Item Response Theory Analyses of Barkley's Adult Attention-Deficit/Hyperactivity Disorder Rating Scales.

Abstract

Abstract There are many challenges associated with assessment and diagnosis of ADHD in adulthood. Utilizing the graded response model (GRM) from item response theory (IRT), a comprehensive item-level analysis of adult ADHD rating scales in a clinical population was conducted with Barkley's Adult ADHD Rating Scale-IV, Self-Report of Current Symptoms (CSS), a self-report diagnostic checklist and a similar self-report measure quantifying retrospective report of childhood symptoms, Barkley's Adult ADHD Rating Scale-IV, Self-Report of Childhood Symptoms (BAARS-C). Differences in item functioning were also considered after identifying and excluding individuals with suspect effort. Items associated with symptoms of inattention (IA) and hyperactivity/impulsivity (H/I) are endorsed differently across the lifespan, and these data suggest that they vary in their relationship to the theoretical constructs of IA and H/I. Screening for sufficient effort did not meaningfully change item level functioning. The application IRT to direct item-to-symptom measures allows for a unique psychometric assessment of how the current DSM-5 symptoms represent latent traits of IA and H/I. Meeting a symptom threshold of five or more symptoms may be misleading. Closer attention given to specific symptoms in the context of the clinical interview and reported difficulties across domains may lead to more informed diagnosis.