[Pharmacotherapy of attention deficit hyperactivity disorder in adults]. / Medikamentöse Therapie der Aufmerksamkeitsdefizit­/Hyperaktivitätsstörung im Erwachsenenalter.

Pharmacotherapy is a central component in the context of an overall therapeutic concept in the treatment of adults with attention deficit hyperactivity disorder (ADHD). In this concept psychosocial interventions with psychoeducation or specific psychotherapy measures also play an important role. In adults three compounds are currently approved for the pharmacological treatment of ADHD in Germany. The long-acting stimulants retarded methylphenidate preparations and lisdexamfetamine can be prescribed. Alternatively, the adrenergic uptake inhibitor atomoxetine can be used. In several meta-analyses good effectiveness and tolerance of these drugs on ADHD psychopathology has been shown. They also improve ADHD-related disorders of emotional regulation capability and disorganization in everyday life. Importantly, an improvement in everyday functionality and quality of life under medication could also be shown in several studies. In this review the evidence for pharmacotherapy of ADHD and its implementation into treatment of adult patients is presented.

[Wender-Reimherr self-report questionnaire on adult ADHD : German version]. / Der Wender-Reimherr-Selbstbeurteilungsfragebogen zur adulten ADHS : Deutsche Version.

BACKGROUND: The Wender-Reimherr adult attention deficit disorder scale (WRAADDS) is an internationally accepted attention-deficit hyperactivity disorder (ADHD) interview with an authorized German translation. The WRAADS not only assesses the symptoms of ADHD but also the severity of the symptoms using the Utah criteria. With the aim of economizing the diagnostic process the original English version of the Wender-Reimherr self-report questionnaire was translated into German (WR-SB) in order to evaluate the test psychometric properties. OBJECTIVES: To explore the psychometric properties of the WR-SB within a classical test theory framework. MATERIAL AND METHODS: The psychometric properties of the WR-SB were determined in a population of 122 adult ADHD patients and 79 healthy controls. RESULTS: For the individual WR-SB subscales the results showed an adequate discriminatory power and a high internal consistency. The correlation between the WRAADS and the WR-SB was significant and the retest reliability was high. CONCLUSION: The WR-SB is a brief, self-report instrument and an economical alternative to assess adult ADHD symptomatology using the Utah criteria. The results of this evaluation study showed the WR-SB to be a valid and reliable measurement for both clinical and research purposes.

In vivo observation of quadrupolar splitting in (39)K magnetic resonance spectroscopy of human muscle tissue.

The purpose of this work was to explore the origin of oscillations of the T(*)2 decay curve of (39)K observed in studies of (39)K magnetic resonance imaging of the human thigh. In addition to their magnetic dipole moment, spin-3/2 nuclei possess an electric quadrupole moment. Its interaction with non-vanishing electrical field gradients leads to oscillations in the free induction decay and to splitting of the resonance. All measurements were performed on a 7T whole-body MRI scanner (MAGNETOM 7T, Siemens AG, Erlangen, Germany) with customer-built coils. According to the theory of quadrupolar splitting, a model with three Lorentzian-shaped peaks is appropriate for (39)K NMR spectra of the thigh and calf. The frequency shifts of the satellites depend on the angle between the calf and the static magnetic field. When the leg is oriented parallel to the static magnetic field, the satellites are shifted by about 200 Hz. In the thigh, rank-2 double quantum coherences arising from anisotropic quadrupolar interaction are observed by double-quantum filtration with magic-angle excitation. In addition to the spectra, an image of the thigh with a nominal resolution of (16 × 16 × 32) mm(3) was acquired with this filtering technique in 1:17 h. From the line width of the resonances, (39)K transverse relaxation time constants T(*)2, fast = (0.51 ± 0.01) ms and T(*)2, slow = (6.21 ± 0.05) ms for the head were determined. In the thigh, the left and right satellite, both corresponding to the short component of the transverse relaxation time constant, take the following values: T(*)2, fast = (1.56 ± 0.03) ms and T(*)2, fast = (1.42 ± 0.03) ms. The centre line, which corresponds to the slow component, is T(*)2, slow = (9.67 ± 0.04) ms. The acquisition time of the spectra was approximately 10 min. Our results agree well with a non-vanishing electrical field gradient interacting with (39)K nuclei in the intracellular space of muscle tissue.

