Defining ADHD symptom persistence in adulthood: optimizing sensitivity and specificity

Margaret H Sibley; James M Swanson; L Eugene Arnold; Lily T Hechtman; Elizabeth B Owens; Annamarie Stehli; Howard Abikoff; Stephen P Hinshaw; Brooke S G Molina; John T Mitchell; Peter S Jensen; Andrea L Howard; Kimberley D Lakes; William E Pelham; MTA Cooperative Group

doi:10.1111/jcpp.12620

Defining ADHD symptom persistence in adulthood: optimizing sensitivity and specificity

J Child Psychol Psychiatry. 2017 Jun;58(6):655-662. doi: 10.1111/jcpp.12620. Epub 2016 Sep 19.

Authors

Collaborators

Affiliations

¹ Department of Psychiatry & Behavioral Health, Florida International University, Miami, FL, USA.
² Child Development Center, School of Medicine, University of California, Irvine, CA, USA.
³ Department of Psychiatry, Nisonger Center, Ohio State University, Columbus, OH, USA.
⁴ Division of Child Psychiatry, Montreal Children's Hospital, McGill University, Montreal, QC, Canada.
⁵ Institute of Human Development, University of California, Berkeley, CA, USA.
⁶ Department of Pediatrics, University of California, Irvine, CA, USA.
⁷ Child Study Center at New York University Langone Medical Center, New York, NY, USA.
⁸ Department of Psychology, University of California, Berkeley, CA, USA.
⁹ Departments of Psychiatry and Psychology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
¹⁰ Department of Psychiatry & Behavioral Sciences, Duke University Medical Center, Durham, NC, USA.
¹¹ The REACH Institute, New York, NY, USA.
¹² Department of Psychology, Carleton University, Ottawa, ON, Canada.
¹³ Department of Psychology, Florida International University, Miami, FL, USA.

Abstract

Objective: Longitudinal studies of children diagnosed with ADHD report widely ranging ADHD persistence rates in adulthood (5-75%). This study documents how information source (parent vs. self-report), method (rating scale vs. interview), and symptom threshold (DSM vs. norm-based) influence reported ADHD persistence rates in adulthood.

Method: Five hundred seventy-nine children were diagnosed with DSM-IV ADHD-Combined Type at baseline (ages 7.0-9.9 years) 289 classmates served as a local normative comparison group (LNCG), 476 and 241 of whom respectively were evaluated in adulthood (Mean Age = 24.7). Parent and self-reports of symptoms and impairment on rating scales and structured interviews were used to investigate ADHD persistence in adulthood.

Results: Persistence rates were higher when using parent rather than self-reports, structured interviews rather than rating scales (for self-report but not parent report), and a norm-based (NB) threshold of 4 symptoms rather than DSM criteria. Receiver-Operating Characteristics (ROC) analyses revealed that sensitivity and specificity were optimized by combining parent and self-reports on a rating scale and applying a NB threshold.

Conclusion: The interview format optimizes young adult self-reporting when parent reports are not available. However, the combination of parent and self-reports from rating scales, using an 'or' rule and a NB threshold optimized the balance between sensitivity and specificity. With this definition, 60% of the ADHD group demonstrated symptom persistence and 41% met both symptom and impairment criteria in adulthood.

Keywords: Adult ADHD; DSM-5; diagnosis.

MeSH terms

Adult
Attention Deficit Disorder with Hyperactivity / diagnosis*
Attention Deficit Disorder with Hyperactivity / epidemiology*
Child
Humans
Interview, Psychological / standards*
Longitudinal Studies
Parents*
Prevalence
Psychiatric Status Rating Scales / standards*
Self Report / standards*
Sensitivity and Specificity
Young Adult

Abstract

MeSH terms

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