Psychiatrist Template

DIVA-5

A professional Psychiatrist template for healthcare professionals.

About this template

The DIVA-5 template is a comprehensive diagnostic tool used by psychiatrists to assess ADHD symptoms in adults and children. This template helps clinicians evaluate persistent patterns of inattention and hyperactivity-impulsivity, providing a structured approach to understanding how these symptoms impact various aspects of life, including work, relationships, and self-image. The DIVA-5 is essential for diagnosing ADHD, ensuring that symptoms are not attributed to other mental disorders. This template is particularly useful for mental health professionals seeking to document ADHD symptoms accurately and efficiently using Heidi, the AI medical scribe.

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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: 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: 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: present Total number of criteria met for Attention Deficit: Adult: 9/9, Child: 9/9 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: 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: present, Child: 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: present, Child: present Total number of criteria met for Hyperactivity/Impulsivity: Adult: 9/9, Child: 9/9 B. Several inattentive or hyperactive-impulsive symptoms were present prior to the age of 12 years: Yes C. Several inattentive or hyperactive-impulsive symptoms are present in two or more areas: Yes - **Work/Education:** The patient struggles with maintaining focus and completing tasks in both academic and professional settings, often requiring additional time to complete assignments. - **Relationships and Family:** The patient experiences difficulties in maintaining romantic relationships and often requires structured support from family members. - **Social Contacts:** The patient finds it challenging to make and maintain friendships, often feeling socially fatigued and exhibiting low self-assertiveness. - **Free Time/Hobbies:** The patient struggles to relax and often tires quickly of hobbies, finding it difficult to engage in leisure activities such as reading or watching films. - **Self-Confidence and Self-Image:** The patient experiences low self-esteem and excessive sensitivity to criticism, which were also present during childhood. D. There is clear evidence that the symptoms interfere with or reduce the quality of social, academic, or occupational functioning: Yes 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

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/not present], Child: [present/not present] - A1(b): Do you often have difficulty sustaining your attention in tasks? And how was that during childhood (in play activities)? Adult: [present/not present], Child: [present/not 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: [present/not present], Child: [present/not 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/not present], Child: [present/not present] - A1(e): Do you often find it difficult to organise tasks and activities? And how was that during childhood? Adult: [present/not present], Child: [present/not 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/not present], Child: [present/not present] - A1(g): Do you often lose things that are necessary for tasks or activities? And how was that during childhood? Adult: [present/not present], Child: [present/not present] - A1(h): Are you often easily distracted by extraneous stimuli? And how was that during childhood? Adult: [present/not present], Child: [present/not present] - A1(i): Are you often forgetful in daily activities? And how was that during childhood? Adult: [present/not present], Child: [present/not present] Total number of criteria met for Attention Deficit: Adult: [X/9], Child: [X/9] 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/not present], Child: [present/not 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: [present/not present], Child: [present/not present] - A2(c): Do you often feel restless? And how was that during childhood? Adult: [present/not present], Child: [present/not 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: [present/not present], Child: [present/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/not present], Child: [present/not present] - A2(f): Do you often talk excessively? And how was that during childhood? Adult: [present/not present], Child: [present/not present] - A2(g): Do you often blurt out an answer before questions have been completed? And how was that during childhood? Adult: [present/not present], Child: [present/not present] - A2(h): Do you often find it difficult to await your turn? And how was that during childhood? Adult: [present/not present], Child: [present/not present] - A2(i): Do you often interrupt or intrude on others? And how was that during childhood? Adult: [present/not present], Child: [present/not present] Total number of criteria met for Hyperactivity/Impulsivity: Adult: [X/9], Child: [X/9] B. Several inattentive or hyperactive-impulsive symptoms were present prior to the age of 12 years: [Yes/No] (Indicate whether the patient exhibited symptoms of ADHD before the age of 12, based on clinical history, self-report, or collateral information.) C. Several inattentive or hyperactive-impulsive symptoms are present in two or more areas: [Yes/No] (State whether symptoms are observed across multiple settings, such as work, school, social relationships, and personal life.) - **Work/Education:** [Describe difficulties in workplace or academic settings] (Summarize whether the patient has struggled with administrative tasks, planning, completing homework, or maintaining focus in professional or educational environments.) - **Relationships and Family:** [Describe challenges in relationships] (State whether the patient has difficulties with household responsibilities, maintaining romantic relationships, or required prolonged parental structure.) - **Social Contacts:** [Describe social difficulties] (Summarize whether the patient struggles with making and maintaining friendships, experiences social fatigue, or exhibits low self-assertiveness.) - **Free Time/Hobbies:** [Describe engagement in leisure activities] (Indicate whether the patient finds it difficult to relax, struggles to complete leisure activities such as reading or watching films, or tires quickly of hobbies.) - **Self-Confidence and Self-Image:** [Describe self-perception and emotional responses] (State whether the patient experiences low self-esteem, fear of failure, perfectionism, or excessive sensitivity to criticism, and whether these difficulties were also present in childhood.) D. There is clear evidence that the symptoms interfere with or reduce the quality of social, academic, or occupational functioning: [Yes/No] (Specify whether ADHD symptoms cause significant impairment in daily life across social, academic, or occupational domains.) 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] (Confirm whether symptoms are best attributed to ADHD rather than another psychiatric or medical condition.)

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