Dysfunctional cortical inhibition in adult ADHD: neural correlates in auditory event-related potentials.

In recent times, the relevance of an accurate diagnosis of attention-deficit/hyperactivity disorder (ADHD) in adults has been the focus of several studies. No longer considered a pathology exclusive to children and adolescents, and taking into account its social implications, developing enhanced support tools for the current diagnostic procedure becomes a priority. Here we present a method for the objective assessment of ADHD in adults using chirp-evoked, paired auditory late responses (ALRs) combined with a two-dimensional ALR denoising scheme to extract correlates of intracortical inhibition. Our method allows for an effective single-sweep denoising, thus requiring less trials to obtain recognizable physiological features, useful as pointers of cortical impairment. Results allow an optimized diagnosis, reduction of data loss and acquisition time; moreover, they do not account exclusively for critical elements within clinical evaluations, but also allow studying the pathophysiology of the condition by providing objective information regarding impaired cortical functions.

Treatment adherence and persistence in adult ADHD: results from a twenty-four week controlled clinical trial with extended release methylphenidate.

PURPOSE: The aim of this analysis is to describe medication adherence, and treatment persistence, in adults with attention deficit/hyperactivity disorder (ADHD) treated for 24 weeks with extended release methylphenidate (MPH-ER). Additionally, patient-, disorder- and treatment-related factors associated with adherence and persistence will be identified. METHOD: Post-hoc analysis of the active treatment group of a placebo-controlled, randomised, 24 week trial with MPH-ER with univariate description and multiple logistic regression models and Hosmer and Lemeshow tests. RESULTS: In the sample of 241 adults with ADHD (mean age of 35.2 ± 10.1 years), 9.4% of the patients were non-adherent, taking less than 80% of the dispensed medication. Factors associated with non-adherence included age<25 years, education level lower than secondary education, lacking family history of ADHD, lower ADHD baseline severity and lower self- and observer-rated medication efficacy. Lacking family history of ADHD, lower education level and lower self-rated medication efficacy, predicted non-adherence with a prediction accuracy of 16%. Seventeen percent of the patients discontinued early with most discontinuing within the first five weeks of the MPH-ER titration phase. Mean persistence in the discontinuing group was 63.4 ± 49.4 days. Factors associated with discontinuation included male gender, lower education level, lacking family history of ADHD and lower self- and observer-rated medication efficacy. Treatment non-response, male gender and lower education level predicted treatment discontinuation with a prediction accuracy of 22.7%. CONCLUSION: Male adults without relatives with ADHD, with lower educational level and lower self- and observer-rated medication efficacy, who are newly treated with MPH-ER, are at increased risk of non-adherence and treatment discontinuation. Patients are at increased risk of treatment discontinuation during the medication titration phase.

[Standardised psychopathological rating scales for the diagnosis of ADHD in adults]. / Standardisierte Skalen zur strukturierten Diagnostik der ADHS im Erwachsenenalter.

Ascertaining the diagnosis of ADHD in adults according to DSM-IV requires determination of the presence of symptoms of inattention, hyperactivity and impulsivity during both childhood and adulthood. Developmental changes of psychopathology, age-related comorbidity and functional and psychosocial problems associated with ADHD have to be taken into account during the diagnostic process. The use of standardised instruments might improve validity and reliability of the diagnosis. These diagnostic tools comprise self and expert ratings as well as observer ratings for the retrospective assessment of childhood and the evaluation of current ADHD symptoms. Here we give an overview of the standardised instruments that are available in German language and present data regarding the validity and reliability of a structured guide for the integrated diagnosis of adult ADHD (IDA) which has been constructed in order to provide a feasible tool for diagnosis of ADHD.

