The structure of adult ADHD

Abstract

Although DSM-5 stipulates that symptoms of attention-deficit/hyperactivity disorder (ADHD) are the same for adults as children, clinical observations suggest that adults have more diverse deficits than children in higher-level executive functioning and emotional control. Previous psychometric analyses to evaluate these observations have been limited in ways addressed in the current study, which analyzes the structure of an expanded set of adult ADHD symptoms in 3 pooled U.S. samples: a national household sample, a sample of health plan members, and a sample of adults referred for evaluation at an adult ADHD clinic. Exploratory factor analysis found 4 factors representing executive dysfunction/inattention (including, but not limited to, all the DSM-5 inattentive symptoms, with non-DSM symptoms having factor loadings comparable to those of DSM symptoms), hyperactivity, impulsivity, and emotional dyscontrol. Empirically-derived multivariate symptom profiles were broadly consistent with the DSM-5 inattentive-only, hyperactive/impulsive-only, and combined presentations, but with inattention including executive dysfunction/inattention and hyperactivity-only limited to hyperactivity without high symptoms of HHS Public Access Author Manuscript Author ManuscriptAuthor Manuscript Author Manuscriptimpulsivity. These results show that executive dysfunction is as central as DSM-5 symptoms to adult ADHD, while emotional dyscontrol is more distinct but prominent resent in the combined presentation of adult ADHD. Keywordsadults; ADHD; attention-deficit hyperactivity disorder; epidemiology Adult Attention Deficit Hyperactivity Disorder (ADHD) is a commonly-occurring childhood-onset disorder that often persists into adulthood (Kessler et al., 2006). Although DSM-5 requires fewer symptoms among adults than children (American Psychiatric Association., 2013), the symptoms are stipulated to be the same for adults as children despite the fact that clinical observations suggest that the frank hyperactivity of childhood ADHD manifests more as a sense of internal restlessness among adults (Adler and Cohen, 2004) and that adults have a more diverse set of deficits than children in higher-level executive functioning and emotional control (Barkley et al., 2008; Faraone et al., 2010;Surman et al., 2011;Ward et al., 1993).A number of researchers have attempted to confirm these clinical observations by developing expanded assessments that include deficits in executive functioning and in emotional control along with the DSM symptoms of inattention (AD) and hyperactivityimpulsivity (HD) and carrying out exploratory factor analyses of this expanded symptom set among patients with ADHD and controls (Amador-Campos et al., 2014;Christiansen et al., 2011;Conners et al., 1999; Kessler et al., 2010; Marchant et al., 2013; Marchant et al., 2015). These studies have found a 2-factor structure in studies of the clinician-administered Wender-Reimherr Adult Attention Deficit Disorder Scale (WRAADDS) (Marchant et al., 2013) and the self-report ...

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