Structure and Diagnosis of Adult Attention-Deficit/Hyperactivity Disorder

Abstract

CONTEXT Controversy exists about the appropriate criteria for a diagnosis of adult attention-deficit/hyperactivity disorder (ADHD) OBJECTIVES To examine the structure and symptoms most predictive of DSM-IV adult ADHD. DESIGN Data come from clinical interviews in enriched sub-samples of the National Comorbidity Survey Replication (NCS-R) (n = 131) and a survey of a large managed healthcare plan (n = 214). The clinician-administered Adult ADHD Clinical Diagnostic Scale (ACDS) was used to assess childhood ADHD and expanded symptoms of current adult ADHD. Analyses examined stability of symptoms from childhood to adulthood, the structure of adult ADHD, and the adult symptoms most predictive of current clinical diagnoses. SETTING The ACDS was administered telephonically by clinical research interviewers with extensive experience in diagnosis and treatment of adult ADHD. PARTICIPANTS An enriched sample of community respondents MAIN OUTCOME MEASURES DSM-IV/ACDS diagnoses of adult ADHD RESULTS Almost half (45.7%) of respondents who had childhood ADHD continued to meet full DSM-IV criteria for current adult ADHD, with 94.9% of these cases having current attention-deficit disorder and 34.6% current hyperactivity disorder. Adult persistence was much greater for inattention than hyperactivity-impulsivity. Additional respondents met full criteria for current adult ADHD despite not having met full childhood criteria. A three-factor structure of adult symptoms included executive functioning, inattention-hyperactivity, and impulsivity. Stepwise logistic regression found executive functioning problems to be the most consistent and discriminating predictors of adult DSM-IV/ACDS ADHD. CONCLUSIONS These findings document the greater persistence of inattentive than hyperactive/impulsive childhood symptoms of ADHD in adulthood, but also show that inattention in not specific to ADHD, as it is strongly associated with other adult mental disorders. Executive functioning problems, in comparison, are more specific and consistently important predictors of DSM-IV adult ADHD despite not being in DSM-IV, suggesting that the number of executive functioning symptoms should be increased in DSM-V/ICD-11.

How Persistent is ADHD into Adulthood? Informant Report and Diagnostic Thresholds in a Female Sample

“…1953)." As the release of DSM-5 approached, a variety of recommendations were made to increase the applicability of ADHD criteria across the lifespan (e.g., Barkley, 2010;Barkley et al, 2008;Bell, 2011;Coghill & Seth, 2011;Hechtman, French, Mongia, & Cherkasova, 2011;Kessler et al, 2010;McGough & Barkley, 2004;McGough & McCracken, 2006;Polanczyk et al, 2010;Ramtekkar, Reiersen, Todorov, & Todd, 2010;Rutter, 2011). Initial proposed changes to the DSM-5 included shifting the diagnostic symptom threshold to 4/9 symptoms of IA or H/I in individuals aged 17 or older (for rationale, see Heiligenstein, Conyers, Berns, & Miller, 1998;Kooij et al, 2005).…”

“…Estimates of the persistence of ADHD from childhood into adulthood in males range hugely from 5%-66% (Mannuzza, Klein, & Moulton, 2003), due in part to crucial methodological differences between extant longitudinal studies. Furthermore, study of the persistence of ADHD into young adulthood is complicated by a number of nosological difficulties, related to the fact that ADHD was first conceptualized as a disorder of childhood and adolescence (Adler, Barkley, & Newcorn, 2008;Kessler et al, 2010;McGough & Barkley, 2004;McGough & McCracken, 2006). Of particular interest herein are the questions of whether the diagnostic thresholds established for children (i.e., 6 of 9 symptoms of inattention [IA] th edition (DSM-IV; American Psychiatric Association, 1994) are excessively stringent when applied across the lifespan, and whether young adults versus their parents (or other informants) are more accurate reporters regarding adult ADHD symptomatology and impairment.…”

Executive function assessment and adult attention-deficit/hyperactivity disorder: Tasks versus ratings on the Barkley Deficits in Executive Functioning Scale.

“…The interview was constructed to assess current and childhood symptoms of attention-deficit/hyperactivity disor der, based upon work by Kessler et al (2010) and modeled after the Adult ADHD Clinical Diagnostic Scale (Adler & Cohen, 2004). The interview assessed all 18 Diagnostic and Statistical Manual o f Mental Disorders (5th ed.…”

Integration of symptom ratings from multiple informants in ADHD diagnosis: A psychometric model with clinical utility.

“…As a secondary check on the effectiveness of the winning method, we consider the issue of the potential redundant information in the ADHD symptom list, one of the longest symptom lists of any disorder in the DSM. We include herein what is, to our knowledge, the first test using these methods of whether the nine symptoms per symptom domain can be cut in half with comparable validity (Kessler et al, 2010). …”