When diagnosing ADHD in young adults emphasize informant reports, DSM items, and impairment.

Abstract

Objective This study examined several questions about the diagnosis of attention-deficit/hyperactivity disorder (ADHD) in young adults using data from a childhood-diagnosed sample of 200 individuals with ADHD (age M = 20.20 years) and 121 demographically similar non-ADHD controls (total N = 321). Method We examined the use of self-versus informant ratings of current and childhood functioning and evaluated the diagnostic utility of adult-specific items versus items from the Diagnostic and Statistical Manuel of Mental Disorders (DSM). Results Results indicated that although a majority of young adults with a childhood diagnosis of ADHD continued to experience elevated ADHD symptoms (75%) and clinically significant impairment (60%), only 9.6%–19.7% of the childhood ADHD group continued to meet DSM–IV–TR (DSM, 4th ed., text rev.) criteria for ADHD in young adulthood. Parent report was more diagnostically sensitive than self-report. Young adults with ADHD tended to underreport current symptoms, while young adults without ADHD tended to overreport symptoms. There was no significant incremental benefit beyond parent report alone to combining self-report with parent report. Non-DSM-based, adult-specific symptoms of ADHD were significantly correlated with functional impairment and endorsed at slightly higher rates than the DSM-IV-TR symptoms. However, DSM-IV-TR items tended to be more predictive of diagnostic group membership than the non-DSM adult-specific items due to elevated control group item endorsement. Conclusions Implications for the assessment and treatment of ADHD in young adults are discussed (i.e., collecting informant reports, lowering the diagnostic threshold, emphasizing impairment, and cautiously interpreting retrospective reports).

How Persistent is ADHD into Adulthood? Informant Report and Diagnostic Thresholds in a Female Sample

“…Contrary to predictions, a significantly higher percentage (22%) of probands self-reported persistent ADHD than did comparison participants (2%). This persistence estimate is higher than those gleaned from selfreport in past longitudinal studies of both female and predominately male samples of young adults (e.g., Barkley et al, 2002;Babinski et al, 2011;Sibley et al, 2012).…”

“…Babinski and colleagues (2011) found that parents reported greater impairment than their daughters, particularly in the domain of intrafamily conflict; Barkley et al (2002) found that parent-reported ADHD status was associated with poorer outcomes on all eight of their study's outcomes, including such objective measures as employer performance ratings and school transcripts. Further, although Sibley et al (2012) found that parent-and self-report DSM-IV ADHD rates did not differ significantly (i.e., 12.0% and 9.6%, respectively), far higher percentages of parents than young adults reported clinically significant impairment (55.6% vs. 14.6%) and elevated symptom severity (71.8% vs. 24.4%).…”

“…Findings from past work regarding parent-reported persistence in predominately male samples are mixed. The Milwaukee Study reported 58% persistence (Barkley et al, 2002), but a recently-published analysis of the broader PALS sample, (mean age = 20.2; 87% male; Sibley et al, 2012) yielded a considerably lower estimate, with only 12% of proband parents reporting symptom levels that met the DSM-IV cutoff. Contrary to predictions, a significantly higher percentage (22%) of probands self-reported persistent ADHD than did comparison participants (2%).…”

“…Because of (a) the generally low correspondence across informants regarding youth emotional/behavioral problems (Achenbach, McConaughy, & Howell, 1987), and (b) the well-documented tendency for children with ADHD to overestimate their competence (Owens, Goldfine, Evangelista, Hoza, & Kaiser, 2007), a multi-informant approach to assessment is crucial. Yet less is known about informant correspondence for adult assessment (Sibley et al, 2010(Sibley et al, , 2012. McGough and Barkley (2004) noted that adults with ADHD often struggle to remember details of their childhood functioning (e.g., Barkley et al, 2002;Mannuzza, Klein, Klein, Bessler, & Shrout, 2002), and may overestimate their current competence (e.g., Knouse, Bagwell, Barkley, & Murphy, 2005) or under-report maladaptive behavior (e.g., Sibley et al, 2010).…”

“…Because it offers a direct ADHD symptom count, Wave 3 SNAP-IV scores were used to set this study's DRC threshold, to test hypotheses concerning dimensional persistence estimates, and to compare the DRC's predictive utility with that of the DSM-IV threshold. Although such dimensional measures cannot include impairment, symptom duration, and the like, this approach has been used in other investigations of ADHD symptom thresholds (e.g., Barkley et al, 2002;DuPaul et al, 2001;Heiligenstein et al, 1998, Sibley et al, 2012.…”