Reliability and Validity of Self- and Other-Ratings of Symptoms of ADHD in Adults

ArticleinJournal of Attention Disorders 15(3):224-34 · April 2011with18 Reads
DOI: 10.1177/1087054709356163 · Source: PubMed
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.
    • "Given the relative dearth of well-validated diagnostic instruments for assessing ADHD in outpatient psychiatric samples, practitioners and researchers have largely relied on self-and observer-rated survey measures, such as the Conners Adult ADHD Rating Scale (CAARS; Conners et al., 1999) and the Adult ADHD Self-Report Scale (ASRS; Kessler et al., 2005 ). These measures typically show acceptable to good reliability and convergent validity, but they lack sufficient specificity to be used as diagnostic instruments (e.g., Barkley et al., 2008; McCann and Roy-Byrne, 2004; Van Voorhees et al., 2011). This is not surprising given that many psychiatric disorders include impaired concentration and/or impulsive , disinhibited behavior among their presenting symptoms, so merely summing up the items endorsed on a survey measure is not likely to yield a well-differentiated diagnostic impression. "
    [Show abstract] [Hide abstract] ABSTRACT: Objective: Despite growing recognition that Attention Deficit/Hyperactivity Disorder (ADHD) is a highly prevalent, impairing, and comorbid disorder that persists into adulthood, reports on the nature and extent of its psychiatric comorbidities have been mixed to date. This study compared the prevalence rates of all major Axis I disorders as well as borderline personality disorder in an unselected sample of adult psychiatric outpatients with and without ADHD. Methods: As part of the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) project, we administered a DSM-IV-based semi-structured diagnostic interview assessing ADHD and other psychiatric disorders to 1,134 patients presenting for initial evaluation at an outpatient psychiatric practice. Logistic regression analyses were used to compare the rates of each disorder in patients with versus without an ADHD diagnosis (both overall and by Combined and Inattentive type). Results: Patients with (versus without) any ADHD diagnosis had significantly higher rates of bipolar disorder, social phobia, impulse control disorders, eating disorders, and BPD, and significantly lower rates of major depressive disorder and adjustment disorder (all p<.05). Patients with (versus without) ADHD-Inattentive type had significantly higher rates of social phobia and eating disorders, whereas those with (versus without) the ADHD-Combined type had significantly higher rates of bipolar disorder, alcohol dependence, and BPD (all p<.05). Conclusion: In this novel investigation of the psychiatric profiles of an unselected sample of treatment-seeking adult outpatients with versus without ADHD, a distinct pattern of comorbidities emerged across subtypes, with implications for the accurate assessment and treatment of patients presenting for psychiatric care.
    Full-text · Article · Jun 2016
    • "In addition, Katz, Wood, Goldstein, Auchenbach, and Geckle (1998) found a low overall classification rate when trying to discriminate between adults with ADHD and adults with depression, although in their study, it was the specificity that was particularly low (.40). Low overall classification rates have also been found in studies comparing adults with ADHD and psychiatric controls using questionnaire data measuring functions such as attention and memory (Solanto, Etefia, & Marks, 2004; Voorhees, Hardy, & Kollins, 2011). Finally, there is one study (Kovner et al., 1998) that stands out from the rest by demonstrating a very high overall classification rate (> 90%), but these findings must be interpreted with care due to the very small sample size used. "
    [Show abstract] [Hide abstract] ABSTRACT: Objective: The aim was to investigate how well neuropsychological measures can discriminate between adults with ADHD and those with other psychiatric disorders. Method: Adults with ADHD and a clinical control group (n = 110) were included. Neuropsychological functioning was investigated using measures of inhibition, working memory, set shifting, planning, fluency, reaction-time variability, and delay aversion. Results: Adults with ADHD performed more poorly compared with clinical controls with regard to all constructs. The effects of verbal memory, inhibition, set shifting, fluency, and delay aversion remained significant when controlling for IQ. However, when controlling for basic cognitive functions, only the effects of inhibition, fluency, and delay aversion were significant. Sensitivity ranged between 64% and 75%, and specificity between 66% and 81%. Conclusion: Neuropsychological tests have a relatively poor ability to discriminate between adults with ADHD and clinical controls, but they may be used to identify individuals at particularly high risk for poor daily functioning. (J. of Att. Dis. XXXX; XX(X) XX-XX).
    Full-text · Article · Oct 2013
    • "Internal consistency for the ADHD-RS items in this sample was very good (α's ranged from 0.90 to 0.95 for the current and retrospective scales). In general, self-reported ADHD symptoms on questionnaires are correlated with collateral reports and diagnostic interviews (Belendiuk et al. 2007; Van Voorhees et al. 2011). Finally, a modified version of the DISC-IVADHD module (NIMH 1997) was administered to the clinical group. "
    [Show abstract] [Hide abstract] ABSTRACT: Recent reviews argue that emotion dysregulation is an important feature of attention-deficit/hyperactivity disorder (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 hyperactivityimpulsivity) and emotional impulsivity is mediated by emotion dysregulation symptoms. A group of adults with (n0 18) and without (n023) 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.
    Full-text · Article · Dec 2012
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