ADHD in a representative sample of the Brazilian population: estimated prevalence and comparative adequacy of criteria between adolescents and adults according to the item response theory

Abstract

Background: Attention deficit hyperactivity disorder (ADHD) is a clinically significant disorder in adulthood, but current diagnostic criteria and instruments do not seem to adequately capture the complexity of the disorder in this developmental phase. Accordingly, there are limited data on the proportion of adults affected by the disorder, specially in developing countries. Method: We assessed a representative household sample of the Brazilian population for ADHD with the Adult ADHD Self-report Scale (ASRS) Screener, and evaluated the instrument according to the Rasch model of item response theory. Results: The sample was comprised by 3007 individuals, and the overal prevalence of positive screeners for ADHD was 5.8% [95% confidence interval (CI), 4.8-7.0]. Rasch analyses revealed the misfitt of the overall sample to expectations of the model. The evaluation of the sample stratified by age revealed that data for adolescents showed a signficant fittnes to the model expectations, while items completed by adults were not adequated. Conclusions:The lack of fitness to the model for adult respondents challenges the possibility of a linear transformation of the ordinal data into interval measures and the utilization of parametric analyses of data. This result suggests that diagnostic criteria and instruments for adult ADHD must take into account a

Lisdexamfetamine dimesylate in the treatment of attention-deficit/hyperactivity disorder: pharmacokinetics, efficacy and safety in children and adolescents

“…In studies in Brazil, the estimates of ADHD prevalence in children and adolescents range from 5.8% to 19.9%, and vary depending on the diagnostic criteria used and the type of sample analyzed [8][9][10][11] . ADHD often persists beyond adolescence into adulthood, although the presentation of symptoms differs between adults, children, and adolescents 12 .…”

Attention deficit hyperactivity disorder and intellectual giftedness: a study of symptom frequency and minor physical anomalies

“…The ASRS scale is a widely standardized tool that has been used in large population studies in the U.S. 30 and Brazil. 31 Version 1.1 is composed of 18 questions, nine referring to inattention and the reminder to hyperactivity-impulsivity (HI). We used three criteria to determine ADHD cases (research screening diagnosis) and calculate the positive case frequency: first, according to Kessler et al, 29 scores above 24 (range, 0-72) are indicative of ADHD, but this symptomatic threshold has not been widely validated.…”

Uso prescrito de cloridrato de metilfenidato e correlatos entre estudantes universitários brasileiros

“…Essa prevalência é menor que aquela de 6% identificada entre adultos de 18 a 44 anos da população geral brasileira 22 . Entretanto, o resultado descrito a essa amostra populacional de universitários brasileiros aproxima-se do divulgado pela pesquisa São Paulo Megacity Mental Health Survey, que identificou que 0,9% da população da cidade de São Paulo tinha alguma sintomatologia para TDAH 23 .…”

“…Ainda, estima-se que 10% a 30% deles tenham algum transtorno associado ao uso de substâncias como comorbidade psiquiátrica, incluindo abuso e dependência de álcool e/ou de outras substâncias. No Brasil, estima-se que 30% dos sujeitos com transtornos relacionados ao uso de substâncias apresentem comorbidade com TDAH, uma taxa significativamente maior que a relatada para a população geral brasileira 22 .…”

“…Finalmente, em linhas gerais, os dados desse manuscrito demonstram uma prevalência de uso de MPH muito semelhante à ocorrência de TDAH na população brasileira e especificamente da cidade de São Paulo 22,23 . Nesse sentido, torna-se mandatória a pesquisa e o tratamento dos transtornos relacionados ao uso de substâncias entre universitários com sintomas de hiperatividade e/ou desatenção e vice-versa.…”