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Psychometric evaluation of a brief measure to capture general population-level variation in ADHD symptoms from childhood through the transition to adulthood
Abstract
To illuminate individual differences in the development of attention-deficit hyperactivity disorder (ADHD) symptoms in the general population, psychometric measures are needed that can capture general population-level symptom variation reliably, validly, and comparably from childhood through to the transition to adulthood. The ADHD subscale of the Social Behavior Questionnaire (SBQ-ADHD) provides a candidate for a measure that can meet this need. We thus evaluate the psychometric properties of the SBQ-ADHD as administered in adulthood (ages 20 and 24) to a large normative sample, as well as the cross-informant (parent-teacher-self-reports) and developmental (ages 7–24) measurement invariance of a core SBQ-ADHD item set. Results support score internal consistency reliability, gender measurement invariance, and criterion validity. Scores from the core item set showed some evidence of non-invariance, providing insights into how ADHD symptoms may manifest and/or be perceived differently by different informants/in different contexts and at different ages. Our findings overall support the use of the SBQ-ADHD items for developmental studies of ADHD symptoms from childhood to adulthood.
... A. Miller et al., 2015;Pritchard et al., 2017;Wood et al., 2021). In studies of attention behavior across the lifespan, these two scales have been used similarly to evaluate attentional constructs for children and adults (Martel et al., 2012;Marx et al., 2010;Roy et al., 2016), and uniform measure of associated attention behaviors across both children and adults has been validated (Herbert, 2019; Murray et al., 2024). Thus, we used scores from these measures as the quality of individual's attention behavior. ...
The locus coeruleus (LC) is a nucleus within the brainstem associated with physiological arousal and altered structure and function in the context of neurodegenerative disorders. Pathologies related to difficulties with attention have previously been associated with abnormalities in neurotransmitter production and sensitivity, suggesting the possibility of abnormality in neurotransmitter producing neural regions. One such region is the LC, associated with norepinephrine production. To examine the possibility that LC alteration is associated with inattentive symptom reporting, a set of analyses have been performed with 141 individuals age-ranged from 8 to 54. We found that the structural integrity value of the LC, especially on the right hemisphere, showed a significant negative association with the level of individual's inattentiveness score. Furthermore, LC volume size was significantly positively associated with inattention, and this finding was also lateralized to the right LC. Interestingly, an inverse association was found between structural integrity and volume size. These findings support the relationship between LC and attention-related behavior through both neuromelanin-sensitive and structural imaging, with important implications for the association between regional structure and function.
A maladaptive response to stress in individuals with high ADHD traits may be a key factor explaining co-occurring ADHD symptoms and internalising problems. The current study investigates whether between-person differences in ADHD traits are associated with differences in the within-person moment-to-moment coupling of stress and negative affect; and whether these can explain between-person differences in internalising problems (N = 262, median-age 20). Results of a dynamic structural equation model indicated that between-person differences in ADHD traits significantly moderated the daily life coupling between stress and negative affect. Further, higher ADHD traits were associated with stronger stress carry-over and higher mean levels of negative affect. Stress carry-over and mean levels of negative affect mediated the association between ADHD traits and internalising problems.
The Zurich Project on the Social Development from Childhood to Adulthood (z-proso) began in 2004 in response to the need for a better evidence base to support optimal child social development and prevent crime and violence. Since then, the study has tracked the development of a diverse sample of youths ( N = 1,675 in the target sample; ~50% female) from age 7 ( n = 1,360) to age 20 ( n = 1,180), with primary data collection waves at ages 7, 8, 9, 10, 11, 12, 13, 15, 17, and 20. The study uses a multi-method, multi-informant design that combines teacher, youth, and parent reports with observational and behavioural measures, biosampling, functional imaging, and ecological momentary assessment. Analyses of the data have contributed important evidence to a diversity of topics in child and adolescent development, illuminating the developmental roots of crime and aggression, the impacts of exposure to different forms and combinations of victimisation, and trajectories of mental health and neurodevelopmental symptoms.
Objective
ADHD symptoms typically decline with age, but less is known about whether the presentation of specific ADHD symptoms differs across development. This study aimed to examine the frequency and associated impairment of specific ADHD symptoms in childhood, adolescence, and young adulthood.
Method
A prospective, longitudinal cohort, the Avon Longitudinal Study of Parents and Children, was utilized (N = 2,327). ADHD symptoms and impairment were assessed using the Development and Well Being Assessment at ages 7, 15, and 25.
Results
Specific ADHD symptom frequencies and their associated impairment varied across development for the majority of symptoms, although easily distracted was one of the most commonly reported symptoms at each age, and difficulty sustaining attention was consistently associated with high levels of impairment.
Conclusion
These findings suggest differences in the presentations of ADHD symptoms across development: current understanding of how ADHD presents in childhood/adolescence may not be generalizable to young adulthood.
Developmental invariance is important for making valid inferences about child development from longitudinal data; however, it is rarely tested. We evaluated developmental and gender invariance for one of the most widely used measures of child mental health: the parent-reported Strengths and Difficulties Questionnaire (SDQ). Using data from the large U.K. population-representative Millennium Cohort Study (N = 10,207; with data at ages 3, 5, 7, 11, 14, and 17 years), we tested configural, metric, scalar, and residual invariance in emotional problems, conduct problems, hyperactivity/inattention, prosociality, and peer problems. We found that the SDQ showed poor fit at age 3 in both males and females and at age 17 in males; however, it fit reasonably well and its scores were measurement invariant up to the residual level across gender at ages 5, 7, 11, and 14 years. Scores were also longitudinally measurement invariant across this age range up to the partial residual level. Results suggest that the parent-reported SDQ can be used to estimate developmental trajectories of emotional problems, conduct problems, hyperactivity/inattention, prosociality, and peer problems and their gender differences across the age range 5 to 14 years using a latent model. Developmental differences outside of this range may; however, partly reflect measurement differences.
Dual systems theories of adolescent risk-taking propose that the socioemotional and self-regulation systems develop at different rates, resulting in a peak in sensation-seeking in adolescence at a time when self-regulation abilities are not yet fully mature. This “developmental imbalance” between bottom-up drives for reward and top-down control is proposed to create a period of vulnerability for high-risk behaviors such as delinquency, substance use, unprotected sex, and reckless driving. In this study, data from the Swiss longitudinal normative z-proso study (n = 1522, n = 784 male; aged 11, 13, 15, 17, and 20) were used to test whether the presence of a developmental imbalance between sensation-seeking and self-regulation is associated with trajectories of engagement in delinquency across early adolescence to adulthood. Using a latent class growth analysis of sensation-seeking, self-regulation, and delinquency, it was found that a model with 3 classes was optimal in the whole sample and male sub-sample, including one class characterized by a developmental imbalance and corresponding adolescent peak in delinquency. In females, there was no evidence for a class that could be described according to the trajectories hypothesized in dual systems theory. This study’s results support the claim that a developmental imbalance may drive an adolescent increase in delinquency. However, this applies only to a small subgroup of individuals, particularly males.
