Psychopathological rating scales for diagnostic use in adults with attention-deficit/hyperactivity disorder (ADHD)

University Hospital of the Saarland, Neurocenter, 66421, Homburg/Saar, Germany.
European Archives of Psychiatry and Clinical Neuroscience (Impact Factor: 3.36). 09/2006; 256 Suppl 1(Suppl 1):i3-11. DOI: 10.1007/s00406-006-1001-7
Source: PubMed

ABSTRACT The diagnosis of attention-deficit hyperactivity disorder (ADHD) in adults is a complex procedure which should include retrospective assessment of childhood ADHD symptoms either by patient recall or third party information, diagnostic criteria according to DSM-IV, current adult ADHD psychopathology including symptom severity and pervasiveness, functional impairment, quality of life and comorbidity. In order to obtain a systematic database for the diagnosis and evaluation of the course ADHD rating scales can be very useful. This article reviews rating instruments that have found general acceptance. The Wender-Utah Rating Scale (WURS) and the Childhood Symptoms Scale by Barkley and Murphy try to make a retrospective assessment of childhood ADHD symptoms. The Connors Adult ADHD Rating Scales (CAARS), the Current Symptoms Scales by Barkley and Murphy (CSS), the Adult Self Report Scale (ASRS) by Adler et al. and Kessler et al. or the Attention Deficit Hyperactivity Disorder--Self Report Scale (ADHD-SR by Rösler et al.) are self report rating scales focusing mainly on the DSM-IV criteria. The CAARS and the CSS have other report forms too. The Brown ADD Rating Scale (Brown ADD-RS) and the Attention Deficit Hyperactivity Disorder--Other Report Scale (ADHD-OR by Rösler et al.) are instruments for use by clinicians or significant others. Both self rating scales and observer report scales quantify the ADHD symptoms by use of a Likert scale mostly ranging from 0 to 3. This makes the instruments useful to follow the course of the disease quantitatively. Comprehensive diagnostic interviews not only evaluate diagnostic criteria, but also assess different psychopathological syndrome scores, functional disability measures, indices of pervasiveness and information about comorbid disorders. The most comprehensive procedures are the Brown ADD Diagnostic Form and the Adult Interview (AI) by Barkley and Murphy. An instrument of particular interest is the Wender Reimherr Interview (WRI) which follows a diagnostic algorithm different from DSM-IV. The interview contains only items delineated from adult psychopathology and not derived from symptoms originally designed for use in children. Other instruments focus on functional impairment, quality of life, comorbid disorders, gender effects and specific psychopathological models.

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Available from: Marc F Schneider, May 06, 2014
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    • "This strategy for assessing impairment was chosen to mimic approaches in clinical settings, in which clinicians tend to rely on the subject's general perception of impairment instead of on extensive evaluations of correlates of functioning. Thus, clinicians tend to assess ADHD impairment based on patient's perceptions (Rösler et al. 2006). Although the threshold for defining impairment is subjective and individual, clinicians diagnose ADHD even in cases without substantial impairment . "
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    ABSTRACT: The DSM criteria for adult attention-deficit/hyperactivity disorder (ADHD) have not been tested in American Psychiatric Association (APA) field trials for either DSM-IV or DSM-5. This study aimed to assess: (a) the prevalence of ADHD according to DSM-5 criteria; (b) the factor solution that provides the best fit for ADHD symptoms; (c) the symptoms with the highest predictive value for clinical impairment; and (d) the best symptomatic threshold for each ADHD dimension (inattention and hyperactivity/impulsivity).
    Psychological Medicine 06/2014; 45(2):1-13. DOI:10.1017/S0033291714001470 · 5.43 Impact Factor
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    • "In particular, also assessment of childhood ADHD symptoms did not necessarily rely on third person observations in this study. However, diagnostic interviews which were primarily used in this study are the fundamental basis of every diagnostic process in adult psychiatry and it has been shown that adults present competent sources of information and that self-reports may lead to valid diagnoses in subjects with ADHD in particular (Murphy and Schachar 2000; R ö sler et al. 2006). "
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    ABSTRACT: This trial was performed to test the efficacy and safety of an extended-release formulation of methylphenidate (MPH ER). A total of 162 adults with ADHD according to DSM-IV were treated for 8 weeks with either two daily individually body weight-adjusted doses of MPH ER up to 1 mg/kg per day (N = 84) or placebo (N = 78). The primary efficacy outcome was the Wender-Reimherr Adult Attention Deficit Disorder Scale (WRAADDS) 8 weeks after randomization. Secondary efficacy measures were the ADHD Diagnostic Checklist (ADHD-DC), the Conners Adult Attention Deficit Disorder Scale (CAARS-S:L), the Clinical Global Impression (CGI) and the Sheehan Disability Scale (SDS). At week 8 a significantly higher decline of the total WRAADDS score was found in the MPH ER group as compared to the placebo group (P = 0.0003). The rates of responders were 50% in the MPH ER and 18% in the placebo group (P < 0.0001). Furthermore, similar effects were observed for the secondary efficacy variable: ADHD-DC score (P = 0.004), CAARS-S:L score (P = 0.008) and the SDS score (P = 0.017). 50% of the MPH ER group and 24.4% of the placebo group were improved "much" or "very much" according to the CGI rating (P = 0.0001). MPH ER treatment was well tolerated. At week 2 also the mean heart rate was significantly higher in the MPH ER group as compared to the placebo group (P = 0.01). No differences between the study groups were observed regarding mean blood pressure at any visit. This clinical trial demonstrated statistically significant and clinical relevant effects of MPH ER in adults with ADHD for several self- and investigator-rated ADHD psychopathology and also functional efficacy measures.
    The World Journal of Biological Psychiatry 12/2010; 13(1):48-59. DOI:10.3109/15622975.2010.540257 · 4.23 Impact Factor
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    • "All had committed felony crimes and were incarcerated for more than 2 years. ADHD syndrome and psychopathy scores were established by means of the ADHD self report scale (Rösler et al., 2006) and the PCL-SV, respectively. We found a rank correlation of 0.2 between PCL-SV and ADHD-SR mean scores, which was statistically significant (p ≤ 0.01), but clinically not meaningful. "
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    ABSTRACT: Disruptive behavior includes psychopathological and behavioral constructs like aggression, impulsivity, violence, antisociality and psychopathy and is often closely related with diagnostic categories like conduct disorder (CD), attention deficit disorder (ADHD) and antisocial personality disorder (ASP). There is now clear evidence that neurobiological and environmental factors contribute to these phenotypes. A mounting body of evidence also suggests interactive effects of genetic and environmental risks. In this selective review we give an overview over epidemiological aspects of the relation between ADHD and antisocial behavior, including violent aggression and psychopathy. Moreover, we summarize recent findings from molecular genetic studies and particularly discuss pleiotropic effects of a functional polymorphism of the serotonin transporter promoter gene (5HTTLPR) and childhood adversity on ADHD and violent behavior. The reported gene-environment interactions are not only informative for understanding the neurobiological underpinnings of disruptive behavior, but also throw some light on the relation between ADHD and violent behavior from a genetic perspective. The impact of genetic research on forensic psychiatry and future directions of neurobiological research are discussed.
    International Journal of Law and Psychiatry 06/2009; 32(4):235-43. DOI:10.1016/j.ijlp.2009.04.006 · 1.19 Impact Factor
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