Quantitative measurement of impairment in ADHD: perspectives for research and clinical practice

Abstract

Background: Functional impairment is needed to make an attention deficit hyperactivity disorder (ADHD) diagnosis, but there is a paucity of instruments addressing this issue. Objective: Perform psychometric analysis of a functional impairment scale (FIE). Methods: A sample of 320 individuals, including ADHD probands, their siblings and parents, filled the FIE. We analyzed psychometric properties for the entire sample and age groups. Factor structure was determined by a principal component factor analysis, using oblique rotation with Kaiser normalization and Eigenvalues higher than 1. Cronbach's alpha and SpearmanBrown were calculated. Results: Family analysis revealed four components: a) "family life", b) "self-perception", c) "performance" and d) "social life". Adults' analysis revealed two components: a) "family life, social life and self-perception" and b) "performance". Children showed the domains: a) "performance and social life", b) "self-perception" and c) "family life" components. Cronbach's alpha were above 0.9 in all components. Discussion: Results revealed up to four domains depending on the group considered. Different life demands might explain the variability of domains on the groups.

By the book: ADHD prevalence in medical students varies with analogous methods of addressing DSM items

“…Impairment was assessed by clinical investigation of different areas of functioning previously shown to be impaired in similar Brazilian samples12,13 “immediately after” investigating ADHD symptoms and before investigating for comorbidities. This procedure aimed to minimize the difficult distinction between ADHD-associated impairments and those associated with highly frequent comorbid conditions; if impairment is addressed at the end of a long investigation of ADHD and comorbid disorders, patients often have difficulties in ascertaining its causes 14…”

Disregarding Impairment in ADHD Diagnosis Inflates Its Prevalence

“…However, the use of Weiss can be a challenge due to its length and copyright protection, limiting its use, especially in clinical settings and in low-income countries. To address this issue, in a previous study, our group developed a quantitative impairment scale named FIS (Fortes et al, 2014), which we applied in this study to evaluate impairment.…”

“…To address these questions, in a previous study, our group developed a quantitative impairment scale named the Functional Impairment Scale (FIS; Fortes et al, 2014). FIS is a quantitative instrument designed to elicit impairments likely to be associated with ADHD in different domains (academic performance, family life, social life, and self-perception).…”

Seeking connection, autonomy, and emotional feedback: A self-determination theory of self-regulation in attention-deficit hyperactivity disorder.

“…Developmentally, and depending on the social–cultural context, an individual with ADHD will encounter more and more task approaches that require DMN suppression and CEN activation, in other words, those that require independent management, cognitive control, and behavioral inhibition leading to an increase in symptomatic behaviors and coping mechanisms (Fleming & McMahon, 2012; Fortes et al, 2014; Knouse & Fleming, 2016; Nigg, Sibley, et al, 2020; Ramsay & Rostain, 2008b; Wender, 1995). Lack of understanding of the altered processing in ADHD results in inefficient learning (Chevrier & Schachar, 2020) and dominance of standardized reinforcement models to develop skills, habits, and routine behaviors are experienced as controlling or amotivating.…”