, then use the examples, asking present before 7-years of age. If the symptoms did not
about each example in turn. For a problem behaviour or commence till later in life, record the age of onset.
symptom to be scored as present, the problem should
occur more frequently or at a more severe level than is Then ask about the examples for the different situations in
usual in an age and IQ matched peer group, or to be which impairment can occur, first in adulthood then in
closely associated with impairments. Tick off each of the childhood. Place a tick next to the examples that the
examples that are described by the patient. If alternative patient recognises and indicate whether the impairment is
examples that fit the criteria are given, make a note of reported for two or more domains of functioning. For the
these under “other”. To score an item as present it is not disorder to be present, it should cause impairment in at
necessary to score all the examples as present, rather the least two situations, such as work and education; relation-
aim is for the investigator to obtain a clear picture of the ships and family life; social contacts; free time and
presence or absence of each criterion. hobbies; self-confidence and self-image, and be at least
moderately impairing.
For each criterion, ask whether the partner or family
member agrees with this or can give further examples of Summary of symptoms
problems that relate to each item. As a rule, the partner In the Summary of Symptoms of Attention Deficit (A) and
would report on adulthood and the family member (usually Hyperactivity-Impulsivity (HI), indicate which of the
parent or older relative) on childhood. The clinician has to 18 symptom criteria are present in both stages of life; and
use clinical judgement in order to determine the most sum the number of criteria for inattention and hyperactivity/
accurate answer. If the answers conflict with one another, impulsivity separately.
the rule of thumb is that the patient is usually the best
informant7. Finally, indicate on the Score Form whether six or more
criteria are scored for each of the symptom domains of
The information received from the partner and family is Attention Deficit (A) and Hyperactivity-Impulsivity (HI). For
mainly intended to supplement the information obtained each domain, indicate whether there was evidence of a
from the patient and to obtain an accurate account of both lifelong persistent course for the symptoms, whether the
current and childhood behaviour; the informant information symptoms were associated with impairment, whether
is particularly useful for childhood since many patients impairment occurred in at least two situations, and
have difficulty recalling their own behaviour retrospective- whether the symptoms might be better explained by
ly. Many people have a good recall for behaviour from another psychiatric disorder. Indicate the degree to which
Date of birth
Sex: ❑M / ❑F
Date of interview
Name of researcher
Patient number
Instructions: the symptoms in adulthood have to have been present for at least 6 months. The symptoms in childhood
relate to the age of 5-12 years. For a symptom to be ascribed to ADHD it should have a chronic trait-like course and
should not be episodic.
A1 Do you often fail to give close attention to detail, or do you make careless mistakes in your work or
during other activities? And how was that during childhood?
❑ Not able to keep attention on tasks for long* ❑ Difficulty keeping attention on schoolwork
❑ Quickly distracted by own thoughts or associations ❑ Difficulty keeping attention on play*
❑ Finds it difficult to watch a film through to the end, or to ❑ Easily distracted
read a book* ❑ Difficulty concentrating*
❑ Quickly becomes bored with things* ❑ Needing structure to avoid becoming distracted
❑ Asks questions about subjects that have already been ❑ Quickly becoming bored of activities*
discussed ❑ Other:
❑ Other:
*Unless the subject is found to be really interesting (e.g.
*Unless the subject is found to be really interesting (e.g. computer or hobby)
computer or hobby)
A3 Does it often seem as though you are not listening when you are spoken to directly? And how was that
during childhood?
❑ Does things that are muddled up together without ❑ Difficulty following instructions
completing them ❑ Difficulty with instructions involving more than one step
❑ Difficulty completing tasks once the novelty has worn off ❑ Not completing things
❑ Needing a time limit to complete tasks ❑ Not completing homework or handing it in
❑ Difficulty completing administrative tasks ❑ Needing a lot of structure in order to complete tasks
❑ Difficultly following instructions from a manual ❑ Other:
❑ Other:
A5 Do you often find it difficult to organise tasks and activities? And how was that during childhood?
