Barkley Adult ADHD Rating Scale-IV Research Articles

Turkish reliability and validity study of Barkley’s BAARS-IV self-report current symptoms

ObjectiveRecall bias of patients and their relatives, low reliability of the history, changes in attention deficit hyperactivity disorder (ADHD) symptoms or compensatory behaviors, and various comorbidities may be associated with difficulties in diagnosing ADHD in adults. Barkley Adult Attention Deficit Hyperactivity Disorder Rating Scale-IV (BAARS-IV), a relatively new scale, needs to be studied for validity and reliability in different societies and cultures. In this study, we investigated whether the Turkish version of BAARS-IV: Present Symptoms Section is valid and reliable in the medical students who constituted the sample.MethodsAdult Attention Deficit Hyperactivity Disorder Self-Report Scale and BAARS-IV: Present Symptoms Section were administered to 402 fifth- and sixth-year medical students. We performed exploratory and confirmatory factor analyzes. Cronbach’s alpha and inter-item correlation were evaluated. Pearson correlation test was used in inter-scale correlation analyses.ResultsFor ADHD items, Kaiser-Meyer-Olkin (KMO) (0.882), Measuring of Sampling Adequacy MSA (0.819), chi-square (2512.455), and p (< 0.001) values showed that the data were suitable for factor analysis. A three-factor structure with an eigenvalue above 1 and explaining 53.14% of the total variance was obtained. In the correlation matrix reconstructed with eight Sluggish Cognitive Tempo (SCT) items, the determinant of the correlation matrix was 0.025, the KMO determinant was 0.852, the lowest MSA value was 0.750, and the residual rate was 14%. A two-factor structure was obtained explaining 67.451% of the variance. Cronbach’s alpha values of the inattention and impulsivity subscales were 0.839 and 0.752, respectively. Cronbach’s alpha value of 8 questions in the SCT scale was found to be 0.871.ConclusionThe results of our study indicate that the BAARS-IV Self-report Present Symptoms scale is valid and reliable among medical students.

A Digital Mental Health Support Program for Depression and Anxiety in Populations With Attention-Deficit/Hyperactivity Disorder: Feasibility and Usability Study.

A total of 1 in 2 adults with attention-deficit/hyperactivity disorder (ADHD) struggles with major depressive or anxiety disorders. The co-occurrence of these disorders adds to the complexity of finding utility in as well as adherence to a treatment option. Digital therapeutic solutions may present a promising alternative treatment option that could mitigate these challenges and alleviate symptoms. This study aims to investigate (1) the feasibility and acceptance of a digital mental health intervention, (2) participants' engagement and retention levels, and (3) the potential efficacy with respect to anxiety and depression symptoms in a population with ADHD. Our main hypothesis was that a digital, data-driven, and personalized intervention for adults with coexisting ADHD and depressive or anxiety symptoms would show high engagement and adherence, which would be accompanied by a decrease in depressive and anxiety symptoms along with an increase in quality of life and life satisfaction levels. This real-world data, single-arm study included 30 adult participants with ADHD symptomatology and coexisting depressive or anxiety symptoms who joined a 16-week digital, data-driven mental health support program. This intervention is based on a combination of evidence-based approaches such as cognitive behavioral therapy, mindfulness, and positive psychology techniques. The targeted symptomatology was evaluated using the Patient Health Questionnaire-9, Generalized Anxiety Disorder-7, and Barkley Adult ADHD Rating Scale-IV. Quality of life aspects were evaluated using the Satisfaction With Life Scale and the Life Satisfaction Questionnaire, and user feedback surveys were used to assess user experience and acceptability. The study retention rate was 97% (29/30), and high engagement levels were observed, as depicted by the 69 minutes spent on the app per week, 5 emotion logs per week, and 11.5 mental health actions per week. An average decrease of 46.2% (P<.001; r=0.89) in depressive symptoms and 46.4% (P<.001; r=0.86) in anxiety symptoms was observed, with clinically significant improvement for more than half (17/30, 57% and 18/30, 60%, respectively) of the participants. This was followed by an average increase of 23% (P<.001; r=0.78) and 20% (P=.003; r=0.8) in Satisfaction With Life Scale and Life Satisfaction Questionnaire scores, respectively. The overall participant satisfaction level was 4.3 out of 5. The findings support the feasibility, acceptability, and value of the examined digital program for adults with ADHD symptomatology to address the coexisting depressive or anxiety symptoms. However, controlled trials with larger sample sizes and more diverse participant profiles are required to provide further evidence of clinical efficacy.

