The Role of Impairment in the Diagnosis of ADHD

Gathje, Rebecca; Lewandowski, Lawrence J.; Gordon, Michael S.

doi:10.1177/1087054707314028

Cited by 85 publications

(78 citation statements)

References 23 publications

(19 reference statements)

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“…Previous studies of school-aged children have found that ADHD symptoms explain about 25% to 30% of variance in impairment (9)(10)(11), which is quite similar to our findings of less than 30%. A pertinent question is of course which other factors determine impairment in children with ADHD, but studies specifically addressing these issues are largely missing.…”

Section: Discussionsupporting

confidence: 92%

Impairment in Young Preschool Children with Symptoms of Attention-Deficit/Hyperactivity Disorder and Co-occurring Oppositional Defiant Disorder and Conduct Disorder

Bendiksen

Aase

Svensson

et al. 2013

Scandinavian Journal of Child and Adolescent Psychiatry and Psychology

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Background: We have limited knowledge of the impact of attention-deficit/hyperactivity disorder (ADHD) symptoms on the daily functioning of young preschool children. Objective: This study investigated the level of impairment related to symptoms of ADHD in different functional domains. It also addressed how impairment caused by ADHD was related to ADHD subtype, symptom load, gender, and the cooccurrence of oppositional defiant disorder, conduct disorder, or both. Method: Participating children (N = 807) who were 3.5 years old were recruited from a population-based sample included in The Norwegian Mother and Child Cohort Study. Children who scored above the 90th percentile for ADHD symptoms were included in the present sample. The assessment of the symptoms and functional impairment described in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, text revision, was based on parental ratings and the semi-structured psychiatric interview entitled "The Preschool Age Psychiatric Assessment." Results: Added burden and discord within family relationships were the areas that were most severely affected. All domain scores were strongly intercorrelated, and they were added to each child's total score. Children with symptoms of ADHD, inattentive type (mean [M], 3.5; standard deviation [SD], 3.4), or ADHD, hyperactive/impulsive type (M, 2.9; SD, 2.7), were significantly less impaired than children with symptoms of ADHD, combined type (M = 6.4; SD = 3.8; p < .001). Furthermore, co-occurring oppositional defiant disorder was associated with higher impairment scores (M, 6.1; SD, 4.3) than ADHD alone (M, 3.2; SD, 2.9; p < .001. About 30% of the variance of impairment score of ADHD was explained by symptoms of ADHD and co-occurring symptoms of oppositional defiant disorder and conduct disorder. Few gender differences were observed. Conclusion: Overall, these non-referred young children with clinical symptoms of ADHD were only modestly impaired. Impairment related to ADHD occurred mainly in the areas of family functioning, and it was associated with ADHD subtype and comorbidity. Still, it is important to assess the impact of ADHD symptoms and coexisting difficulties among preschoolers to identify children and families who are in need of early intervention efforts.

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Section: Discussionsupporting

confidence: 92%

Impairment in Young Preschool Children with Symptoms of Attention-Deficit/Hyperactivity Disorder and Co-occurring Oppositional Defiant Disorder and Conduct Disorder

Bendiksen

Aase

Svensson

et al. 2013

Scandinavian Journal of Child and Adolescent Psychiatry and Psychology

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“…Given its importance in the referral for ADHD and its relevance in treatment planning, it follows that such information could also be helpful in the assessment process. For example, recent studies suggest that consideration of impairment as a separate construct enhances the accuracy of diagnosis [9,16].…”

Section: Assessment Of Adhdmentioning

confidence: 99%

The Utility of Home Problem Pervasiveness and Severity in Classifying Children Identified with Attention-Deficit/Hyperactivity Disorder

Barry

Pinard

Barry

et al. 2010

Child Psychiatry Hum Dev

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Given the propensity for clinical assessment of Attention-Deficit/Hyperactivity Disorder (ADHD) to focus on core behavioral symptoms, the current study examined how well other predictors classified children who were diagnosed with ADHD by licensed practitioners. Participants were 91 children (39 ADHD-identified, 52 without ADHD), aged 8 to 13 years. In addition to significantly more ADHD symptoms, the ADHD-identified group exhibited significantly more externalizing problems and internalizing symptoms, less adaptive functioning, and greater problem pervasiveness and severity. Binary logistic regression analyses indicated that problem pervasiveness and severity significantly predicted diagnostic group membership when controlling for other predictors, and pervasiveness added unique variance beyond measures of core ADHD symptoms. Diagnostic utility analyses showed measurement of problem pervasiveness and severity to be a useful tool in the identification of ADHD. Findings provide support for the practical use of a parent-report measure of impairment in the home as part of evidence-based assessment of ADHD.

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“…Lack of clarity of what impairment is (or how it can be measured) or even the assumption that symptoms and impairment are equivalent dimensions may underlie the inconsistent use of impairment measures 4,5 . Overlooking impairment leads to false positive diagnoses and overestimates of prevalence rates 6 .…”

Section: Introductionmentioning

confidence: 99%

“…Since the correlation between ADHD symptoms and impairment may be only moderate 5 , it is necessary for the clinician to minimize as much as possible any potentially interfering aspects during consultation. b) Although research data does not support the idea that ADHD is a cultural construct 15 , we and others have suggested 16 that there is a wide variation in beliefs related to ADHD among countries -both cultural and historical.…”

Section: Introductionmentioning

confidence: 99%

Quantitative measurement of impairment in ADHD: perspectives for research and clinical practice

Fortes¹,

Serra-Pinheiro²,

Coutinho³

et al. 2014

Arch. Clin. Psychiatry (São Saulo)

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Background: Functional impairment is needed to make an attention deficit hyperactivity disorder (ADHD) diagnosis, but there is a paucity of instruments addressing this issue. Objective: Perform psychometric analysis of a functional impairment scale (FIE). Methods: A sample of 320 individuals, including ADHD probands, their siblings and parents, filled the FIE. We analyzed psychometric properties for the entire sample and age groups. Factor structure was determined by a principal component factor analysis, using oblique rotation with Kaiser normalization and Eigenvalues higher than 1. Cronbach's alpha and SpearmanBrown were calculated. Results: Family analysis revealed four components: a) "family life", b) "self-perception", c) "performance" and d) "social life". Adults' analysis revealed two components: a) "family life, social life and self-perception" and b) "performance". Children showed the domains: a) "performance and social life", b) "self-perception" and c) "family life" components. Cronbach's alpha were above 0.9 in all components. Discussion: Results revealed up to four domains depending on the group considered. Different life demands might explain the variability of domains on the groups.

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The Role of Impairment in the Diagnosis of ADHD

Abstract: Symptoms and impairment are related yet distinct constructs that should be measured independently to determine the presence of ADHD.

Cited by 85 publications

References 23 publications

Impairment in Young Preschool Children with Symptoms of Attention-Deficit/Hyperactivity Disorder and Co-occurring Oppositional Defiant Disorder and Conduct Disorder

Impairment in Young Preschool Children with Symptoms of Attention-Deficit/Hyperactivity Disorder and Co-occurring Oppositional Defiant Disorder and Conduct Disorder

The Utility of Home Problem Pervasiveness and Severity in Classifying Children Identified with Attention-Deficit/Hyperactivity Disorder

Quantitative measurement of impairment in ADHD: perspectives for research and clinical practice

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