Diagnosing ADHD in Adults: An Examination of the Discriminative Validity of Neuropsychological Tests and Diagnostic Assessment Instruments

Pettersson, Robert; Söderström, Staffan; Nilsson, Kent W.

doi:10.1177/1087054715618788

Cited by 81 publications

(93 citation statements)

References 48 publications

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“…A second aspect of the MOXO-CPT that should be considered when interpreting our results is that the test distinguishes between commission errors associated with impulsivity and hyperactive responses associated with increased activity level. While previous CPT studies consistently showed higher rates of commission responses among boys than girls (Hasson and Fine, 2012), they could not indicate whether these uninhibited responses were associated with impulsivity or with increased activity level (Pettersson et al, 2018). The MOXO-CPT may offer a more nuanced observation of gender differences in these two ADHD-related symptoms, suggesting that boys may be more impulsive but not more active than girls.…”

Section: Discussionmentioning

confidence: 71%

Gender Differences in Objective and Subjective Measures of ADHD Among Clinic-Referred Children

Slobodin

Davidovitch

2019

Front. Hum. Neurosci.

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Attention deficit hyperactivity disorder (ADHD), one of the most prevalent childhood disorders today, is generally more likely to be diagnosed and treated in boys than in girls. However, gender differences in ADHD are currently poorly understood, partly because previous research included only a limited proportion of girls and relied mainly on subjective measures of ADHD, which are highly vulnerable to reporter's bias. To further examine gender differences in ADHD and to address some of the shortcomings of previous studies, this study examined gender differences in subjective and objective measures of ADHD among clinic-referred children with ADHD. Participants were 204 children aged 6-17 years-old with ADHD (129 boys, 75 girls). A retrospective analysis was conducted using records of a clinical database. Obtained data included parent and teacher forms of the Conners ADHD rating scales, Child Behavior Checklist (CBCL), Teacher's Report Form (TRF), and child's continuous performance test (CPT) scores. Results showed that according to parents' and teachers' reports of ADHD-related symptoms (Conners ADHD rating scales), girls had more inattention problems than boys, but no differences were identified in the level of hyperactivity and impulsivity symptoms. CPT data, however, revealed higher impulsivity among boys. We did not find gender differences in the level of distractibility during CPT performance. Specifically, the effects of distractors type (visual environmental stimuli, auditory stimuli, or a combination of them) and distractors load (one or two distracting stimuli at a time) on CPT performance did not differ between boys and girls with ADHD. These findings suggest that gender effects on ADHD symptoms may differ between subjective and objective measures. Understanding gender differences in ADHD may lead to improved identification of girls with the disorder, helping to reduce the gender gap in diagnosis and treatment.

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Section: Discussionmentioning

confidence: 71%

Gender Differences in Objective and Subjective Measures of ADHD Among Clinic-Referred Children

Slobodin

Davidovitch

2019

Front. Hum. Neurosci.

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“…They also found the Adult ADHD Self-Report Scale (ASRS, Kessler, Adler, Ames, Demler, et al, 2005) had a sensitivity of 90% but a specificity of only 35% in differentiating these two groups. Furthermore, Pettersson et al (2018) reported the ASRS had a sensitivity of 92% and specificity of 27% in a subsequent study.…”

Section: Diagnostic Accuracymentioning

confidence: 91%

“…This is because the results of a clinical interview itself are the primaryif not the sole basisfor the "gold standard" diagnosis of the ADHD criterion group in most research. Pettersson, Soderstrom, and Nilsson (2018) found the aforementioned DIVA had a sensitivity of 90% and specificity of 73%, in a group of adult outpatients presenting for ADHD assessment. Marshall, Hoelzle, Heyerdahl, and Nelson (2016) found that, of 102 patients later diagnosed with ADHD based not only on the interview but additional assessment, 39% had an interview consistent with ADHD, 45% had an indeterminate interview, and 16% had an interview inconsistent with their having this disorder.…”

Section: Diagnostic Accuracymentioning

confidence: 94%

“…Soderstrom et al (2014) reported that a discriminant function analysis based on the self-report ASRS and BCSS rating scales as well as the QBT þ inattention and impulsivity measures had a sensitivity of 75% and a specificity of 62% in differentiating between patients diagnosed with adult ADHD and clinical control participants. Pettersson et al (2018) found that a regression model based on the ASRS and a cognitive test battery as well as a clinical interview (the DIVA) had a sensitivity of 90% and specificity of 81% in a group of adult outpatients presenting for ADHD evaluations. It is important to note, however, that the results of these studies by Pettersson, Soderstrom, and Nilsson are confounded by the fact the QBTþ, ADHD behavior rating scales, and interview were considered in making the original ADHD diagnosis in the ADHD criterion group.…”

