Reliability and validity of self- and other-ratings of symptoms of ADHD in adults.
ABSTRACT Few studies have examined concordance between raters of ADHD symptoms in adults; there is less information on how well rating scales function in distinguishing adult ADHD from other disorders. This study examined these variables using the Conners Adult ADHD Rating Scales (CAARS).
The sample included 349 adults evaluated for attention problems. Correlations and kappa values were calculated using self- and observer-ratings of item-level symptoms; sensitivity, specificity, and discriminant validity of cluster scores in predicting clinician diagnoses were computed for 269 participants.
Item-level concordance rates ranged from slight to fair. Cluster scores demonstrated a poor balance of sensitivity and specificity in predicting ADHD diagnosis; a high percentage of participants with internalizing disorders had scores in the clinical range.
Self-and observer- ratings on the CAARS provide clinically relevant data about attention problems in adults, but the instrument does not effectively distinguish between ADHD and other adult psychiatric disorders.
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ABSTRACT: Recent reviews argue that emotion dysregulation is an important feature of attention-deficit/hyperactivity dis-order (ADHD) and involves a failure to inhibit negative emotions that leads to negative affectively-driven impulsive behavior (i.e., emotional impulsivity). The goal of the current study was to assess (a) whether emotion dysregulation and emotional impulsivity was higher in a group of adults diagnosed with ADHD and (b) if the relationship between core ADHD symptoms (i.e., inattention and hyperactivity-impulsivity) and emotional impulsivity is mediated by emotion dysregulation symptoms. A group of adults with (n = 18) and without (n = 23) ADHD completed measures of core ADHD symptoms, emotion dysregulation, and emotional impulsivity. A series of one-way analyses of covariance indicated significant between-group differences in emotion dysregulation and emotional impulsivity when current depression and oppositional defiant disorder ratings were covaried. In addition, the relationship between ADHD symptoms and emotional impulsivity was mediated by emotion dysregulation symptoms. These findings suggest that emotion dysregulation and emotional impulsivity are higher in adults diagnosed with ADHD and that emotion dysregulation symptoms have predictive value beyond core ADHD symptoms. Keywords ADHD . Emotion dysregulation . Emotional impulsivity Attention-deficit/hyperactivity disorder (ADHD) is a developmental disorder that persists into adulthood for the majority of cases (Barkley et al. 2008; Mannuzza et al. 1993; G. Weiss and Hechtman 1993) and occurs among approximately 4 % of adults (Kessler et al. 2006). Though developmentally inappropriate symptoms of inattention and hyperactivity-impulsivity are the two core symptom sets of the disorder (American Psychiatric Association 2000), recent reviews argue that emo-tion dysregulation is an additional feature of ADHD that should be incorporated into theoretical conceptualizations and diagnostic criteria (Barkley 2010; Martel 2009; Skirrow et al. 2009). Even though there is no consistently agreed upon defini-tion of emotion dysregulation (Putnam and Silk 2005), most accounts describe it as a multidimensional construct (Gratz and Roemer 2004) that includes (a) the lack of inhibition of behavior associated with strong negative or positive emo-tion and (b) subsequent failure to engage in self-regulatory actions, including self-soothing, refocusing attention, mod-erating the initial emotion, and organizing for coordinated action in the service of goal-directed behavior (Barkley 2010; Gottman and Katz 1989; Hinshaw 2003; Martel 2009; Melnick and Hinshaw 2000). According to one ac-count of emotion dysregulation in ADHD (Barkley 2010), those with the disorder are less likely to inhibit their emo-tions, particularly those pertaining to frustration, impatience, and anger, as a result of deficient cognitive control. The outcome of this poor inhibitory process is emotional impul-sivity, which "refers to the quickness or speed with which and the greater likelihood that an individual with ADHD will react with negative emotions in response to events J. T. Mitchell (*) : S. H. KollinsJournal of Psychopathology and Behavioral Assessment 01/2012; · 1.55 Impact Factor
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ABSTRACT: Attention deficit hyperactivity disorder (ADHD) in adults is a prevalent, yet under-appreciated, under-researched and poorly understood condition. Given this, it is imperative that information and awareness regarding this condition are made more widespread, both amongst the general public and amongst healthcare professionals. Further, given our poor understanding of the aetiology of the condition, meaningful translational research that migrates into and better informs clinical practice must be a priority. In this brief review we highlight areas regarding the clinical diagnosis and management of ADHD in adults (guidelines, rating scales, pharmacotherapy, psychotherapy) as well as areas of promising translational research (genetics, neuroimaging, sleep and circadian rhythms, animal models of ADHD). We address some of the challenges presented for both clinicians and healthcare providers and research scientists working to improve the lives of those adults with ADHD.ADHD Attention Deficit and Hyperactivity Disorders 02/2012;
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ABSTRACT: Objective: To review measures used to assess treatment response in patients with attention-deficit/hyperactivity disorder (ADHD) across the life span. Data Sources: Keyword searches of English-language articles in the PubMed database up to and including the May 4, 2011, index date were performed with the search strings (1) (attention deficit disorder with hyperactivity [MeSH] OR ADHD) AND (outcome assessment [MeSH] OR adaptation of life skills OR executive function [MeSH]) and (2) (attention deficit disorder with hyperactivity [MeSH] OR ADHD) AND (function OR functioning OR quality of life [MeSH]). Study Selection: Articles found through this search were then selected based on relevance to the topic area; no specific quality criteria were applied. Data Extraction: Narrative review. Results: The vast majority of studies assessing ADHD treatments have measured treatment response using ADHD symptom measures. Additional domains relevant for assessing treatment response among children and adults with ADHD include functional impairment, quality of life, adaptive life skills, and executive function. Validated rating scales exist for assessing these additional domains, but there has been minimal research evaluating the sensitivity of these instruments for detecting treatment response in pediatric and adult samples. Conclusions: Assessment of treatment outcomes in ADHD should move beyond symptom assessment to incorporate measures of functioning, quality of life, adaptive skills, and executive function, especially when assessing long-term treatment response. The authors recommend a potential battery and schedule of measures that could be used to more comprehensively assess treatment response in patients with ADHD.The primary care companion to CNS disorders. 01/2012; 14(6).