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

Defining ADHD symptom persistence in adulthood: optimizing sensitivity and specificity.

Author information

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

PMID:
27642116
PMCID:
PMC5809153
DOI:
10.1111/jcpp.12620
[Indexed for MEDLINE]
Free PMC Article

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