Implementation and Results of a Protocol Created by Amaha for ADHD Assessment in Adult Psychiatric Practice: A Quality Check Study

Objective: This study aimed to evaluate the implementation and adherence to a standard operating protocol for the assessment and initial management of Attention-Deficit/Hyperactivity Disorder (ADHD) in adults within a large mental health organisation in India (Amaha). Material and Methods: A retrospective clinical audit was conducted on 200 client cases assessed for Adult ADHD using the Diagnostic Interview for ADHD in Adults (DIVA-5) between January and September 2024. Data regarding adherence to protocol steps were collected via a structured questionnaire completed by 10 treating psychiatrists based on clinical notes in the electronic record system. A random 8% sample was verified for accuracy, revealing a 12.5% discrepancy rate. Results: High adherence was observed for several protocol steps: 92% (n=184) of initial consultations were conducted by the treating psychiatrist, an informant was present in 98.5% (n=197) of DIVA assessments, and 94% (n=188) of clients received psychoeducation post-assessment. 87% (n=174) of assessed clients met criteria for ADHD. Comorbidity was present in 54.5% (n=109), with depression (47.7% of comorbid cases) and anxiety (31.8% of comorbid cases) being the most common. Current substance misuse was reported in 20.5% (n=41). Methylphenidate was the most common prescribed medication (52.9% of prescriptions). Therapy was recommended in 64.8% (n=130). Areas for improvement included timeliness of DIVA assessment (30% >1-month post-intake) and completeness of report uploads (16% missing from the system). Discussion & Conclusion: The standardised protocol demonstrates generally strong implementation in key areas of adult ADHD assessment within this setting. Findings highlight high rates of diagnosis and comorbidity. Key recommendations and directions for the future are discussed.