A Scoping Review of Attention-Deficit/Hyperactivity Disorder Assessment and Diagnosis: Tools, Practices, and Sex Bias

Abstract

Objectives: Accurately diagnosing attention-deficit/hyperactivity disorder (ADHD) is challenging due to the overlap of symptoms with other mental health conditions. This scoping review evaluated the dependability and accuracy of prevalent diagnostic scales and investigates potential obstacles to ADHD assessment diagnosis including potential sex bias.

Method: Following the PRISMA-ScR guidelines, 11 widely used diagnostic scales were identified and included. All scales were evaluated based on their psychometric quality and alignment with DSM-5 diagnostic criteria for ADHD.

Results: The Attention Deficit Disorders Evaluation Scale emerged as the most reliable among the 11 scales, with the Symptom Checklist-4 ranking as the least reliable. No single assessment tool was adequate for ADHD diagnosis; additional testing was required for accurate conclusions. The literature revealed sex and age biases in some of the assessments. It was discovered that girls were diagnosed with ADHD less often than boys, yet their likelihood of misdiagnosis was notably lower.

Conclusions: This review emphasizes the necessity of comprehensive, multi-method assessment approaches for accurate ADHD diagnosis, as no single tool demonstrated sufficient diagnostic precision. Effective clinical assessment design must incorporate strong psychometric measures, address sex-based diagnostic disparities, and emphasize the importance of evaluating behavioural changes over time and their functional impact across settings.