Psychometric properties of the Barkley Adult Attention Deficit Hyperactivity Disorder Rating Scale-IV in the Korean population

Discriminating attention-related symptoms is a key factor for the appropriate diagnosis of attention deficit hyperactivity disorder (ADHD) and sluggish cognitive tempo (SCT). The Barkley Adult Attention Deficit Hyperactivity Disorder Rating Scale-IV (BAARS-IV) is the most widely used tool to measure such symptoms. This study investigated the psychometric properties of the BAARS-IV with a sample of 771 participants in the Korean population. We identified a five-factor model for measuring ADHD and SCT, and determined the scale was appropriate for use in the Korean population. Sustained attention (SA) was a unique factor of the Korean version of the BAARSIV. Internal consistency was good and the positive association between the BAARS-IV and an alternative measure of depression/anxiety supported the scale's concurrent validity. To conclude, a cautious approach is needed when applying the BAARS-IV in different cultural contexts.

Atomoxetine in comorbid ADHD/PTSD: A randomized, placebo controlled, pilot, and feasibility study.

PTSD and ADHD often occur comorbidly. Research indicates that the cognitive deficits in PTSD may be related to the same disturbance of fronto-temporal systems as observed in ADHD, and ADHD has been shown to impact PTSD treatment outcomes. The presented study evaluated the safety and efficacy of atomoxetine in Veterans with comorbid ADHD/PTSD. A double blind, randomized, placebo controlled, cross-over pilot and feasibility study was conducted. Atomoxetine was examined as an adjunctive treatment over this 10 weeks, two phase, crossover study which compared treatment with atomoxetine 80 mg daily to placebo daily. The primary outcome was improvement in ADHD symptoms as measured by the Conners' Adult ADHD Rating Scales-Self-Report: Short Version (CAARS-S:S), the Barkley Adult ADHD Rating Scale-IV (BAARS-IV), and the Adult ADHD Quality of Life-29 (AAQoL-29). Secondary outcomes included the Clinician Administered PTSD Scale (CAPS), Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36), and the response inhibition task Go/NoGo (GNG). Atomoxetine treated patients had greater reductions in ADHD symptoms as defined by total scores on the CAARS-S:S (F(1, 29) = 6.37, p = .017); both the BAARS-IV (F(1, 26) = 3.16, p = .087); and GNG overall errors test (F(1, 29) = 3.88, p = .06), reached a trend level of significance. No significant differences were noted in quality of life assessments, GNG latency periods, or CAPS scores. Atomoxetine was well-tolerated with no serious adverse events observed. In Veterans with ADHD comorbid with PTSD, atomoxetine demonstrated modest efficacy for ADHD symptoms; quality of life measures and PTSD symptoms were not affected.

A Placebo-Controlled Trial of Lisdexamfetamine in the Treatment of Comorbid Sluggish Cognitive Tempo and Adult ADHD.

