Date of this Version
2025
Document Type
DNP Project
Abstract
Background: Although typically diagnosed in childhood, Attention-Deficit/Hyperactivity Disorder (ADHD) is increasingly recognized in adults. Current diagnostic criteria for adults mirror those for children, differing mainly in the number of criteria required. Despite established guidelines, many providers lack confidence in diagnosing adult ADHD accurately, often due to
challenges in confirming symptom onset before age 12, concerns about malingering, and uncertainty about the rising prevalence. Educating providers and developing a standardized diagnostic protocol may increase confidence and improve diagnostic accuracy.
Purpose: The purpose of this quality improvement project is to improve psychiatric providers’ diagnostic process of adult ADHD by implementing an evidence-based diagnostic protocol in a psychiatric outpatient setting. This protocol was developed through a scoping review that evaluated the validity, reliability, and accuracy of adult ADHD diagnostic tools to inform clinical recommendations.
Methods: A scoping literature review was conducted to evaluate the validity, reliability, and accuracy of diagnostic tools for ADHD. Based on the findings, and evidence-based diagnostic protocol was developed and implements in a psychiatric outpatient clinic over a one-month
period. Pre- and post-intervention surveys were used to assess provider confidence and satisfaction. Cohen’s d was used to analyze changes.
Results: Following protocol implementation, provider confidence improved in diagnosing ADHD (d = 0.78) and differentiating it from other conditions (d = 0.87). However, confidence declined when diagnosing under time constraints (-0.55). Providers rated the protocol highly for clarity (M = 5.00; SD = 0) and accuracy (M = 5.00; SD = 0), though time efficiency (M = 2.00; SD = 0.82) and practicality (M = 2.25; SD = 1.26) received lower satisfaction ratings. Variability in confidence and satisfaction correlated with provider experience, with less experienced providers reporting greater gains.
Conclusion: Implementing an evidence-based Adult ADHD Diagnostic Protocol enhanced
provider knowledge and confidence, especially among less experienced clinicians. Despite strong ratings for clarity and accuracy, limited time efficiency hindered broader adoption. Future refinements should streamline the protocol and address patient engagement to improve usability and sustained clinical implementation.
Recommended Citation
Cendan, Isis, "Enhancing the Adult ADHD Diagnosis: Developing a Best Practice Protocol for the Psychiatric Outpatient Setting" (2025). Nicole Wertheim College of Nursing Student Projects. 343.
https://digitalcommons.fiu.edu/cnhs-studentprojects/343