German validation of the Conners Adult ADHD Rating Scales (CAARS) II: reliability, validity, diagnostic sensitivity and specificity.

BACKGROUND: The German version of the Conners Adult ADHD Rating Scales (CAARS) has proven to show very high model fit in confirmative factor analyses with the established factors inattention/memory problems, hyperactivity/restlessness, impulsivity/emotional lability, and problems with self-concept in both large healthy control and ADHD patient samples. This study now presents data on the psychometric properties of the German CAARS-self-report (CAARS-S) and observer-report (CAARS-O) questionnaires. METHODS: CAARS-S/O and questions on sociodemographic variables were filled out by 466 patients with ADHD, 847 healthy control subjects that already participated in two prior studies, and a total of 896 observer data sets were available. Cronbach's-alpha was calculated to obtain internal reliability coefficients. Pearson correlations were performed to assess test-retest reliability, and concurrent, criterion, and discriminant validity. Receiver Operating Characteristics (ROC-analyses) were used to establish sensitivity and specificity for all subscales. RESULTS: Coefficient alphas ranged from .74 to .95, and test-retest reliability from .85 to .92 for the CAARS-S, and from .65 to .85 for the CAARS-O. All CAARS subscales, except problems with self-concept correlated significantly with the Barrett Impulsiveness Scale (BIS), but not with the Wender Utah Rating Scale (WURS). Criterion validity was established with ADHD subtype and diagnosis based on DSM-IV criteria. Sensitivity and specificity were high for all four subscales. CONCLUSION: The reported results confirm our previous study and show that the German CAARS-S/O do indeed represent a reliable and cross-culturally valid measure of current ADHD symptoms in adults.

A case report of necrophilia--a psychopathological view.

This paper presents the case of a 40-year-old German man who was convicted for disturbing the dead. He performed heterosexual necrophilic acts over the course of two decades. The most recent case was well documented by the necrophiliac himself by means of photography and video. His actions ranged from visiting cemeteries to dissecting bodies and taking the body parts home with him for sexual purposes. The perpetrator displayed no signs of other psychiatric illnesses. The case is discussed in light of the currently available literature.

Psychopathological rating scales as efficacy parameters in adult ADHD treatment investigations - benchmarking instruments for international multicentre trials.

INTRODUCTION: The selection of appropriate instruments in clinical studies is an essential point to detect the effects of pharmacological and/or psychotherapeutic treatments. METHODS: We performed a Medline search to identify the controlled pharmacological treatment studies and controlled and open psychotherapeutic investigations since 1999 in adult ADHD. The efficacy parameters were collected in order to compare their psychometric properties and psychopathological content. RESULTS: We identified 21 pharmacological and 6 psychotherapeutic treatment studies. The ADHD-Rating Scale-IV (ADHD-RS-IV), the Conners Adult ADHD Rating Scale-Observer Version (CAARS-O), and the Wender Reimherr Adult Attention Disorder Rating Scale (WRAADDS) are the clinical expert rating scales, which were used most frequently. The Conners Adult ADHD Rating Scale-Self -Report: Short Version (CAARS-S:S) and the Adult ADHD Self-Report Scale (ASRS) are self-report rating instruments which have found general acceptance. DISCUSSION: The instruments offer appropriate psychometric properties. The psychopathological item content of the ADHD-RS-IV and the CAARS-O is focused on inattention, impulsivity and hyperactivity. The WRAADDS comprises additionally emotional symptoms and disorganization.

Gender differences in self- and investigator-rated psychopathology in adult attention-deficit/hyperactivity disorder.