Objective: To examine the efficacy of lisdexamfetamine (LDX) versus placebo on behavioral attributes of sluggish cognitive tempo (SCT) in adults with attention-deficit/hyperactivity disorder (ADHD) and SCT. Methods: In a randomized crossover trial conducted January 2016–April 2018, 38 adults with DSM-5 ADHD (via the Adult ADHD Clinical Diagnostic Scale v1.2) and SCT were recruited at 2 academic medical centers and assessed for symptoms of ADHD, SCT, executive function deficits, and functional impairment at baseline and weekly during treatment. Participants received 4 weeks of treatment with either LDX (30–70 mg/d; mean = 59.1 ± 14.8 mg/d) or matching placebo (mean = 66.6 ± 9.1 mg/d) with a 2-week washout before switching to the other arm. The ADHD Rating Scale and Barkley Adult ADHD Rating Scale-IV SCT subscale were coprimary outcome measures. Results: There were moderately large treatment effects of LDX vs placebo on SCT ratings in both treatment periods (block 1 effect size = 0.68; block 2 effect size = 0.61), which reached significance only in block 1 owing to carryover effects of the first treatment epoch into the second. Significant effects were also seen for LDX over placebo in ADHD, executive function deficit, and functional impairment ratings, without order effects; no site differences were seen except on the Global Executive Complex score of the Behavior Rating Inventory of Executive Function—Adult Version. No moderating effects of sex, age, race, and ethnicity were seen. Conclusions: Adults with ADHD and comorbid SCT had significant improvement after LDX vs placebo in ratings of SCT, ADHD, executive function deficits, and functional impairment. This is the first study to show improvement in SCT after stimulant therapy in adults with ADHD. Trial Registration: ClinicalTrials.gov identifier: NCT02635035

Investigating the validity of the Strengths and Difficulties Questionnaire to assess ADHD in young adulthood

Attention Deficit Hyperactivity Disorder (ADHD) symptoms typically onset early and persist into adulthood for many. Robust investigation of symptom continuity and discontinuity requires repeated assessments using the same measure, but research is lacking into whether measures used to assess ADHD symptoms in childhood are also valid in adulthood. The Strengths and Difficulties Questionnaire (SDQ) is widely used to assess ADHD symptoms in children, but little is known about its utility in adulthood. The aim of this study was to assess the validity of the SDQ hyperactivity/ADHD subscale to distinguish between cases and non-cases of DSM-5 ADHD at age 25 years in a UK population cohort (N = 4121). ADHD diagnosis was derived using the Barkley Adult ADHD Rating Scale-IV. Analyses suggested that the self-rated SDQ ADHD subscale had high validity in distinguishing ADHD cases/non-cases in young adulthood (area under the curve=0.90, 95% CI=0.87–0.93) and indicated a lower cut-point for identifying those who may have an ADHD diagnosis in this age group compared to that currently recommended for younger ages. Findings were similar for parent-reports. Our findings suggest that the SDQ is suitable for ADHD research across different developmental periods, which will aid the robust investigation of ADHD from childhood to young adulthood.

The Deficit of Early Selective Attention in Adults With Sluggish Cognitive Tempo: In Comparison With Those With Attention-Deficit/Hyperactivity Disorder.

Sluggish cognitive tempo (SCT) is a cluster of attentional symptoms characterized by slow information processing and behavior, distractibility, mental confusion, absent-mindedness, and hypoactivity. The present study aimed to compare early and late selective attention in the information processing speed of adults with SCT to those with attention-deficit/hyperactivity disorder (ADHD) and adults without any attentional problems. The participants were screened using Barkley Adult ADHD Rating Scale-IV and divided into the following groups: SCT (N = 24), ADHD (N = 24), and controls (N = 25). All participants completed the irrelevant distractor task measuring early and late selective attention under load condition (low vs. high) and distractor condition (no-distractor vs. distractor). The inefficiency index was calculated by subtracting the reaction time of no-distractor condition of correct trials from the reaction time of distractor condition to control the impact of accuracy. Upon analysis, the SCT group showed a lower efficiency compared to the ADHD group under high load, while the ADHD group showed lower efficiency under low load than high load. This meant that the ADHD group had increased efficiency of selective attention with higher load, while the SCT group had low efficiency of selective attention even under high loads. These results suggest that the symptoms of “slow” or “distracted” in SCT could be attributed to the reduced speed and efficiency of selective attention in early information processing and the problem can be pronounced in situations with distractors. The results of the study imply that the attention-deficit-like symptoms shown in those with SCT and ADHD can be distinguished in specific stage of information processing.