Background
Attention-deficit hyperactivity disorder (ADHD) is associated with later depression and there is considerable genetic overlap between them. This study investigated if ADHD and ADHD genetic liability are causally related to depression using two different methods.
Methods
First, a longitudinal population cohort design was used to assess the association between childhood ADHD (age 7 years) and recurrent depression in young-adulthood (age 18–25 years) in N = 8310 individuals in the Avon Longitudinal Study of Parents and Children (ALSPAC). Second, two-sample Mendelian randomization (MR) analyses examined relationships between genetic liability for ADHD and depression utilising published Genome-Wide Association Study (GWAS) data.
Results
Childhood ADHD was associated with an increased risk of recurrent depression in young-adulthood (OR 1.35, 95% CI 1.05–1.73). MR analyses suggested a causal effect of ADHD genetic liability on major depression (OR 1.21, 95% CI 1.12–1.31). MR findings using a broader definition of depression differed, showing a weak influence on depression (OR 1.07, 95% CI 1.02–1.13).
Conclusions
Our findings suggest that ADHD increases the risk of depression later in life and are consistent with a causal effect of ADHD genetic liability on subsequent major depression. However, findings were different for more broadly defined depression.
The present study aimed to investigate the measurement invariance across age, gender, clinical status, and informant of the Attention-Deficit/Hyperactivity Disorder Rating Scale–IV (ADHD-RS-IV) Home and School versions. The participants were 1,106 Romanian children and adolescents (mean age = 12.74 years, standard deviation = 2.84, age range 6-18 years). Both parents and teachers assessed ADHD symptoms. The factorial structure of the scale was assessed using confirmatory factor analysis, and measurement invariance was assessed using multigroup confirmatory factor analysis. The results supported the reliability of the ADHD-RS-IV, with high internal consistency coefficients for both versions. Confirmatory factor analysis validated a two-factor model. Multigroup confirmatory factor analysis confirmed the measurement invariance of ADHD-RS-IV across age, gender, clinical status, and informant. ADHD-RS-IV had good psychometric properties in a sample of Romanian children and adolescents. It is a reliable instrument given its strong invariance. Implications for evidence-based assessment of ADHD are discussed.
School-based psychosocial interventions are a widely used approach to prevent or reduce externalising behaviour. However, evaluating the effects of such interventions is complicated by the fact that the interventions may not only change the target behaviour, but also the way that informants report on that behaviour. For example, teachers may become more aware of bullying behaviour after delivering lessons on the topic, resulting in increased teacher reports of the behaviour. In this study, we used multi-group confirmatory factor analysis to evaluate whether teachers exposed to the Promoting Alternative Thinking Strategies (PATHS) intervention changed the way they reported on child externalising behaviour. Using data from the z-proso study (802 participants; 51% male; 69 teachers), teacher reports of aggressive behaviour, attention deficit hyperactivity disorder and non-aggressive conduct disorder symptoms were compared pre- and post- intervention and across the intervention and control conditions. There was no evidence that teacher reporting was affected by exposure to the intervention. This helps bolster the interpretation of intervention effects as reflecting changes in child behaviour, rather than in the manner of informant reporting.
ADHD symptoms show considerable individual variation in the contexts in which they are expressed. It has previously been proposed that subtyping individuals according to the contexts in which symptoms are expressed may be clinically useful. We examined context-based patterns of ADHD symptoms in a longitudinal cohort study of n = 1388 children, as well as context-specific and context-general predictors of symptoms. Participants were community-ascertained and provided ADHD symptom data at ages 7, 9, and 11. Using growth mixture modelling we identified five inattention and five hyperactivity/impulsivity categories that differed in the developmental patterns of symptoms reported by parent and teacher informants. We found some evidence that context-specific predictors were related to context-specific expressions. Specifically, after controlling for other risk factors for ADHD symptoms, relationships with teachers predicted school-specific (teacher-reported) but not home-specific (parent-reported) symptom levels. However, no subtypes defined by exclusively home-based symptoms emerged, suggesting that while symptoms may sometimes be specific to the school context, they are only rarely confined to the home context. Subtyping by context could be informative; however, further work will required to uncover the nature of any etiological, functional, or outcome differences between those who show symptom expression in different contexts.
Electronic supplementary material
The online version of this article (10.1007/s10578-018-0842-4) contains supplementary material, which is available to authorized users.
Previous studies have hinted at sex differences in developmental trajectories in ADHD symptoms; however, little is known about the nature or cause of these differences and their implications for clinical practice. We used growth mixture modelling in a community‐ascertained cohort of n = 1,571 participants to study sex differences in ADHD symptom developmental trajectories across the elementary and secondary school years. Participants were measured at ages 7, 8, 9, 10, 11, 12, 13, and 15. We found that females were more likely to show large symptom increases in early adolescence while males were more likely to show elevated symptoms from childhood. For both males and females, early adolescence represented a period of vulnerability characterized by relatively sudden symptom increases. Females affected by hyperactivity/impulsivity may be more likely to be excluded from diagnosis due to current age of onset criteria. More attention should be paid to early adolescence as a period of risk for hyperactivity/impulsivity symptom onset or worsening.
Objective: Substantial individual variation exists in the age of onset and course of ADHD symptoms over development. We evaluated whether, within this variation, meaningful developmental subtypes can be defined. Method: Using growth mixture modeling in a community-based sample (N = 1,571), we analyzed ADHD symptom trajectories based on measures taken at ages 7, 8, 9, 10, 11, 13, and 15 years. We evaluated whether those showing developmental trajectories characterized by later onsets versus early onsets differed in terms of mental health and behavioral outcomes in late adolescence (age 17 years). Result: The late onset category was best conceptualized as a milder subtype than early onset. The former was, however, more similar in outcomes to the latter than to the unaffected category, suggesting that later onsets are still associated with impairment. Conclusion: Considering diagnoses for those affected by ADHD symptoms but who do not meet current age of onset criteria may be important for ensuring that they receive appropriate support.
Background: Previous studies have reported a high prevalence of attention deficit hyperactivity disorder (ADHD) among people living in detention (PLD) corresponding to a five- to ten-fold increase compared to the general population. Our main study objective was to provide an updated ADHD prevalence rate for PLD, including PLD in psychiatric units. Sub-objectives included (i) comparing different ways of assessing ADHD, including DSM-5 criteria and (ii) identifying which types of PLD are more likely to have ADHD.
