ADHD Symptoms vs. Impairment: Revisited

Abstract

We concluded that symptoms and impairment were somewhat distinct dimensions that should be considered as such in the diagnostic process. We further concluded that there appeared to be a weak relationship between symptoms and impairment such that clinical cases of ADHD could display the full range of ADHD‐type symptoms without necessarily displaying significant impairment. The prior article also highlighted limitations in current approaches to the assessment of impairment and statistical methods used to evaluate its relationship to symptom severity. The present article illustrates this issue by examining the relationship of ADHD symptom severity to impairment using different means of defining impairment and of analyzing the risk for impairment in major life activities. Specifically, we report on the relationship of ADHD symptoms to several investigator‐created omnibus impairment indexes. These are largely drawn from the types of specific measures of impairment used in our earlier paper. In this case, however, we convert these largely dimensional measures into discrete dichotomous categories (being impaired or not) on each specific measure. The omnibus index is then created by summing across these discrete measures to achieve a count of the total number of different measures on which impairment could be said to exist. We also examine self, other, employer, and clinician ratings of impairment across a number of domains of major life activities (work, school, family, social, driving,