Despite the growing interest in the diagnosis of ADHD in adults, most of the knowledge in ADHD still relies on research with children and adolescents. Gender differences in adult ADHD patients were neglected for a long time and only few studies have focused this topic. The goal of this study was to investigate differences in ADHD psychopathology in male and female adults. We examined gender differences in ADHD core and associated symptoms and in personality traits in adults with ADHD. In order to discriminate between general and ADHD-specific gender differences, we compared data of adult ADHD patients with two control groups (patients with substance abuse and healthy controls). Regarding differences in ADHD core symptoms-attention problems, hyperactivity, and impulsivity-between male and female subjects, we found inconsistent results depending on the applied diagnostic instruments. Using standardized self-report, there were no gender differences regarding attention problems and hyperactivity but regarding impulsivity. Results of a semi-standardized interview (WRAADDS) according to the Utah criteria of adult ADHD showed no gender differences regarding impulsivity and hyperactivity but regarding attention problems. Moreover, differences were found between female and male healthy controls in the domains "over reactivity" and "hot temper" but not in the group of ADHD patients. Thus, it seems that gender differences in normal population were leveled by the disorder. Concerning general personality traits, some differences between male and female ADHD patients were also present in healthy controls, suggesting no ADHD-specific effect of gender. In conclusion, male and female ADHD patients seem to be more similar than different regarding ADHD-related psychopathology and general personality traits.

Motor circuit abnormalities in first-episode schizophrenia assessed with transcranial magnetic stimulation.

INTRODUCTION: Abnormalities in corticosubcortical circuits in schizophrenia have been described by previous neuroimaging and electrophysiological studies. Previous studies assessing excitability of the motoneural system by measuring cortical silent period (CSP), short interval intracortical inhibition (SICI) and intracortical facilitation (ICF) with transcranial magnetic stimulation (TMS) revealed conflicting results. METHODS: We assessed resting motor threshold (RMT), SICI (interstimulus interval 3 milliseconds), ICF (interstimulus interval 7 milliseconds) and the duration of the contralateral CSP in the left and right first dorsal interosseus muscles (FDI) in 29 first-episode schizophrenia patients (FE-SZ) with limited exposure to antipsychotic treatment compared to 44 healthy control subjects (HC). CSP was measured during isometric contraction using stimulation intensities of 120, 140, 160 and 180% of RMT. RESULTS: Patients with FE-SZ demonstrated significant prolongation of CSP using stimulation intensities of 120% RMT (p=0.027), 140% RMT (p=0.015) and 160% RMT (p =0.010) of left motor cortex (right FDI) compared to HC. In addition, reduced SICI after stimulation of the right motor cortex was observed in FE-SZ (58.9% in FE-SZ vs. 31.4% in HC; p=0.050). RMT was similar in patients and controls. DISCUSSION: The reduced SICI in first-episode patients points towards a GABA(A)ergic deficit in schizophrenia. The prolonged CSP may reflect compensatory increased GABA(B)ergic transmission induced by hyperactivity of the dopaminergic system, although effects of antipsychotic medication could not be excluded.

[Attention deficit hyperactivity syndrome throughout the life span]. / Aufmerksamkeitsdefizit-/Hyperaktivitätssyndrom in der Lebensspanne.

Attention deficit hyperactivity disorder (ADHD) is one of the most common neuropsychiatric disorders in children. ADHD is often chronic persisting into adulthood in about 60% of patients. The disorder is frequently associated with co-occurring disruptive, anxiety, mood and personality disorders as well as substance abuse. The diagnosis of ADHD has to be based on careful assessment of symptoms and impairments in the different phases of life. Recent neuroimaging and genetic data support the neurobiological basis of the disorder. Multimodal treatment options including stimulants, antidepressants and behavioral therapy play a fundamental role in the management of ADHD across the life span.

Reduced cortical inhibition in first-episode schizophrenia.