Methods: We conducted a systematic review and meta-analysis following the PRISMA guidelines and the MOOSE checklist. PubMed/Medline, PsycINFO, and Web of Sciences were searched combining “ADHD” and “prison” keywords and synonyms for articles published between January 1, 1966 and January 2, 2018. Potential sources of variation to the meta-analytic ADHD prevalence rate were investigated using meta-regressions and subgroups analyses.
Results: The meta-analysis pooled 102 original studies including 69,997 participants. The adult ADHD prevalence rate was 26.2% (95% confidence interval: 22.7–29.6). Retrospective assessments of ADHD in childhood were associated with an increased prevalence estimate (41.1, 95% confidence interval: 34.9–47.2, p < 0.001). There was no significant difference in the prevalence estimate between screenings and clinical interviews in adulthood. Only three studies used the DSM-5 definition of ADHD and results were non-significantly different with other DSM versions. We found no difference according to participants' characteristics.
Conclusion: Our results confirmed the high prevalence rate of ADHD among PLD, corresponding to a five-fold increase compared to the general population. In light of such high ADHD prevalence, our results reinforce the importance of addressing this critical public health issue by (i) systematically offering ADHD screening and diagnosis to all individuals entering detention, and (ii) delivering treatment, monitoring, and care for ADHD during and after detention. These strategies may help reduce recidivism and reincarceration, as well as violence in detention settings, in addition to improving the health and wellbeing of people living in detention. Additionally, our study suggests that using screening scales may be a reliable way of assessing ADHD, although caution is needed because a complete evaluation by an experienced clinician is required to provide a formal diagnosis.
Objective: The aim of this study is to validate the Adult ADHD Self-Report Scale (ASRS) and Adult ADHD Investigator Symptom Rating Scale (AISRS) expanded versions, including executive function deficits (EFDs) and emotional dyscontrol (EC) items, and to present ASRS and AISRS pilot normative data. Method: Two patient samples (referred and primary care physician [PCP] controls) were pooled together for these analyses. Results: Final analysis included 297 respondents, 171 with adult ADHD. Cronbach’s alphas were high for all sections of the scales. Examining histograms of ASRS 31-item and AISRS 18-item total scores for ADHD controls, 95% cutoff scores were 70 and 23, respectively; histograms for pilot normative sample suggest cutoffs of 82 and 26, respectively. Conclusion: (a) ASRS- and AISRS-expanded versions have high validity in assessment of core 18 adult ADHD Diagnostic and Statistical Manual of Mental Disorders (DSM) symptoms and EFD and EC symptoms. (b) ASRS (31-item) scores 70 to 82 and AISRS (18-item) scores from 23 to 26 suggest a high likelihood of adult ADHD.
The shift toward transdiagnostic and dimensional approaches to psychopathology research has created a growing need for psychometric assessments that reflect this conceptualization. We aimed to test whether an omnibus measure of psychopathology, the Social Behavior Questionnaire (SBQ), has suitable properties to serve as a dimensional, transdiagnostic assessment. We used an item response theory (IRT) approach to evaluate the reliable ranges of measurement of the psychopathology dimensions measured by the SBQ. For the dimensions of attention-deficit hyperactivity disorder (ADHD), Prosociality, Internalizing, and Externalizing, the SBQ can provide a reliable measure for below average to very high levels in a normative sample.
Measurement invariance over time (longitudinal invariance) is a core but seldom-tested assumption of many longitudinal studies on adolescent psychosocial development. In this study, we evaluated the longitudinal invariance of a brief measure of adolescent mental health: the Social Behavior Questionnaire (SBQ). The SBQ was administered to participants of the Zurich Project on the Social Development of Children and Youths in up to four waves spanning ages 11 to 17. Using a confirmatory factor analysis approach, metric invariance held for all constructs, but there were some violations of scalar and strict invariance. Overall, intercepts tended to increase over time while residual variances decreased. This suggests that participants may become more willing or able to identify and report on certain behaviors over time. The noninvariance was not practically significant in magnitude, except for the Anxiety dimension where artifactual increases over development would be liable to occur if invariance is not appropriately modeled. Overall, results support the utility of the SBQ as an omnibus measure of psychosocial health across adolescence.
Objective: The objective of this study was to examine the independent association between inattention and hyperactivity/impulsivity symptoms and perceived stress among French college students. Method: Participants (N = 6,951) completed self-report surveys assessing ADHD symptoms, perceived stress, and sociodemographic characteristics. Multinomial logistic regression models were used to evaluate the association between ADHD symptoms and perceived stress. Results: Participants had a mean age of 20.8 years, and 75.6% were female. We found significant associations between increasing levels of inattention and hyperactivity/impulsivity symptoms and high level of perceived stress after adjustment for confounding variables. The association was stronger for inattention (odds ratio [OR] = 4.58, 95% confidence interval [CI] = [4.02, 5.22]) than for hyperactivity/impulsivity symptoms (OR = 1.21, 95% CI = [1.05 to 1.39]). Conclusion: Higher levels of inattention and hyperactivity/impulsivity were independently associated with perceived stress in French college students. This association was mainly driven by inattention. Screenings to better detect ADHD symptoms should be implemented in universities.
There is a renewed interest in better conceptualizing trajectories of attention-deficit/hyperactivity disorder (ADHD) from childhood to adulthood, driven by an increased recognition of long-term impairment and potential persistence beyond childhood and adolescence. This review addresses the following major issues relevant to the course of ADHD in light of current evidence from longitudinal studies: (1) conceptual and methodological issues related to measurement of persistence of ADHD, (2) estimates of persistence rate from childhood to adulthood and its predictors, (3) long-term negative outcomes of childhood ADHD and their early predictors, and (4) the recently proposed new adult-onset ADHD. Estimates of persistence vary widely in the literature, and diagnostic criteria, sample characteristics, and information source are the most important factors explaining variability among studies. Evidence indicates that ADHD severity, comorbid conduct disorder and major depressive disorder, and treatment for ADHD are the main predictors of ADHD persistence from childhood to adulthood. Comorbid conduct disorder and ADHD severity in childhood are the most important predictors of adverse outcomes in adulthood among children with ADHD. Three recent population studies suggested the existence of a significant proportion of individuals who report onset of ADHD symptoms and impairments after childhood. Finally, we highlight areas for improvement to increase our understanding of ADHD across the life span.
Objective:
Attention-deficit/hyperactivity disorder (ADHD) and conduct disorder (CD) are common externalizing disorders. Despite previous research demonstrating that both are longitudinally associated with adverse outcomes, there have been no systematic reviews examining all of the available evidence linking ADHD and CD with a range of health and psychosocial outcomes.