Trait-Based Dimensions Discriminating Adults with Attention Deficit Hyperactivity Disorder (ADHD), Autism Spectrum Disorder (ASD) and, Co-occurring ADHD/ASD.

This study assessed the co-occurrence of attention deficit hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) in newly diagnosed adults of normal intelligence and the contribution of trait-based dimensions deriving from the Barkley Adult ADHD Rating Scale-IV (BAARS-IV), the Autism-Spectrum Quotient (AQ), and the Empathy Quotient (EQ) to the differentiation of patients with ADHD, ASD, and ADHD/ASD. A total of 16.1% of patients with ADHD received a co-occurring ASD diagnosis, while 33.3% of patients with ASD received an ADHD diagnosis. Subjects with ADHD or ADHD/ASD had higher scores in all ADHD traits compared to ASD subjects. Compared to the ADHD group, the ASD group had AQ scores that were significantly greater, except for attention to detail. ADHD/ASD co-occurrence significantly increased the score of attention to detail. The total EQ score was greater in the ADHD group. In the stepwise logistic regression analyses, past hyperactivity, current inattention and impulsivity, attention switching, communication, imagination, and total EQ score discriminated ADHD patients from ASD patients. Attention to detail, imagination, and total EQ score discriminated ADHD cases from ADHD/ASD cases, while past hyperactivity and current impulsivity discriminated ASD subjects from ADHD/ASD subjects. Our findings highlight the importance of particular trait-based dimensions when discriminating adults with ADHD, ASD, and co-occurring ADHD/ASD.

Measurement Invariance Across Adult Self-Ratings of Current and Retrospective Childhood ADHD Symptoms

This study examined measurement invariance across adult self-ratings of current and retrospective childhood ADHD symptoms. A group of 265 adults (135 females and 130 males) from the general community completed ratings of their current and retrospective childhood ADHD symptoms presented in the Barkley Adult ADHD Rating Scale-IV (BAARS-IV; Barkley 2011). Initially, confirmatory factor analysis (CFA) of the both sets of ratings provided more support for a bifactor ADHD model (a model with an orthogonal general factor and specific factors for inattention [IA] and hyperactivity/impulsivity [HI]) over a 2-factor oblique model (with factors for IA and HI). Using the bifactor model, chi-square difference test indicated non-invariance for 12 factor loadings on the general factor, and 13 thresholds. Differences in approximate fit indices indicated that only 4 factor loadings were not invariant. The clinical theoretical, and psychometric implications of the findings are discussed.

Time Perspective in Individuals with Sluggish Cognitive Tempo

Individuals with sluggish cognitive tempo (SCT) experience difficulties in achieving goal-directed behaviors. As time perspective (TP) helps elaborate problems in goal pursuit, this study aimed to identify the TP of individuals with SCT and compare it to individuals with attention-deficit/hyperactivity disorder (ADHD). The screening was performed using the Barkley Adult ADHD Rating Scale-IV, and participants were divided into the following groups: SCT & ADHD (n=20), SCT only (n=46), ADHD only (n=22), and healthy controls (n=28). To assess TP, participants also completed the Swedish Zimbardo Time Perspective Inventory. After controlling for depression and anxiety, the SCT only group showed higher present-fatalistic and future-negative TP compared to healthy controls. The ADHD only group showed higher present-hedonistic and futurenegative TP when compared to healthy controls. These results indicate that individuals with SCT have a generally fatalistic attitude and an aversive view of the future, possibly associated with low engagement in social and academic activities. On the other hand, individuals with ADHD have a present-oriented view and an aversive view of the future, possibly related to impulsivity.

Association of Childhood Attention Deficit Hyperactivity Disorder Symptoms with Academic and Psychopathological Outcomes in Indian College Students: a Retrospective Survey.

