DIVA-5

Part 2: Diagnosis and Formulation

”Summary of the DIVA-5 outcome measure”

"A. Persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development – characterised by deficits in social communication and social interaction across multiple contexts, as manifested by, all the following, currently or by history"

A1 - Symptoms of Inattention

• "A1(a): Do you often fail to give close attention to details, or do you make careless mistakes in your work or during other activities?" "And how was that during childhood (in schoolwork or during other activities)?" Adult: present, Child: present
• "A1(b): Do you often have difficulty sustaining your attention in tasks?" "And how was that during childhood (in play activities)?" Adult: present, Child: present
• "A1(c): Does it often seem as though you are not listening when you are spoken to directly?" "And how was that during childhood?" Adult: not present, Child: present
• "A1(d): Do you often not follow through on instructions and often fail to finish chores or duties in the workplace?" "And how was that during childhood (in schoolwork)?" Adult: present, Child: present
• "A1(e): Do you often find it difficult to organise tasks and activities?" "And how was that during childhood?" Adult: present, Child: present
• "A1(f): Do you often avoid (or do you dislike, or are you reluctant to engage in) tasks that require sustained mental effort?" "And how was that during childhood?" Adult: present, Child: present
• "A1(g): Do you often lose things that are necessary for tasks or activities?" "And how was that during childhood?" Adult: present, Child: not present
• "A1(h): Are you often easily distracted by extraneous stimuli?" "And how was that during childhood?" Adult: present, Child: present
• "A1(i): Are you often forgetful in daily activities?" "And how was that during childhood?" Adult: present, Child: not present

Total number of criteria met for Attention Deficit: Adult: 8, Child: 7

A2 - Symptoms of Hyperactivity and Impulsivity

• "A2(a): Do you often fidget with or tap hands or feet, or do you often squirm in your seat?" "And how was that during childhood?" Adult: present, Child: present
• "A2(b): Do you often leave your seat in situations where it is expected that you remain seated?" "And how was that during childhood?" Adult: not present, Child: present
• "A2(c): Do you often feel restless?" "And how was that during childhood?" Adult: present, Child: present
• "A2(d): Do you often find it difficult to engage in leisure activities quietly?" "And how was that during childhood (in play activities)?" Adult: not present, Child: not present
• "A2(e): Are you often "on the go" or do you often act as if "driven by a motor"?" "And how was that during childhood?" Adult: present, Child: present
• "A2(f): Do you often talk excessively?" "And how was that during childhood?" Adult: present, Child: present
• "A2(g): Do you often blurt out an answer before questions have been completed?" "And how was that during childhood?" Adult: present, Child: present
• "A2(h): Do you often find it difficult to await your turn?" "And how was that during childhood?" Adult: present, Child: present
• "A2(i): Do you often interrupt or intrude on others?" "And how was that during childhood?" Adult: not present, Child: present

Total number of criteria met for Hyperactivity/Impulsivity: Adult: 6, Child: 8

"B. Several inattentive or hyperactive-impulsive symptoms were present prior to the age of 12 years"

Yes. Self-report, primary school reports, and collateral history from mother confirm marked inattention, disorganisation, and motor restlessness from age 7.

"C. Several inattentive or hyperactive-impulsive symptoms are present in two or more areas"

Yes. Symptoms are pervasive across occupational, domestic, and social domains.

• Work/Education: Chronic procrastination with administrative tasks, missed deadlines, and inability to sustain focus in meetings. Currently on performance review. In childhood, frequently failed to complete homework and had messy, incomplete workbooks.
• Relationships and Family: Frequent arguments with partner due to forgotten household chores, unpaid bills, and zoned-out behaviour during conversations. Relied heavily on maternal scaffolding for daily routines until leaving home at age 21.
• Social Contacts: Struggles to maintain long-term friendships due to forgetting to reply to messages. Interrupts peers in group settings, leading to social exhaustion and subsequent withdrawal.
• Free Time/Hobbies: Unable to relax or watch a full film without dual-screening. Starts numerous expensive hobbies (e.g., photography, woodworking) but abandons them rapidly once novelty fades.
• Self-Confidence and Self-Image: Chronic low self-esteem and imposter syndrome stemming from underachievement relative to intellectual potential. Exhibits rejection sensitivity and compensatory perfectionism; labelled "lazy" and "disruptive" throughout schooling.

"D. There is clear evidence that the symptoms interfere with or reduce the quality of social, academic, or occupational functioning"

Yes. Symptoms cause moderate-to-severe impairment, evidenced by current occupational disciplinary action, financial penalties from late payments, and significant marital strain.

"E. The symptoms do not occur exclusively during the course of schizophrenia or another psychotic disorder and are not better explained by another mental disorder (e.g., mood disorder, anxiety disorder, dissociative disorder, personality disorder, substance intoxication or withdrawal)"

Yes. No history of psychosis, mania, or substance misuse. Mild generalised anxiety is present but is secondary to chronic executive dysfunction. Symptoms are best explained by ADHD, combined presentation.