Disturbances in cortico-cortical and cortico-subcortical circuits in schizophrenia have been described by previous neuroimaging and electrophysiological studies. Transcranial magnetic stimulation (TMS) provides a neurophysiological technique for the measurement of cortical excitability, especially of the motoneural system. Previous studies using paired-pulse TMS to investigate short-interval cortical inhibition (SICI) and intracortical facilitation (ICF), mainly involving chronic schizophrenia patients, have been inconsistent and only one study in first-episode patients has been conducted so far. We assessed SICI (interstimulus interval, ISI, 3 milliseconds, ms) and ICF (ISI 7 ms) in 29 first-episode schizophrenia patients (FE-SZ) with limited exposure to antipsychotic treatment against measures of 28 healthy controls (HC). Amplitudes of motor evoked potentials (MEPs) were measured from the left and right first dorsal interosseus muscle (FDI). The conditioning stimulus was set at 80% intensity of resting motor threshold (RMT) and the test stimulus (TS) was set at an intensity that produced an MEP amplitude of about 1 mV. For SICI conditions, FE-SZ demonstrated significantly higher MEP amplitudes from left motor cortex (right FDI) compared to HC, and for MEPs from right motor cortex (left FDI) a similar trend was observable (FE-SZ 41% vs. HC 21% of TS, p=0.017 for left motor cortex, and FE-SZ 59% vs. HC 31% of TS, p=0.059 for right motor cortex; Mann-Whitney U-test). No significant difference in MEPs could be detected for ICF on either hemisphere. In addition, there was no difference in left and right RMT comparing patients and control subjects. Our result of a reduced SICI in a large sample of well characterized first-episode schizophrenia patients suggests that a GABAergic deficit may be involved in schizophrenic pathophysiology, already early in the disease course, supporting the intracortical dysconnectivity hypothesis.

[Age and gender aspects of attention-deficit hyperactivity disorder]. / Alters- und geschlechtsspezifische Besonderheiten der Aufmerksamkeitsdefizit-/Hyperaktivitätsstörung.

Attention-deficit hyperactivity disorder (ADHD) is a syndrome with onset in childhood which persists at least partially in about 60% of afflicted individuals. Core symptoms include inattention, hyperactivity, and impulsivity. Additional psychopathology with disorganized behavior and emotional dysregulation is common in adulthood. The vast majority of adults affected also present psychiatric comorbidities. There is severe impairment of everyday life and quality of life. Developmental psychopathologic changes, age-related comorbidity, and functional and psychosocial problems associated with ADHD must be taken into account during the diagnostic process. Regarding clinical subtypes of ADHD according to DSM-IV and particularly gender differences, knowledge about these factors in adults with ADHD is limited.

[Attention deficit hyperactivity disorder in adults. Benchmarking diagnosis using the Wender-Reimherr adult rating scale]. / ADHS-Diagnose bei Erwachsenen. Nach DSM-IV, ICD-10 und den UTAH-Kriterien.

We report on a study comparing different systems for the diagnosis of attention deficit hyperactivity disorder (ADHD) in adulthood. Recruited for evaluation were 168 patients referred to our ADHD outpatient unit. We used the Diagnostic and Statistical Manual of Mental Disorders 4th edn. (DSM-IV), International Classification of Diseases 10th edn. (ICD-10), and Utah criteria for diagnostic assessment and the Wender Utah rating scale, ADHD Self Report (ADHD-SR), and Wender Reimherr Adult Attention Deficit Disorder Rating Scale as psychopathological assessment tools. We present basic psychometric data of the Wender-Reimherr Interview (WRI). Internal consistency was determined as 0.82 (alpha). The inter-rater reliability was 1.0 (kappa coefficient) regarding ADHD diagnoses, and the ICC was 0.98 referring to the WRI total scores. The convergent validity with the ADHD-SR was 0.65 (Spearman coefficient). In 126 of 168 patients an ADHD diagnosis was made according to at least one of the three systems. The DSM-IV diagnostic set led to 119 ADHD diagnoses. As compared with the two other systems, this is about the minimum level for an ADHD diagnosis. All of the 87 ADHD diagnoses according to ICD-10 were covered by DSM-IV. The ICD-10 had no independent psychopathological items and therefore offered no additional points for the diagnostic procedure than the DSM-IV. The situation regarding Utah criteria is different. These criteria contain seven psychopathological domains: inattention, hyperactivity, disorganisation, impulsivity, affective lability, overreactivity, and hot temper. They can be assessed by use of the WRI. Ninety-three of 168 patients were diagnosed as having ADHD according to the Utah concept, which is much lower than with the DSM-IV. The particular definition of the disorder by the Utah criteria resulted in seven patients having only a Utah diagnosis but no DSM-IV diagnosis. Thus we are in a position to say that the Utah criteria have a relatively high level for making an ADHD diagnosis but in certain cases move beyond the DSM-IV. Of the patients 56% had ADHD diagnoses according to all three classification instruments. Examining the factor structure of the ADHD psychopathology represented by seven WRI and three ADHD-SR subscales, we found a two-factor solution explaining for 63% of the variance. Factor 1 was designated by impulsivity, affective lability, hyperactivity, and hot temper; factor 2 consisted of inattention, disorganisation, and overreactivity.