Method:
Electronic databases (EMBASE, Medline, and PsycINFO) were searched for studies published from 1980 up to March 2015. Published cohort and case-control studies were included if they reported a longitudinal association between ADHD or CD and adverse outcomes with a minimum follow-up of 2 years. Outcomes with sufficient data were pooled in a random effects meta-analysis to give overall odds ratios (ORs) with corresponding 95% CIs.
Results:
Of the 278 studies assessed, 114 met inclusion criteria and 98 were used in subsequent meta-analyses. ADHD was associated with adverse outcomes including academic achievement (e.g. failure to complete high school; odds ratio [OR] = 3.7, 95% CIs 2.0-7.0), other mental and substance use disorders (e.g. depression; OR = 2.3, 1.5-3.7), criminality (e.g. arrest; OR = 2.4, 1.5-3.8), and employment (e.g., unemployment; OR = 2.0, 1.0-3.9). CD was associated with outcomes relating to academic achievement (e.g. failure to complete high school; OR = 2.7, 1.5-4.7), other mental and substance use disorders (e.g., illicit drug use; OR = 2.1, 1.7-2.6), and criminality (e.g. violence; OR = 3.5, 2.3-5.3).
Conclusion:
This study demonstrated that ADHD and CD are associated with disability beyond immediate health loss. Although the analyses could not determine the mechanisms behind these longitudinal associations, they demonstrate the importance of addressing ADHD and CD early in life so as to potentially avert a wide range of future adverse outcomes.
Objective: The current study examines psychometric properties of the Weiss Functional Impairment Rating Scale (WFIRS), a measure of adult ADHD-related impairment. It is a self-report questionnaire that provides a metric of overall life impairment and domain-specific dysfunction. Method: Using data from a large (N = 2,093), multi-institution sample of college students and including a subsample of collateral informants (n = 262), a series of analyses were conducted. Results: The WFIRS demonstrated robust internal reliability, cross-informant agreement on par or superior to other measures of ADHD symptomatology and impairment, and concurrent validity. The WFIRS was not shown to be uniquely associated with ADHD, as internalizing symptoms also associated with the total and domain scores. Conclusion: The use of the WFIRS in identifying ADHD-related impairment in emerging adults appears to be psychometrically supported, and will prove useful to clinicians and researchers.
A diagnosis of attention-deficit/hyperactivity disorder (ADHD) according to the Diagnostic and Statistical Manual, 5th Edition (DSM-5) is assessed in youth using ratings from both a parent and a teacher. However, individual and contextual differences between informants may lead to discrepancies in these ratings (De Los Reyes and Kazdin in Psychol Bull 131(4):483, 2005). The purpose of this study was to examine predictors of discrepancies between mother and middle school teacher reports of ADHD symptoms and related impairment. In an ethnically diverse sample of middle school students with well-diagnosed DSM-IV-TR ADHD (N = 112), we examined a range of mother and school setting characteristics that may contribute to informant discrepancies in this population. Hierarchical multiple regression analyses suggested that mothers with higher levels of education and psychopathology (i.e., ADHD symptom severity, parenting stress) may be most likely to report adolescent ADHD symptom severity that is higher than reported by teachers. Reports from general education teachers (vs. special education) were associated with lower symptom severity compared to mothers. Finally, a documented diagnosis of ADHD in the school was predictive of more severe reports from mothers. We discuss explanations for these findings and implications for assessment of middle school students with ADHD.
According to the dual systems perspective, risk taking peaks during adolescence because activation of an early-maturing socioemotional-incentive processing system amplifies adolescents’ affinity for exciting, pleasurable, and novel activities at a time when a still immature cognitive control system is not yet strong enough to consistently restrain potentially hazardous impulses. We review evidence from both the psychological and neuroimaging literatures that has emerged since 2008, when this perspective was originally articulated. Although there are occasional exceptions to the general trends, studies show that, as predicted, psychological and neural manifestations of reward sensitivity increase between childhood and adolescence, peak sometime during the late teen years, and decline thereafter, whereas psychological and neural reflections of better cognitive control increase gradually and linearly throughout adolescence and into the early 20s. While some forms of real-world risky behavior peak at a later age than predicted, this likely reflects differential opportunities for risk-taking in late adolescence and young adulthood, rather than neurobiological differences that make this age group more reckless. Although it is admittedly an oversimplification, as a heuristic device, the dual systems model provides a far more accurate account of adolescent risk taking than prior models that have attributed adolescent recklessness to cognitive deficiencies.
A sample of 356 children recruited from Head Start (58% European American, 25% African American, and 17% Hispanic; 54% girls; M age = 4.59 years) were followed longitudinally from prekindergarten through fifth grade. Latent profile analyses of teacher-rated inattention from kindergarten through third grade identified four developmental trajectories: stable low (53% of the sample), stable high (11.3%), rising over time (16.4%), and declining over time (19.3%). Children with stable low inattention had the best academic outcomes in fifth grade, and children exhibiting stable high inattention had the worst, with the others in between. Self-regulation difficulties in preschool (poor executive function skills and elevated opposition-aggression) differentiated children with rising versus stable low inattention. Elementary schools characterized by higher achievement differentiated children with declining versus stable high inattention. Boys and children from single-parent families were more likely to remain high or rise in inattention, whereas girls and children from dual-parent families were more likely to remain low or decline in inattention.
Assessment of genetic influences on behavior depends on context, informants, and study design: We show (analytically) that, conditional on study design, informant specific genetic variance is included in the genetic variance component or in the environmental variance component. To aid the explanation, we present an illustrative empirical analysis of data from the Netherlands Twin Register. Subjects included 1,571 monozygotic and 2,672 dizygotic 12-year-old twin pairs whose attention problems (AP) were rated by their parents, teachers, and themselves. Heritability estimates (h (2)) of AP were about ~0.75 for same informant ratings (mother, father, and same teacher ratings) and ~0.54 for different informants' ratings (different parents', different teachers', and two twins' self-ratings). Awareness of assessment effects is relevant to research into psychiatric disorders. Differences in assessment can account for age effects, such as a drop in heritability of ADHD symptoms. In genome-wide association studies, effects of rating specific genetic influences will be undetectable.
Objective:
This study examined several questions about the diagnosis of attention-deficit/hyperactivity disorder (ADHD) in young adults using data from a childhood-diagnosed sample of 200 individuals with ADHD (age M = 20.20 years) and 121 demographically similar non-ADHD controls (total N = 321).
Method:
We examined the use of self- versus informant ratings of current and childhood functioning and evaluated the diagnostic utility of adult-specific items versus items from the Diagnostic and Statistical Manual of Mental Disorders (DSM).
