Clinicians

Adult ADHD Intake: The 12 Questions That Matter Most

September 12, 2026 · 7 min read

Last updated September 12, 2026

Rating scales quantify symptoms; the interview determines whether they mean ADHD. A good adult intake covers onset, pervasiveness, impairment, and the differential in under an hour, and it does so with questions that are hard to answer in a rehearsed way. These are the twelve I return to, grouped by what they establish. Ask them in the client’s own life, not in DSM language, and write down the concrete examples rather than the yes or no.

Establishing onset (criterion B)

One: What did your teachers say about you, in their words, on report cards or at conferences? Adults with ADHD almost always have a phrase: ‘bright but doesn’t apply himself,’ ‘daydreams,’ ‘disruptive,’ ‘careless work.’ A client who has no such phrase and describes an unremarkable school career needs a much closer look at alternative explanations. Two: Who from your childhood could I talk to, and what would they say? This both gathers collateral and tests whether the client expects corroboration. Three: When did the problems first cost you something real: a grade, a job, a relationship? Impairment that begins in the twenties or thirties without a childhood history points away from ADHD toward mood, anxiety, sleep, or life circumstance.

Establishing pervasiveness (criterion C)

Four: Describe a typical weekday from waking to sleep, and where it goes wrong. Listen for whether difficulties appear at work, at home, and in relationships, or only in one domain. Five: What do the people who live with you complain about? Partners and roommates report the home-setting symptoms clients minimize: the unfinished tasks, the interrupting, the lateness, the lost items. Six: Is there any setting in which you function well, and what is different about it? A client who is excellent under deadline and in crisis and poor in routine is describing ADHD. A client who is fine at home and falls apart only at work may be describing a job problem.

Establishing impairment (criterion D)

Seven: What has this cost you? Ask for specifics: jobs lost or left, degrees unfinished, debt, tickets, accidents, relationships ended. Impairment must be clinically significant, and the list makes the case in the report. Eight: What have you already tried to fix it, and what happened? This reveals the compensatory systems the client has built (or not), the failed self-help attempts, and any previous treatment or evaluation, and it tells you how much insight the client has into their own patterns.

Ruling out the look-alikes (criterion E)

Nine: When your mind wanders, where does it go? Anxiety wanders to worry; depression wanders to rumination; ADHD wanders to nothing in particular or to something more interesting. Ten: Tell me about your sleep: hours, quality, snoring, phone in bed. Chronic short or disordered sleep reproduces every ADHD symptom and is common enough that it should be addressed before or alongside any diagnosis. Eleven: Was there a period, even a short one, when you felt fine and functioned well? For ADHD the honest answer is usually no, apart from periods of unusual structure or interest. For mood disorders the answer is yes, and the concentration problems track the episodes.

The question that reorganizes the others

Twelve: Why now? Why is the client seeking evaluation this month rather than five years ago? The answer is diagnostic in itself. A child’s recent diagnosis, a new job that removed old structure, a partner’s ultimatum, or a lifelong suspicion finally acted on are all consistent with ADHD. A recent loss, a new medication, or a stressor that began at the same time as the symptoms points elsewhere. And a request for a specific stimulant by name, with reluctance to consider alternatives, is worth noting without prejudging it.

What to do with the answers

Write down the examples, not the ratings. ‘Client reports three jobs left in four years, two after conflicts about missed deadlines; partner reports client loses keys or wallet weekly and has not finished a household project in two years’ is evidence a prescriber and a report reader can use. ‘Client endorses inattention’ is not. Then move to collateral, screening measures for the alternatives you have flagged, and standardized testing. The differential checklist picks up where the interview leaves off.

The bottom line

Twelve questions, asked in the client’s own life, will establish onset, pervasiveness, and impairment, flag the main alternatives, and give you a report that reads as an evaluation rather than a screen. The instruments come after. The interview is the evaluation.