ADHS-Diagnose bei Erwachsenen

Abstract

We report on a study comparing different systems for the diagnosis of attention deficit hyperactivity disorder (ADHD) in adulthood. Recruited for evaluation were 168 patients referred to our ADHD outpatient unit. We used the Diagnostic and Statistical Manual of Mental Disorders 4th edn. (DSM-IV), International Classification of Diseases 10th edn. (ICD-10), and Utah criteria for diagnostic assessment and the Wender Utah rating scale, ADHD Self Report (ADHD-SR), and Wender Reimherr Adult Attention Deficit Disorder Rating Scale as psychopathological assessment tools. We present basic psychometric data of the Wender-Reimherr Interview (WRI). Internal consistency was determined as 0.82 (alpha). The inter-rater reliability was 1.0 (kappa coefficient) regarding ADHD diagnoses, and the ICC was 0.98 referring to the WRI total scores. The convergent validity with the ADHD-SR was 0.65 (Spearman coefficient). In 126 of 168 patients an ADHD diagnosis was made according to at least one of the three systems. The DSM-IV diagnostic set led to 119 ADHD diagnoses. As compared with the two other systems, this is about the minimum level for an ADHD diagnosis. All of the 87 ADHD diagnoses according to ICD-10 were covered by DSM-IV. The ICD-10 had no independent psychopathological items and therefore offered no additional points for the diagnostic procedure than the DSM-IV. The situation regarding Utah criteria is different. These criteria contain seven psychopathological domains: inattention, hyperactivity, disorganisation, impulsivity, affective lability, overreactivity, and hot temper. They can be assessed by use of the WRI. Ninety-three of 168 patients were diagnosed as having ADHD according to the Utah concept, which is much lower than with the DSM-IV. The particular definition of the disorder by the Utah criteria resulted in seven patients having only a Utah diagnosis but no DSM-IV diagnosis. Thus we are in a position to say that the Utah criteria have a relatively high level for making an ADHD diagnosis but in certain cases move beyond the DSM-IV. Of the patients 56% had ADHD diagnoses according to all three classification instruments. Examining the factor structure of the ADHD psychopathology represented by seven WRI and three ADHD-SR subscales, we found a two-factor solution explaining for 63% of the variance. Factor 1 was designated by impulsivity, affective lability, hyperactivity, and hot temper; factor 2 consisted of inattention, disorganisation, and overreactivity.

Impulsivity and Aggression in Female BPD and ADHD Patients: Association with ACC Glutamate and GABA Concentrations

“…Inclusion criteria for the BPD group were at least five DSM-IV criteria for BPD (APA, 2000). For exclusion of ADHD diagnosis in BPD patients, three different measurements were applied: (1) the short version of the Wender Utah Rating Scale (WURS-k (Retz-Junginger et al, 2003)) to assess childhood ADHD symptoms; (2) the Connor Adult ADHD Rating Scale (Conners et al, 2002) was used, based on the DSM-IV criteria for ADHD (APA, 2000); (3) the Wender-Reimherr Adult Attention Deficit Disorder Scale (Rösler et al, 2008), which is a clinical interview conceptualized for adult ADHD. For the ADHD group, the same measurements were applied and BPD diagnosis was excluded via the IPDE.…”

Anger and aggression in borderline personality disorder and attention deficit hyperactivity disorder – does stress matter?

“…Furthermore, 4) the Wender-Reimherr Adult Attention Deficit Disorder Scale (WRAADDS; [59]) was applied, which is a clinical interview conceptualized for adult ADHD to assess the core features of inattention, hyperactivity and impulsivity, and additional features comprising temperament, affective lability, stress tolerance and disorganization. Experienced clinical psychologists and psychiatrists clarified possible inconsistencies in the self-measurements by the WRAADDS [59] and integrated external assessments (e.g. school reports, interviews with parents or relatives) to reach the diagnosis of ADHD.…”

Gender differences in self- and investigator-rated psychopathology in adult attention-deficit/hyperactivity disorder

“…It has been designed as a semi-standardized interview based on the Utah criteria for adult ADHD (Wender 1995;Rösler et al 2008) and consists of 28 items, which are rated 0 (none or slight), 1 (somewhat or sometimes true), or 2 (very true or often true), resulting in a maximum score of 56. The instrument comprises 7 psychopathological domains, including ''attention difficulties'', ''hyperactivity/restlessness'', ''temper'', ''mood instability'', ''over reactivity'', ''disorganization'', and ''impulsivity''.…”

“…Psychiatric diagnoses of ADHD and SUD based on clinical interview and examination. Diagnosis of ADHD was performed according to DSM-IV criteria and using standardized instruments (ADHS-SB, Rösler et al 2008). Each subject of the ADHD group had a clinical diagnosis of childhood-onset ADHD confirmed by the German short version of the Wender Utah Rating Scale (WURS-k, Retz-Junginger et al 2002, 2003.…”

“…Utah criteria for ADHD were assessed with the German version of the WRAADDS (Wender-Reimherr Interview-WRI; Rösler et al 2008). This interview was performed with a subgroup of the entire sample, which consisted of 113 male and 58 female ADHD patients and 243 male and 53 female healthy controls.…”