Results:
Results indicated that although a majority of young adults with a childhood diagnosis of ADHD continued to experience elevated ADHD symptoms (75%) and clinically significant impairment (60%), only 9.6%-19.7% of the childhood ADHD group continued to meet DSM-IV-TR (DSM, 4th ed., text rev.) criteria for ADHD in young adulthood. Parent report was more diagnostically sensitive than self-report. Young adults with ADHD tended to underreport current symptoms, while young adults without ADHD tended to overreport symptoms. There was no significant incremental benefit beyond parent report alone to combining self-report with parent report. Non-DSM-based, adult-specific symptoms of ADHD were significantly correlated with functional impairment and endorsed at slightly higher rates than the DSM-IV-TR symptoms. However, DSM-IV-TR items tended to be more predictive of diagnostic group membership than the non-DSM adult-specific items due to elevated control group item endorsement.
Conclusions:
Implications for the assessment and treatment of ADHD in young adults are discussed (i.e., collecting informant reports, lowering the diagnostic threshold, emphasizing impairment, and cautiously interpreting retrospective reports).
Objective: To explore the literature focusing on cultural influences in the diagnosis of adult ADHD and respective societal burden. Method: A review of the literature over the past 10 years was performed using OVID. Results: Although numerous articles focused on diagnosis and burden of adult ADHD, few focused on cultural factors influencing diagnosis. Like other mental health disorders, cultural and social perspectives contribute to our understanding of adult ADHD and may play a significant role in the diagnosis and varying acceptance of the condition. Moreover, adults with ADHD may underestimate the impact of ADHD symptoms, and in many cases have learned to compensate for ADHD related impairments by choosing lifestyles that help compensate for symptoms. Some adults with ADHD may appear to function well, however they may expend excessive amounts of energy to overcome impairments; and they may be distressed by ongoing symptoms such as restlessness, mood instability and low self-esteem. Research shows that ADHD can be detrimental to many areas of life including work, daily activities, social and family relationships and psychological and physical well-being. Patient-reported impairments in productivity due to poor time management, procrastination, and distractibility can translate into significant indirect costs and decreased quality of life. ADHD in adults is also associated with increased accidents, medical resource utilization, antisocial behaviour and drug alcohol abuse. Conclusion: The substantial societal burden of adult ADHD highlights the importance of providing a better understanding of the factors that contribute to accurate diagnosis and of improving the low recognition of the disorder in many world regions.
This article reports the effectiveness of two universal prevention programs in reducing externalizing behavior in elementary school children. A sample of 1,675 first graders in 56 Swiss elementary schools was randomly assigned to a school-based social competence intervention, a parental training intervention, both, or control. Externalizing psychopathology and social competence ratings were provided by the children, primary caregivers, and teachers at the beginning and end of the 2-year program, with a follow-up 2 years later. Intention-to-treat analyses revealed that long-term effects on teacher- and parent-rated externalizing behavior were greater for the social competence intervention than for the control. However, for most outcomes, no statistically significant positive effects were observed.
Literature clearly documents the association between mental health problems, particularly attention deficit hyperactivity disorder (ADHD), and educational attainment. However, inattention and hyperactivity are generally not considered independently from each other in prospective studies. The aim of the present study was to differentiate the unique, additive, or interactive contributions of inattention and hyperactivity symptoms to educational attainment.
The authors randomly selected 2,000 participants from a representative sample of Canadian children and estimated developmental trajectories of inattention and hyperactivity between the ages of 6 and 12 years using yearly assessments. High school graduation status, at age 22-23 years, was obtained from official records.
Four trajectories of inattention and four trajectories of hyperactivity were observed between the ages of 6 and 12 years. After controlling for hyperactivity and other confounding variables, a high inattention trajectory (compared with low inattention) strongly predicted not having a high school diploma at 22-23 years of age (odds ratio=7.66, 95% confidence interval [CI]=5.06-11.58). To a lesser extent, a declining or rising trajectory of inattention also made a significant contribution (odds ratios of 2.67 [95% CI=1.90-3.75] and 3.87 [95% CI=2.75-5.45], respectively). Hyperactivity was not a significant predictor once inattention was taken into account.
Inattention rather than hyperactivity during elementary school significantly predicts long-term educational attainment. Children with attention problems, regardless of hyperactivity, need preventive intervention early in their development.
Controversy exists about the appropriate criteria for a diagnosis of adult attention-deficit/hyperactivity disorder (ADHD).
To examine the structure and symptoms most predictive of DSM-IV adult ADHD.
The data are from clinical interviews in enriched subsamples of the National Comorbidity Survey Replication (n = 131) and a survey of a large managed health care plan (n = 214). The physician-administered Adult ADHD Clinical Diagnostic Scale (ACDS) was used to assess childhood ADHD and expanded symptoms of current adult ADHD. Analyses examined the stability of symptoms from childhood to adulthood, the structure of adult ADHD, and the adult symptoms most predictive of current clinical diagnoses.
The ACDS was administered telephonically by clinical research interviewers with extensive experience in the diagnosis and treatment of adult ADHD.
An enriched sample of community respondents.
Diagnoses of DSM-IV /ACDS adult ADHD.
Almost half of the respondents (45.7%) who had childhood ADHD continued to meet the full DSM-IV criteria for current adult ADHD, with 94.9% of these patients having current attention-deficit disorder and 34.6% having current hyperactivity disorder. Adult persistence was much greater for inattention than for hyperactivity/impulsivity. Additional respondents met the full criteria for current adult ADHD despite not having met the full childhood criteria. A 3-factor structure of adult symptoms included executive functioning (EF), inattention/hyperactivity, and impulsivity. Stepwise logistic regression found EF problems to be the most consistent and discriminating predictors of adult DSM-IV /ACDS ADHD.
These findings document the greater persistence of inattentive than of hyperactive/impulsive childhood symptoms of ADHD in adulthood but also show that inattention is not specific to ADHD because it is strongly associated with other adult mental disorders. In comparison, EF problems are more specific and consistently important predictors of DSM-IV adult ADHD despite not being in the DSM-IV, suggesting that the number of EF symptoms should be increased in the DSM-V/ICD-11.
It has been hypothesized that sensation seeking and impulsivity, which are often conflated, in fact develop along different timetables and have different neural underpinnings, and that the difference in their timetables helps account for heightened risk taking during adolescence. In order to test these propositions, the authors examined age differences in sensation seeking and impulsivity in a socioeconomically and ethnically diverse sample of 935 individuals between the ages of 10 and 30, using self-report and behavioral measures of each construct. Consistent with the authors' predictions, age differences in sensation seeking, which are linked to pubertal maturation, follow a curvilinear pattern, with sensation seeking increasing between 10 and 15 and declining or remaining stable thereafter. In contrast, age differences in impulsivity, which are unrelated to puberty, follow a linear pattern, with impulsivity declining steadily from age 10 on. Heightened vulnerability to risk taking in middle adolescence may be due to the combination of relatively higher inclinations to seek excitement and relatively immature capacities for self-control that are typical of this period of development.