❑ Difficultly with planning activities of daily life ❑ Difficultly being ready on time
❑ House and/or workplace are disorganised ❑ Messy room or desk
❑ Planning too many tasks or non-efficient planning ❑ Difficultly playing alone
❑ Regularly booking things to take place at the same ❑ Difficulty planning tasks or homework
time (double-booking) ❑ Doing things in a muddled way
❑ Arriving late ❑ Arriving late
❑ Not able to use an agenda or diary consistently ❑ Poor sense of time
❑ Inflexible because of the need to keep to schedules ❑ Difficulty keeping himself/herself entertained
❑ Poor sense of time ❑ Other:
❑ Creating schedules but not using them
❑ Needing other people to structure things
❑ Other:
❑ Do the easiest or nicest things first of all ❑ Avoidance of homework or has an aversion to this
❑ Often postpone boring or difficult tasks ❑ Reads few books or does not feel like reading due to
❑ Postpone tasks so that deadlines are missed mental effort
❑ Avoid monotonous work, such as administration ❑ Avoidance of tasks that require a lot of concentration
❑ Do not like reading due to mental effort ❑ Aversion to school subjects that require a lot of
❑ Avoidance of tasks that require a lot of concentration concentration
❑ Other: ❑ Often postpones boring or difficult tasks.
❑ Other:
A7 Do you often lose things that are needed for tasks or activities? And how was that during childhood?
❑ Mislays wallet, keys, or agenda ❑ Loses diaries, pens, gym kit or other items
❑ Often leaves things behind ❑ Mislays toys, clothing, or homework
❑ Loses papers for work ❑ Spends a lot of time searching for things
❑ Loses a lot of time searching for things ❑ Gets in a panic if other people move things around
❑ Gets in a panic if other people move things around ❑ Comments from parents and/or teacher about things
❑ Stores things away in the wrong place being lost
❑ Loses notes, lists or telephone numbers ❑ Other:
❑ Other:
❑ Difficulty shutting off from external stimuli ❑ In the classroom, often looking outside
❑ After being distracted, difficult to pick up the thread again ❑ Easily distracted by noises or events
❑ Easily distracted by noises or events ❑ After being distracted, has difficultly picking up the
❑ Easily distracted by the conversations of others thread again
❑ Difficulty in filtering and/or selecting information ❑ Other:
❑ Other:
A9 Are you often forgetful during daily activities? And how was that during childhood?
Supplement criterion A
Adulthood:
Do you have more of these symptoms of attention deficit than other people, or do you experience these more frequently
than other people of your age?
❑ Yes / ❑ No
Childhood:
Did you have more of these symptoms of attention deficit than other children of your age, or did you experience these
more frequently than other children of your age?
❑ Yes / ❑ No
Instructions: the symptoms in adulthood have to have been present for at least 6 months. The symptoms in childhood
relate to the age of 5-12 years. For a symptom to be ascribed to ADHD it should have a chronic trait-like course and
should not be episodic.
H/I 1 Do you often move your hands or feet in a restless manner, or do you often fidget in your chair?
And how was that during childhood?
H/I 2 Do you often stand up in situations where the expectation is that you should remain in your seat?
And how was that during childhood?
❑ Avoids symposiums, lectures, church etc. ❑ Often stands up while eating or in the classroom
❑ Prefers to walk around rather than sit ❑ Finds it very difficult to stay seated at school or during
❑ Never sits still for long, always moving around meals
❑ Stressed owing to the difficulty of sitting still ❑ Being told to remain seated
❑ Makes excuses in order to be able to walk around ❑ Making excuses in order to walk around
❑ Other: ❑ Other:
H/I 4 Do you often find it difficult to engage in leisure activities quietly? And how was that during
childhood?
❑ Talks during activities when this is not appropriate ❑ Being loud-spoken during play or in the classroom
❑ Becoming quickly too cocky in public ❑ Unable to watch TV or films quietly
❑ Being loud in all kinds of situations ❑ Asked to be quieter or calm down
❑ Difficulty doing activities quietly ❑ Becoming quickly too cocky in public
❑ Difficultly in speaking softly ❑ Other:
❑ Other:
H/I 6 Do you often talk excessively? And how was that during childhood?
❑ So busy talking that other people find it tiring ❑ Known as a chatterbox
❑ Known to be an incessant talker ❑ Teachers and parents often ask you to be quiet
❑ Finds it difficult to stop talking ❑ Comments in school reports about talking too much
❑ Tendency to talk too much ❑ Being punished for talking too much
❑ Not giving others room to interject during a conversa- ❑ Keeping others from doing schoolwork by talking too
tion much
❑ Needing a lot of words to say something ❑ Not giving others room during a conversation
❑ Other: ❑ Other:
❑ Being a blabbermouth, saying what you think ❑ Being a blabbermouth, saying things without thinking
❑ Saying things without thinking first first
❑ Giving people answers before they have finished ❑ Wants to be the first to answer questions at school
speaking ❑ Blurts out an answer even if it is wrong
❑ Completing other people’s words ❑ Interrupts others before sentences are finished
❑ Being tactless ❑ Coming across as being tactless
❑ Other: ❑ Other:
H/I 8 Do you often find it difficult to await your turn? And how was that during childhood?
