Unpicking assessment for Adult ADHD

Last updated 15 December 2023

Variability in assessment methods could be behind the vast range of rates given for the persistence of ADHD into adulthood – from 5% up to 75%.

To unpick this uncertainty, Margaret Sibley at Florida International University and colleagues explored the persistence rates obtained from various combinations of parent versus patient reporting, interviews versus rating scales and DSM symptom thresholds versus those that were norm-based.

The authors used data from the MTA study, a 14-month trial of 579 children with ADHD.

They found persistence rates of ADHD symptoms into adulthood of between 1.9% and 61.4%, depending on the mix of measures used.

As no ‘gold standard’ exists with which to compare their assessment approaches, the authors aimed to maximise the sensitivity – the ability of their measures to detect ADHD, and specificity – how well they avoided over-diagnosis.

They settled on an approach that included reports by parents, interviews to judge impairment, rating scales for symptoms and a threshold that took into account the individual’s earlier development.

Sibley, M. H., Swanson, J. M., Arnold, L. E., Hechtman, L. T., Owens, E. B., Stehli, A., Abikoff, H., Hinshaw, S. P., Molina, B. S.G., Mitchell, J. T., Jensen, P. S., Howard, A. L., Lakes, K. D., Pelham, W. E. and the MTA Cooperative Group (2017), Defining ADHD symptom persistence in adulthood: optimizing sensitivity and specificity. J Child Psychol Psychiatr, 58: 655–662. doi:10.1111/jcpp.12620

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