Section: Diagnostic Accuracymentioning

confidence: 99%

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Diagnosing Attention-Deficit/Hyperactivity Disorder (ADHD) in young adults: A qualitative review of the utility of assessment measures and recommendations for improving the diagnostic process

Marshall

Hoelzle

Nikolas

2019

The Clinical Neuropsychologist

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Objective: Identify assessment measures that augment the clinical interview and improve the diagnostic accuracy of adult ADHD assessment. Method: The sometimes limited research literatures concerning the diagnostic efficacies of the clinical interview, standard and novel ADHD behavior rating scales, performance and symptom validity testing, and cognitive tests are critically reviewed. Results: Based on this qualitative review, both clinical interviews alone and ADHD behavior rating scales alone have adequate sensitivity but poor specificity in diagnosing ADHD. Response validity and symptom validity tests have reasonably good sensitivity and very good specificity in detecting invalid symptom presentation. Cognitive test batteries have inadequate sensitivity and specificity in identifying ADHD. Using cognitive tests in conjunction with behavior rating scales significantly improves the specificity of an assessment battery. Executive function behavior rating scales and functional impairment rating scales are unlikely to improve the diagnostic accuracy of ADHD assessment. Conclusions: Based on this review, key clinical interview questions, behavior rating scales, symptom validity tests, and cognitive tests that have promise to enhance current assessment practices are recommended. These are the authors' personal opinions, not consensus standards, or guidelines promulgated by any organization. These measures are incorporated in a practical, somewhat abbreviated, battery that has the potential to improve clinicians' ability to diagnose adult ADHD.

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“…The results from the Dutch LASA study further showed that younger elderly adults (60)(61)(62)(63)(64)(65)(66)(67)(68)(69)(70) years) reported more ADHD symptoms than the oldest group (71-94 years) [37]. This may be an indication of earlier death in those with ADHD symptoms, but this has to be further explored.…”

Section: Prevalence Of Adhd In Older Adultsmentioning

confidence: 98%

ADHD in old age: a review of the literature and proposal for assessment and treatment

Kooij

Michielsen

Kruithof

et al. 2016

Expert Review of Neurotherapeutics

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ADHD is an often heritable, neurodevelopmental disorder with a prevalence of 4-5% in children and adults and about 3% in older adults. The disorder in older adults (> 55 years) is accompanied by similar comorbidities such as anxiety and depression, and social impairment as in younger age groups. Areas covered: An overview of the literature on diagnostic assessment, differential diagnosis, and treatment of older adults with ADHD is described. Case studies show that stimulant treatment is beneficial for ADHD in old age, but randomized controlled trials are lacking. Stimulant treatment has been studied in depression and even dementia in older adults, and seems safe with active cardiovascular risk management. In this paper, a proposal for diagnostic assessment and treatment is described for ADHD in older adults, including differential diagnosis with other psychiatric and neurocognitive disorders. Expert commentary: Regarding the organization of mental health, professionals in geriatric psychiatry need to be trained in assessment and treatment of ADHD in older age. Lifespan ADHD clinics may help patients of all ages to receive better specialized care.

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Diagnosing ADHD in Adults: An Examination of the Discriminative Validity of Neuropsychological Tests and Diagnostic Assessment Instruments

Abstract: Neuropsychological tests have a poor ability to discriminate between patients diagnosed with ADHD and patients not diagnosed with ADHD, but variables from CPT tests can contribute to increasing the specificity by 10% if used in combination with the DIVA.

Cited by 81 publications

References 48 publications

Gender Differences in Objective and Subjective Measures of ADHD Among Clinic-Referred Children

Gender Differences in Objective and Subjective Measures of ADHD Among Clinic-Referred Children

Diagnosing Attention-Deficit/Hyperactivity Disorder (ADHD) in young adults: A qualitative review of the utility of assessment measures and recommendations for improving the diagnostic process

ADHD in old age: a review of the literature and proposal for assessment and treatment

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