To survey the prevalence of retrospectively recalled clinically significant symptoms of attention deficit hyperactivity disorder (ADHD) in childhood and determine the association of ADHD symptoms in childhood with current academic achievement and psychopathological outcomes among college students in the state of Kerala, India. A self-administered questionnaire was distributed to 5784 students from 58 colleges selected by cluster random sampling. The Barkley Adult ADHD Rating Scale-IV was used for recollection of childhood ADHD symptoms; a total score of ≥60 (indicating the 99 percentile) was taken as the cut-off for clinically significant ADHD symptoms in childhood. The Alcohol, Smoking and Substance Involvement Screening Test was used to assess lifetime use of alcohol and tobacco. The Kessler Psychological Distress Scale was used to assess non-specific psychological distress. Lifetime suicidality and exposure to sexual abuse were assessed by asking relevant questions. Students who recalled having clinically significant ADHD symptoms in childhood were compared with those who did not. Of 5784 students, 639 (11.5%) did not complete the questionnaire. Of the remaining 5145 students, 1750 (34.8%) were men and 3395 (65.2%) were women, with a mean age of 19.4 years. 143 (2.8%) students reported clinically significant ADHD symptoms in childhood. Childhood ADHD symptoms were significantly more common in men and in those living in urban areas. In the bivariate analysis, those with clinically significant ADHD symptoms in childhood had significantly higher odds of poorer academic performance, alcohol use, tobacco use, psychological distress, suicidal thoughts, suicidal attempts, and contact and non-contact sexual abuse, after adjusting for sex and residence. Clinical evaluation and appropriate management may be warranted for adults who retrospectively recall clinically significant ADHD symptoms in childhood.

The ADHD Symptom Infrequency Scale (ASIS): A novel measure designed to detect adult ADHD simulators.

The current project outlines the development of the Attention-Deficit/Hyperactivity Disorder (ADHD) Symptom Infrequency Scale (ASIS), a stand-alone measure designed to identify individuals feigning or exaggerating symptoms to receive a diagnosis of ADHD. Over the course of 3 studies, valid data was collected from 402 participants assigned to control, simulator, ADHD diagnosed, or possible undiagnosed ADHD groups. Group assignment was based on self-reported history of ADHD diagnosis including information about the credentials of diagnosing professional and methods used. The ASIS includes an Infrequency Scale (INF) designed to detect rarely reported symptoms of ADHD and several clinical scales designed to measure genuine symptoms. The final version of the ASIS demonstrated high internal consistency for the INF (α = .96) and the ADHD Total scales (α= .96). Convergent validity for the ADHD Total was established through a strong correlation with Barkley Adult ADHD Rating Scale-IV (r = .92). Initial validation of the INF yielded high discriminability between groups (d = 2.76; 95% confidence interval [2.17, 3.36]). The final INF scale demonstrated strong sensitivity (.79-.86) and excellent specificity (.89). Using our study's malingering base rate of 29%, positive and negative predictive values were strong (.71-.79 and .92-.93, respectively). Additional information is provided for a range of base rates. Current results suggest that the ASIS has potential as a reliable and valid measure of ADHD that is sensitive to malingering when compared to a sample of individuals self-reporting a history of ADHD diagnosis. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

ADHD and SCT Symptomatology in Relation to College Students’ Use of Self-Regulated Learning Strategies

Objective: The present study examined the relation between self-regulated learning (SRL) strategies and ADHD and sluggish cognitive tempo (SCT) symptomatology. Method: Participants were 303 college students, aged 18 to 25 (M = 20.04, SD = 1.45), from a Midwestern university who completed the Barkley Adult ADHD Rating Scale-IV (BAARS-IV), and a shortened, generalized version of the Motivated Strategies for Learning Questionnaire (MSLQ). Results: Among college students, inattention symptomatology was consistently predictive of deficits in use of value, expectancy, and self-regulation strategies, while SCT symptomatology was only predictive of deficits in the use of self-regulation strategies. Conclusion: This study is the first to examine the relation between SCT symptomatology and SRL strategy use in college students. The findings revealed that SRL strategy use differs between college students exhibiting ADHD or SCT symptomatology. Remediation focusing on these deficits would likely increase academic achievement. Clinical implications, limitations, and suggestions for future research are discussed.

Prevalence of adult ADHD in an all-female prison unit.