Norepinephrine transporter and catecholamine-O-methyltransferase gene variants and attention-deficit/hyperactivity disorder symptoms in adults.

Attention deficit/hyperactivity disorder (ADHD) is a complex, highly heritable psychiatric condition. Neuropsychological and pharmacological studies suggest a dysregulation of central noradrenergic neurotransmission in addition to dopaminergic and serotonergic mechanisms. Only a few studies have focused on the association of noradrenergic susceptibility genes with ADHD. In this study, we investigated the association of several ADHD symptom scores (German short form of the Wender Utah Rating Scale, WURS-k; ADHD self report, ADHD-SB, and the German validated version of the WRAADDS, WRI) with haplotypes of the catechol-O-methyltransferase (COMT) and the norepinephrine transporter (SLC6A2) genes. Subjects were genotyped for three SLC6A2 (rs5569, rs998424, rs2242447) and two COMT single nucleotide polymorphisms (rs4680, rs4818). In addition, psychosocial adversity in childhood was assessed in order to evaluate putative gene-environment interactions. We did not find main effects of the COMT and SLC6A2 NET1 gene haplotypes on any ADHD symptom severity score. Childhood psychosocial adversity was strongly associated with number of ADHD symptoms. No gene-environment interaction was found. A specific combination of two COMT and SLC6A2 gene haplotypes, containing the low functioning COMT variant was nominally associated with low ADHD scores in all scales. Results do not support the hypothesis that common variants in the SLC6A2 and COMT genes in particular are associated with ADHD, but might give some evidence for interactive effects between these gene variants on ADHD severity.

Impaired cortical inhibition in adult ADHD patients: a study with transcranial magnetic stimulation.

The aim of this study was to analyze motor inhibition and facilitation of adult ADHD patients using double pulse transcranial magnetic stimulation (TMS). Twenty-six right handed adult ADHD patients according to DSM-IV were investigated and compared to 26 age and sex-matched controls. In the left hemisphere, mean motor inhibition was 0.53 +/- 0.33 (mean +/- SD) in ADHD patients and 0.34 +/- 0.16 (mean +/- SD) in controls (p = 0.012). There were no significant differences in motor excitability concerning facilitation or in the right hemisphere. Decreased motor inhibition correlated with a higher symptom score derived from the Wender Reimherr Interview (WRI) (p = 0.28; p = 0.04) and also with self rated hyperactivity/impulsivity symptoms (p = 0.30; p = 0.03). In conclusion, decreased motor inhibition in adult ADHD corroborate similar findings in children with ADHD (Moll et al., 2000) and reflect disturbed impulsivity and hyperactivity on a neurophysiological level.

[Gender differences in self-descriptions of child psychopathology in attention deficit hyperactivity disorder]. / Der Einfluss des Geschlechts auf die Selbstbeschreibung kindlicher ADHS-Symptome.