Previous research suggests that aggression is associated with ADHD symptoms and this may partly reflect problems with emotional regulation. Using data from the D2M study (n=260) we found that ADHD symptoms were associated with both emotional lability and aggression, but emotional lability did not mediate the ADHD-aggression association. Results suggest that other factors may be more important for explaining elevated levels of aggression in ADHD.
Previous ecological momentary assessment (EMA) research in children has suggested that emotional dysregulation problems are commonly associated with ADHD symptoms and may help explain their relatively strong co-occurrence with anxiety and depression (collectively referred to as ‘internalising problems’); however, this has yet to be replicated for adults. In this study, we used data from a n=260 longitudinal cohort and EMA study, to evaluate the hypothesis that emotional dysregulation mediates the association between ADHD symptoms and internalising problems in emerging adulthood. Emotional dysregulation was based on affect data collected in near real time and in ecological context over a 14-day period, providing a measure of emotional lability in the context of participants’ daily lives. Cross-sectional mediation was tested using structural equation modelling. Emotional lability significantly mediated the association between ADHD symptoms and internalising problems. Results suggest that interventions that address the emotional dysregulation aspects of ADHD are likely to be beneficial for preventing and managing secondary internalising symptoms.
Several structural equation modeling (SEM) strategies were developed for assessing measurement invariance (MI) across groups relaxing the assumptions of strict MI to partial, approximate, and partial approximate MI. Nonetheless, applied researchers still do not know if and under what conditions these strategies might provide results that allow for valid comparisons across groups in large-scale comparative surveys. We perform a comprehensive Monte Carlo simulation study to assess the conditions under which various SEM methods are appropriate to estimate latent means and path coefficients and their differences across groups. We find that while SEM path coefficients are relatively robust to violations of full MI and can be rather effectively recovered, recovering latent means and their group rankings might be difficult. Our results suggest that, contrary to some previous recommendations, partial invariance may rather effectively recover both path coefficients and latent means even when the majority of items are noninvariant. Although it is more difficult to recover latent means using approximate and partial approximate MI methods, it is possible under specific conditions and using appropriate models. These models also have the advantage of providing accurate standard errors. Alignment is recommended for recovering latent means in cases where there are only a few noninvariant parameters across groups.
The aim of the study is to explore the impact of Generalized Anxiety Disorder (GAD) comorbidity in children with Attention Deficit Hyperactivity Disorder (ADHD). Six hundred children with ADHD (mean age = 9.12 years), recruited from 2013 to 2017, participated in the study. A total of 96 (16%) children with ADHD displayed a comorbidity with GAD. ADHD + GAD were compared to 504 ADHD children without GAD in terms of cognitive and psychiatric profile, ADHD subtype and family psychiatric history. The ADHD + GAD, predominantly represented from ADHD combined (72.6%), displayed higher psychiatry comorbidity, in particular with depressive disorders, and were associated with higher rates of maternal depression, of ADHD in fathers, and bipolar disorders in second degree relatives. Moreover, younger preschool-primary school age children with ADHD + GAD showed significant higher frequency of depressive disorders versus younger preschool-primary children with ADHD without GAD. ADHD + GAD comorbidity represents a more complex clinical condition compared to ADHD without GAD, characterized by the higher frequency of multiple comorbidities and by a psychiatric family with higher rates of mood and disruptive disorders.
Due to its consistent association with a wide range of criminal and deviant outcomes, low self-control (LSC) has become among the most extensively measured concepts in criminology. Conversely, attention deficit hyperactivity disorder (ADHD), the most commonly diagnosed of mental illnesses in young people has not received similar attention despite what appears to be a close conceptual association with LSC. Using data from a sample of students at a medium-sized southwestern university, we analyze the association between LSC and ADHD in predicting a range of criminal and deviant behaviors. Findings indicate an association between the two concepts and that they predicted offending in similar ways, but that the precise nature of the relationship between LSC and ADHD remains uncertain.
Both anxiety and aggression commonly co-occur with ADHD symptoms. Two competing hypotheses describing the role of anxiety in aggression associated with ADHD symptoms have previously been advanced. The exacerbation hypothesis proposes that the presence of anxiety increases the risk of aggression in the context of ADHD symptoms. The attenuation hypothesis proposes that the presence of anxiety protects against aggression in the context of ADHD symptoms. We tested these hypotheses using moderated cross-lagged panel models in the Zurich project on social development from childhood to adulthood (z-proso) sample using both self-report (3 waves) and informant-report (8 waves) data spanning ages 7-17. We found evidence that anxiety protects against both reactive and proactive aggression; however, the effect was direct: there was no evidence for anxiety moderating the strength of ADHD symptom-aggression links. Results suggest that anxiety likely plays an important role in inhibiting aggression but does not interact with ADHD symptoms in the manner predicted by either the exacerbation or attenuation hypothesis.
Objectives
It is well‐known that in cross‐sectional analyses, agreement between informants is modest as best when rating attention‐deficit/hyperactivity disorder and other disruptive behaviour disorder symptoms. We here aimed to develop recommendations for the use of multi‐informant data in the context of longitudinal developmental analyses that examine symptom trajectories over time.
Method
Using parallel process modelling, we estimated parent–teacher agreement in inattention and hyperactivity/impulsivity symptom initial levels and slopes across the elementary school years (ages 7, 9, and 11) for a community sample of n = 1,388 youth. We also used these models to examine whether initial levels and slopes differed significantly across informants.
Results
Informant agreement was low to moderate and higher for inattention slopes (r = .47) than for hyperactivity/impulsivity slopes (r = .23). Parents and teachers reported opposite developmental trends for inattention with teachers reporting declines and parents reporting increases over time. Parents reported overall higher levels of hyperactivity/impulsivity, but there were no average informant differences in slopes.
Conclusion
Of the options available, we recommend specifying separate but correlated factors for different informants in developmental analyses of attention‐deficit/hyperactivity disorder. This can be achieved within latent growth curve and growth mixture models.
Importance:
Recognition that adult attention-deficit/hyperactivity disorder (ADHD) is common, seriously impairing, and usually undiagnosed has led to the development of adult ADHD screening scales for use in community, workplace, and primary care settings. However, these scales are all calibrated to DSM-IV criteria, which are narrower than the recently developed DSM-5 criteria.