There is increasing evidence suggesting a link between ADHD and criminality, including a strong association between ADHD symptoms and the likelihood of being on probation or in prison. Most studies investigating the prevalence of ADHD in prison populations have focused on adult male offenders. In the current study, 69 female prisoners were screened for both childhood and adult ADHD symptoms using the Barkley Adult ADHD Rating Scale-IV. The results indicate that 41% of the prisoners met the diagnostic criteria for ADHD in childhood and continued to meet criteria for ADHD as adults. More importantly, young female prisoners (aged 18-25) were significantly more likely to report symptoms of ADHD than older prisoners. Prisoners who reported symptoms of ADHD also reported high levels of impairment associated with these symptoms. A better understanding of the prevalence of ADHD in female prison units can highlight specific areas for intervention during rehabilitation, as well as the management of serious incidents within prison.

Are sluggish cognitive tempo and daytime sleepiness distinct constructs?

Sluggish cognitive tempo (SCT) and daytime sleepiness are both common in individuals with attention-deficit/hyperactivity disorder (ADHD). There appears to be considerable overlap between the tired and lethargic aspects of SCT and behaviors frequently exhibited by individuals with daytime sleepiness. However, no studies have examined the degree to which these constructs overlap and whether or not they are empirically distinct. In Study 1, a confirmatory factor analysis with the SCT subscale of the Barkley Adult ADHD Rating Scale-IV (BAARS-IV) and the Epworth Sleepiness Scale (ESS) was conducted in a sample of 768 college students. Results demonstrated that SCT and daytime sleepiness exhibit considerable overlap but are empirically distinct. In Study 2, we examined the relation between SCT and daytime sleepiness and also the impact of comorbid SCT and sleepiness on the functioning of 58 college students rigorously diagnosed with ADHD. Regression analyses in both Study 1 and Study 2 showed that SCT predicts daytime sleepiness above and beyond symptoms of ADHD, anxiety, and depression. The 2 constructs were significantly related (r = .51), with the highest correlations occurring between the SCT tired and lethargic items with daytime sleepiness. College students with ADHD + SCT and daytime sleepiness were significantly more impaired than college students diagnosed with ADHD without SCT or daytime sleepiness. Together, these results fill an important gap in the literature by confirming SCT to be overlapping but empirically distinct from daytime sleepiness and demonstrating that SCT and daytime sleepiness are associated with functioning in college students with ADHD.

Sluggish Cognitive Tempo is Associated With Academic Functioning and Internalizing Symptoms in College Students With and Without Attention-Deficit/Hyperactivity Disorder

The purposes of the present studies were to (a) examine the factor structure of sluggish cognitive tempo (SCT) and attention-deficit/hyperactivity disorder (ADHD) in college students and (b) examine the associations between SCT and academic functioning and internalizing symptoms in college students with and without ADHD. In Study 1, a confirmatory factor analysis of the Barkley Adult ADHD Rating Scale-IV (BAARS-IV) was conducted in a sample of 768 college students (aged 17-34 years, 68% female). In Study 2, we examined the relation of SCT to academic functioning and internalizing symptoms in a sample of 72 college students rigorously diagnosed with ADHD (aged 17-35 years, 44% female). Study 1 results supported the factor structure of the BAARS-IV, with the optimal model comprising 4 correlated but distinct factors: SCT, Inattention, Hyperactivity, and Impulsivity. After controlling for correlated demographic variables and ADHD symptoms, SCT was significantly related to academic impairment (including grade point average), anxiety, and depression. In Study 2, SCT again contributed unique variance to internalizing symptoms and academic impairment after controlling for correlated participant characteristics (i.e., sex, age, race, parent education level, family income, ADHD medication use, and mental health service utilization) and ADHD symptom severity. These results fill an important gap in the literature by (a) confirming SCT to be distinct from ADHD in emerging adulthood, (b) demonstrating SCT to be strongly linked to college student adjustment, and (c) providing support for the hypothesis that SCT is associated with psychosocial functioning in both individuals with and without ADHD.