Diagnosing attention deficit hyperactivity disorder (ADHD) in adults requires retrospective assessment of ADHD symptoms in childhood. The Wender Utah Rating Scale (WURS) and its German validated version (WURS-k) may offer a helpful tool to acertain relevant childhood problems associated with ADHD. Up to now validating data of the WURS-k were limited to male population. In a population of 69 female adult ADHD patients and 97 controls, ROC analysis indicated a sensitivity of 93% and specificity of 92% at a cut-off of 30 points in the WURS-k. This cut-off value is equivalent to those of males. Symptom report varies significantly by gender and females describe more internalizing problems while males report more externalizing behaviour. Regarding different subtypes according to DSM-IV males and females did not differ in the items of the WURS-k.

[Drug addiction in young prison inmates with and without attention deficit hyperactivity disorder (ADHD)]. / Suchtmittelgebrauch bei jungen erwachsenen Straftätern mit und ohne Aufmerksamkeitsdefizit-/Hyperaktivitätsstörung (ADHS).

Prospective studies of children with ADHD have shown a high level of substance use disorder comorbidity, particularly when associated with social maladaptation and antisocial behavior. Conversely, studies of drug abusing participants and delinquents revealed a high prevalence of ADHD comorbidity. In this study 129 young male prison inmates were systematically examined for ADHD and substance use disorders. 64,3 % showed harmful alcohol consumption. 67,4 % fulfilled DSM-IV criteria for any drug abuse or dependence. 28,8 % of these participants were diagnosed with ADHD, combined type, other 52,1 % showed ADHD residual type. Opioid dependence was more common in delinquents without ADHD. Addicted delinquents with ADHD showed worse social environment and a higher degree of psychopathology, including externalizing and internalizing behavior, compared to addicted delinquents without ADHD. Neuroticism and conscientiousness ratings of the addicted ADHD group, but not of those without ADHD, differed from non-addicted delinquents. The results underline the need of adequate therapeutic programs for addicted young prison inmates considering ADHD comorbidity, which is associated with additional psychopathology and social problems.

Psychopathological rating scales for diagnostic use in adults with attention-deficit/hyperactivity disorder (ADHD).

The diagnosis of attention-deficit hyperactivity disorder (ADHD) in adults is a complex procedure which should include retrospective assessment of childhood ADHD symptoms either by patient recall or third party information, diagnostic criteria according to DSM-IV, current adult ADHD psychopathology including symptom severity and pervasiveness, functional impairment, quality of life and comorbidity. In order to obtain a systematic database for the diagnosis and evaluation of the course ADHD rating scales can be very useful. This article reviews rating instruments that have found general acceptance. The Wender-Utah Rating Scale (WURS) and the Childhood Symptoms Scale by Barkley and Murphy try to make a retrospective assessment of childhood ADHD symptoms. The Connors Adult ADHD Rating Scales (CAARS), the Current Symptoms Scales by Barkley and Murphy (CSS), the Adult Self Report Scale (ASRS) by Adler et al. and Kessler et al. or the Attention Deficit Hyperactivity Disorder--Self Report Scale (ADHD-SR by Rösler et al.) are self report rating scales focusing mainly on the DSM-IV criteria. The CAARS and the CSS have other report forms too. The Brown ADD Rating Scale (Brown ADD-RS) and the Attention Deficit Hyperactivity Disorder--Other Report Scale (ADHD-OR by Rösler et al.) are instruments for use by clinicians or significant others. Both self rating scales and observer report scales quantify the ADHD symptoms by use of a Likert scale mostly ranging from 0 to 3. This makes the instruments useful to follow the course of the disease quantitatively. Comprehensive diagnostic interviews not only evaluate diagnostic criteria, but also assess different psychopathological syndrome scores, functional disability measures, indices of pervasiveness and information about comorbid disorders. The most comprehensive procedures are the Brown ADD Diagnostic Form and the Adult Interview (AI) by Barkley and Murphy. An instrument of particular interest is the Wender Reimherr Interview (WRI) which follows a diagnostic algorithm different from DSM-IV. The interview contains only items delineated from adult psychopathology and not derived from symptoms originally designed for use in children. Other instruments focus on functional impairment, quality of life, comorbid disorders, gender effects and specific psychopathological models.