Objectives:
To update for DSM-5 criteria and improve the operating characteristics of the widely used World Health Organization Adult ADHD Self-Report Scale (ASRS) for screening.
Design, setting, and participants:
Probability subsamples of participants in 2 general population surveys (2001-2003 household survey [n = 119] and 2004-2005 managed care subscriber survey [n = 218]) who completed the full 29-question self-report ASRS, with both subsamples over-sampling ASRS-screened positives, were blindly administered a semistructured research diagnostic interview for DSM-5 adult ADHD. In 2016, the Risk-Calibrated Supersparse Linear Integer Model, a novel machine-learning algorithm designed to create screening scales with optimal integer weights and limited numbers of screening questions, was applied to the pooled data to create a DSM-5 version of the ASRS screening scale. The accuracy of the new scale was then confirmed in an independent 2011-2012 clinical sample of patients seeking evaluation at the New York University Langone Medical Center Adult ADHD Program (NYU Langone) and 2015-2016 primary care controls (n = 300). Data analysis was conducted from April 4, 2016, to September 22, 2016.
Main outcomes and measures:
The sensitivity, specificity, area under the curve (AUC), and positive predictive value (PPV) of the revised ASRS.
Results:
Of the total 637 participants, 44 (37.0%) household survey respondents, 51 (23.4%) managed care respondents, and 173 (57.7%) NYU Langone respondents met DSM-5 criteria for adult ADHD in the semistructured diagnostic interview. Of the respondents who met DSM-5 criteria for adult ADHD, 123 were male (45.9%); mean (SD) age was 33.1 (11.4) years. A 6-question screening scale was found to be optimal in distinguishing cases from noncases in the first 2 samples. Operating characteristics were excellent at the diagnostic threshold in the weighted (to the 8.2% DSM-5/Adult ADHD Clinical Diagnostic Scale population prevalence) data (sensitivity, 91.4%; specificity, 96.0%; AUC, 0.94; PPV, 67.3%). Operating characteristics were similar despite a much higher prevalence (57.7%) when the scale was applied to the NYU Langone clinical sample (sensitivity, 91.9%; specificity, 74.0%; AUC, 0.83; PPV, 82.8%).
Conclusions and relevance:
The new ADHD screening scale is short, easily scored, detects the vast majority of general population cases at a threshold that also has high specificity and PPV, and could be used as a screening tool in specialty treatment settings.
Violent ideations occur more frequently in individuals with mental health problems. They may be of interest in clinical contexts as possible indicators of dangerousness, as corollaries of mental health problems, as candidate treatment targets and as potentially playing a role in perpetuation or onset of symptoms. In spite of their relevance to mental health, some fundamental questions about their place within the broader landscape of mental health problems remain unanswered. To provide a basic characterisation of the relations between violent ideations and dimensions of mental health and provide a foundation for future research in this area we factor analysed a measure of violent ideations and an omnibus measure of mental health dimensions in a normative sample of 1306 youth (at age 17). Results supported a separate dimension of violent ideations with a small to moderate correlation with five other dimensions of mental health: internalising, prosociality, ADHD, indirect/proactive aggression, and physical/reactive aggression. Controlling for comorbidity among mental health dimensions, all but ADHD had unique relations with violent ideations. This suggests that violent ideations are potentially of broad relevance to mental health and related behaviours and there should be a greater research effort aimed at understanding their possible role in mental health.
Certain characteristics of attention-deficit/hyperactivity disorder (ADHD) in children have long been known to differ by gender. What has not been as widely studied is whether gender is similarly associated with ADHD differences in adults. In this review, the relation between gender and adult ADHD prevalence, persistence, impairment, comorbidity, cognitive functioning, and treatment response was examined across 73 studies. Although gender was related to several characteristics and correlates of adult ADHD, it appeared that many of these gender differences may be at least be partially attributed to methodological artifacts or social and cultural influences, rather than fundamental differences in the expression of ADHD in men and women. We highlight how understanding the nature of the relation between gender and ADHD across the lifespan is complicated by a number of methodological difficulties, and offer recommendations for how emerging research and clinical practice can better incorporate gender into the conceptualization of ADHD in adulthood.
Copyright © 2014 Elsevier Ltd. All rights reserved.
In latent growth modeling, measurement invariance across groups has received little attention. Considering that a group difference is commonly of interest in social science, a Monte Carlo study explored the performance of multigroup second-order latent growth modeling (MSLGM) in testing measurement invariance. True positive and false positive rates in detecting noninvariance across groups in addition to bias estimates of major MSLGM parameters were investigated. Simulation results support the suitability of MSLGM for measurement invariance testing when either forward or iterative likelihood ratio procedure is applied.
Objective:
Clinically, attention-deficit/hyperactivity disorder (ADHD) is characterized by hyperactivity, impulsivity, and inattention and is among the most common childhood disorders. These same traits that define ADHD are variable in the general population, and the clinical diagnosis may represent the extreme end of a continuous distribution of inattentive and hyperactive behaviors. This hypothesis can be tested by assessing the predictive value of polygenic risk scores derived from a discovery sample of ADHD patients in a target sample from the general population with continuous scores of inattention and hyperactivity. In addition, the genetic overlap between ADHD and continuous ADHD scores can be tested across rater and age.
Method:
The Psychiatric Genomics Consortium has performed the largest genome-wide analysis (GWA) study of ADHD so far, including 5,621 clinical patients and 13,589 controls. The effects sizes of single nucleotide polymorphisms (SNPs) estimated in this meta-analysis were used to obtain individual polygenic risk scores in an independent population-based cohort of 2,437 children from the Netherlands Twin Register. The variance explained in Attention Problems scale scores by the polygenic risk scores was estimated by linear mixed modeling.
Results:
The ADHD polygenic risk scores significantly predicted both parent and teacher ratings of attention problems in preschool and school-age children.
Conclusion:
These results indicate genetic overlap between a diagnosis of ADHD and Attention Problems scale scores across raters and age groups and provides evidence for a dimensional model of ADHD. Future GWA studies on ADHD can likely benefit from the inclusion of population-based cohorts and the analysis of continuous scores.
Some consider responding to survey questions as a sophisticated cognitive process whereby respondents go through, often iterative, steps to process the information provided to them by questions and response options. Others focus more on the interplay between questions and answers as a complex communication process between researchers and respondents, their assumptions, expectations and perceptions. In this article, cognitive and communication research is reviewed that has tested the impact of different question and answer alternatives on the responses obtained. This leads to evidence-based recommendations for market researchers, who frequently have to make decisions regarding various aspects of questionnaire design such as question length and order, question wording, as well as the optimal number of response options and the desirability or otherwise of a ‘don't know’ option or a middle alternative.