❑ Difficulty waiting in a queue, jumping the queue ❑ Difficultly waiting turn in group activities
❑ Difficulty in patiently waiting in the traffic/traffic jams ❑ Difficultly waiting turn in the classroom
❑ Difficulty waiting your turn during conversations ❑ Always being the first to talk or act
❑ Being impatient ❑ Becomes quickly impatient
❑ Quickly starting relationships/jobs, or ending/leaving ❑ Crosses the road without looking
these because of impatience ❑ Other:
❑ Other:
Supplement criterion A
Adulthood:
Do you have more of these symptoms of hyperactivity/impulsivity than other people, or do you experience these more
frequently than other people?
❑ Yes / ❑ No
Childhood:
Did you have more of these symptoms of hyperactivity/impulsivity than other children of your age, or did you experience
these more frequently than other children of your age?
❑ Yes / ❑ No
Criterion B
Have you always had these symptoms of attention deficit and/or hyperactivity/impulsivity?
❑ Yes (a number of symptoms were present prior to the 7th year of age).
❑ No
If no is answered above, starting as from year of age.
In which areas do you have / have you had problems with these symptoms?
Work/education Education
❑ Did not complete education/training needed for work ❑ Lower educational level than expected based on IQ
❑ Work below level of education ❑ Staying back (repeating classes) as a result of
❑ Tire quickly of a workplace concentration problems
❑ Pattern of many short-lasting jobs ❑ Education not completed / rejected from school
❑ Difficulty with administrative work/planning ❑ Took much longer to complete education than usual
❑ Not achieving promotions ❑ Achieved education suited to IQ with a lot of effort
❑ Under-performing at work ❑ Difficulty doing homework
❑ Left work following arguments or dismissal ❑ Followed special education on account of symptoms
❑ Sickness benefits/disability benefit as a result of ❑ Comments from teachers about behaviour or concen-
symptoms tration
❑ Limited impairment through compensation of high IQ ❑ Limited impairment through compensation of high IQ
❑ Limited impairment through compensation of external ❑ Limited impairment through compensation of external
structure structure
❑ Other ❑ Other:
Potential details:
A1c A3. Often does not seem to listen when spoken to directly
A1d A4. Often does not follow through on instructions and fails to finish
schoolwork, chores, or duties in the workplace
A2g H/I 7. Often blurts out answers before questions have been completed
DSM-IV Childhood
criterion A Is the number of A characteristics ≥ 6? ❑ Yes / ❑ No
Is the number of H/I characteristics ≥ 6? ❑ Yes / ❑ No
Adulthood*
Is the number of A characteristics ≥ 6? ❑ Yes / ❑ No
Is the number of H/I characteristics ≥ 6? ❑ Yes / ❑ No
DSM-IV Are there signs of a lifelong pattern of symptoms and limita-
criterion B tions?
❑ Yes / ❑ No
DSM-IV The symptoms and the impairment are expressed in at least
criterion C two domains of functioning
and D
Adulthood ❑ Yes / ❑ No
Childhood ❑ Yes / ❑ No
DSM-IV The symptoms cannot be (better) explained by the presence
criterion E of another psychiatric disorder
❑ No
Yes, by
Is the diagnosis supported by collateral information?
Diagnosis ADHD*** ❑ No
Yes, subtype
❑ 3 14.01 Combined type
❑ 3 14.00 Predominantly inattentive
type
❑ 3 14.01 Predominantly
hyperactive-impulsive type
* Research has indicated that at adult age, four or more characteristics of attention problems and/or hyperactivity-impulsivity are sufficient for
the diagnosis of ADHD to be made. Kooij e.a., Internal and external validity of Attention-Deficit Hyperactivity Disorder in a population-based
sample of adults. Psychological Medicine 2005; 35(6):817-827. Barkley RA: Age dependent decline in ADHD: True recovery or statistical
illusion? The ADHD Report 1997; 5:1-5.
** Indicate from whom the collateral information was taken.
*** If the established sub-types differ in childhood and adulthood, the current adult sub-type prevails for the diagnosis.
diagnostic interview
for ADHD
ENGLISH in adults