SUMMARY When making sampling distribution inferences about the parameter of the data, θ, it is appropriate to ignore the process
that causes missing data if the missing data are ‘missing at random’ and the observed data are ‘observed at random’, but these
inferences are generally conditional on the observed pattern of missing data. When making direct-likelihood or Bayesian inferences
about θ, it is appropriate to ignore the process that causes missing data if the missing data are missing at random and the
parameter of the missing data process is ‘distinct’ from θ. These conditions are the weakest general conditions under which
ignoring the process that causes missing data always leads to correct inferences.
Age is one of the most robust correlates of criminal behavior. Yet, explanations for this relationship are varied and conflicting. Developmental theories point to a multitude of sociological, psychological, and biological changes that occur during adolescence and adulthood. One prominent criminological perspective outlined by Gottfredson and Hirschi claims that age has a direct effect on crime, inexplicable from sociological and psychological variables. Despite the attention this claim has received, few direct empirical tests of it have been conducted. We use data from Pathways to Desistance, a longitudinal study of over 1,300 serious youthful offenders (85.8 % male, 40.1 % African-American, 34.3 % Hispanic, 21.0 % White), to test this claim. On average, youths were 16.5 years old at the initial interview and were followed for 7 years. We use multilevel longitudinal models to assess the extent to which the direct effects of age are reduced to statistical and substantive non-significance when constructs from a wide range of developmental and criminological theories are controlled. Unlike previous studies, we are able to control for changes across numerous realms emphasized within differing theoretical perspectives including social control (e.g., employment and marriage), procedural justice (e.g., perceptions of the legitimacy and fairness of the legal system), learning (e.g., gang membership and exposure to antisocial peers), strain (e.g., victimization and relationship breakup), psychosocial maturity (e.g., impulse control, self-regulation and moral disengagement), and rational choice (e.g., costs and rewards of crime). Assessed separately, these perspectives explain anywhere from 3 % (procedural justice) to 49 % (social learning) of the age-crime relationship. Together, changes in these constructs explain 69 % of the drop in crime from ages 15 to 25. We conclude that the relationship between age and crime in adolescence and early adulthood is largely explainable, though not entirely, attributable to multiple co-occurring developmental changes.
Two Monte Carlo studies were conducted to examine the sensitivity of goodness of fit indexes to lack of measurement invariance at 3 commonly tested levels: factor loadings, intercepts, and residual variances. Standardized root mean square residual (SRMR) appears to be more sensitive to lack of invariance in factor loadings than in intercepts or residual variances. Comparative fit index (CFI) and root mean square error of approximation (RMSEA) appear to be equally sensitive to all 3 types of lack of invariance. The most intriguing finding is that changes in fit statistics are affected by the interaction between the pattern of invariance and the proportion of invariant items: when the pattern of lack of invariance is uniform, the relation is nonmonotonic, whereas when the pattern of lack of invariance is mixed, the relation is monotonic. Unequal sample sizes affect changes across all 3 levels of invariance: Changes are bigger when sample sizes are equal rather than when they are unequal. Cutoff points for testing invariance at different levels are recommended.
Favorable evidence on the validity of the Grasmick et al. (1993) self-control scale has been reported in studies using general population samples. However, the scale has never been tested among persons extensively involved in crime. We assessed the construct validity of this scale, slightly revised, in a heterogeneous sample of drug-using criminal offenders. Factor analyses identified five subscales, mostly congruent with existing formulations of the self-control construct. Also, recent crimes of force and fraud were more frequent among people scoring lower on self-control. However, the five-factor solution was not tenable among women, and the scale was no more closely related to crime than were three subscales representing more specific constructs already established in criminology.
Gottfredson and Hirschi'sA General Theory of Crime contends that individual differences in involvement in criminal and analogous behavior are due largely to individual differences in the personality trait they call low self-control. Among the various behaviors considered analogous to crime are imprudent behaviors such as smoking, drinking, and gambling. This research explores the generality of Gottfredson and Hirschi's theory by examining the link between low self-control and these imprudent behaviors. The results are mixed. In support of the theory, the data reveal a modest but significant effect of a scale designed to capture the various components of low self-control on an index of imprudent behavior. A more detailed analysis, however, reveals that some of the components of low self-control, specifically those probably linked to low intelligence, detract from the scale's predictive power. In fact, one of the components, risk-seeking, is more predictive than the more inclusive scale. Furthermore, one of the imprudent acts, smoking, appears to be unaffected by low self-control. These contradictory findings suggest the need for theoretical refinements.
The German version of the Conners Adult ADHD Rating Scales (CAARS) has proven to show very high model fit in confirmative factor analyses with the established factors inattention/memory problems, hyperactivity/restlessness, impulsivity/emotional lability, and problems with self-concept in both large healthy control and ADHD patient samples. This study now presents data on the psychometric properties of the German CAARS-self-report (CAARS-S) and observer-report (CAARS-O) questionnaires.
CAARS-S/O and questions on sociodemographic variables were filled out by 466 patients with ADHD, 847 healthy control subjects that already participated in two prior studies, and a total of 896 observer data sets were available. Cronbach's-alpha was calculated to obtain internal reliability coefficients. Pearson correlations were performed to assess test-retest reliability, and concurrent, criterion, and discriminant validity. Receiver Operating Characteristics (ROC-analyses) were used to establish sensitivity and specificity for all subscales.
Coefficient alphas ranged from .74 to .95, and test-retest reliability from .85 to .92 for the CAARS-S, and from .65 to .85 for the CAARS-O. All CAARS subscales, except problems with self-concept correlated significantly with the Barrett Impulsiveness Scale (BIS), but not with the Wender Utah Rating Scale (WURS). Criterion validity was established with ADHD subtype and diagnosis based on DSM-IV criteria. Sensitivity and specificity were high for all four subscales.
The reported results confirm our previous study and show that the German CAARS-S/O do indeed represent a reliable and cross-culturally valid measure of current ADHD symptoms in adults.
Charting change in behavior as a function of age and investigating longitudinal relations among constructs are primary goals of developmental research. Traditionally, researchers rely on a single measure (e.g., scale score) for a given construct for each person at each occasion of measurement, assuming that measure reflects the same construct at each occasion. With multiple indicators of a latent construct at each time of measurement, the researcher can evaluate whether factorial invariance holds. If factorial invariance constraints are satisfied, latent variable scores at each time of measurement are on the same metric and stronger conclusions are warranted. In this paper we discuss factorial invariance in longitudinal studies, contrasting analytic approaches and highlighting strengths of the multiple-indicator approach to modeling developmental processes.