Conners' Adult ADHD Rating Scale Research Articles

Symptom validity testing in adults with clinically diagnosed ADHD: comparison of the Conner’s Adult ADHD Rating Scale (CAARS) and the Self-Report Symptom Inventory (SRSI)

ABSTRACT Objectives Compared to the number of performance validity measures, the range of available symptom validity measures is limited. The Self-Report Symptom Inventory (SRSI) is a recently developed freestanding symptom validity test with promising psychometric characteristics for use on non-criminal forensic and a range of clinical populations. The goal of this study was to evaluate the utility of the SRSI for symptom validity testing in the clinical evaluation of adults with attention-deficit/hyperactivity disorder (ADHD). Methods This analogue study compared 76 German patients diagnosed with ADHD (age range 19–63 years) with typically developing individuals from the Netherlands/Germany who were assigned to either a control group (N = 58; age range 18–73 years) or a simulation group (N = 46; age range 18–57 years). All participants completed the Conners’ Adult ADHD Rating Scale (CAARS) with its two embedded validity indicators Infrequency Index (CII) and ADHD Credibility Index (ACI), the SRSI, and the Digit Span (to derive the Reliable Digit Span). Results Specificity in controls was perfect for the CAARS, but reached only about 90% for the SRSI. In contrast, sensitivity in experimental simulators ranged from 24% to 65% for the CAARS, but reached high rates of 69% to 82% for the SRSI. In the sample of patients with ADHD, the failure rate ranged from 8% to 34% (CAARS), and 33% to 47% (SRSI). Further, we found limited classification agreement between the validity measures. Conclusion The divergent results on the different validity indicators reflects the ongoing discussion on poor construct unity and clarity, and calls for more research addressing the heterogeneous construct. The utility of the SRSI to reliably distinguish between valid and invalid symptom report in the clinical evaluation of adult ADHD has to be investigated by more refined studies including both symptom and performance validity indicators.

Detecting Noncredible Responding in College Student ADHD Assessment: A Comparison of Several Brief Symptom Validity Tests

AbstractA diagnosis of attention-deficit/hyperactivity disorder (ADHD) offers tangible and psychological benefits to college students. These incentives lead some students to exaggerate symptoms on self-report rating scales. Although validity tests can detect noncredible responding, they are seldom used by clinicians who conduct adult ADHD evaluations. Many validity tests require considerable time, are expensive to administer, or are not accessible to many clinicians. We conducted a between-subjects simulation study examining the ability of several brief symptom validity tests to differentiate college students with self-reported ADHD (n = 229) and students without ADHD randomly assigned to honest control (n = 260) or simulator (n = 239) conditions. All participants completed the Conners’ Adult ADHD Rating Scales (CAARS) with several embedded validity indicators (i.e., CAARS Inconsistency Index, CAARS Infrequency Index [CII], Dissociative Experiences Scale, Exaggeration Index [EI]), and the Subtle ADHD Malingering Screener. Results showed that students without ADHD could easily simulate this condition. Simulators earned significantly higher scores than participants in the ADHD and control conditions on all the validity tests that we examined, except the CAARS Inconsistency Index. Elevated scores on the CAARS hyperactive-impulsive scale, the CII, or the EI yielded the best classification statistics with specificity to controls ranging from 98.5 to 100%, sensitivity to simulators ranging from 35.6 to 42.7%, and low positive cases among participants in the ADHD condition. Associations between these validity scales were moderate. Requiring elevated scores on multiple validity scales yielded perfect specificity to controls, sensitivities to simulators between 27.2 and 31.8%, and few positive cases among participants in the ADHD condition (0 to 3.1%). These tests may offer clinicians a time- and cost-effective way to evaluate the validity of students’ self-reports, especially when integrated with objective information from other sources.

Validation of the dispositional adult hyperfocus questionnaire (AHQ-D)

Hyperfocus (HF), or intense, deep concentration on a task, has gained significant research attention in recent years, particularly in regard to clinical populations such as Attention-Deficit/Hyperactivity Disorder (ADHD). The present work aims to provide validation of the 12-item dispositional adult hyperfocus questionnaire (AHQ-D) as a quantitative metric of HF in adults. We preregistered the study design and hypotheses. We administered the AHQ-D and several additional questionnaires to 347 adults (mean ± SD age: 33 ± 11 years; 47% female). Exploratory factor analysis revealed high factor loadings (0.57–0.81) on a single HF factor; item response theory analysis suggested that the questionnaire items had high discrimination and covered a wide range of responses; and we report strong internal consistency metrics (Cronbach’s alpha 0.93, mean split-half reliability 0.93). Replicating our previous work, HF was positively correlated with Conners’ Adult ADHD Rating Scale (CAARS) scores (r(345) = 0.53), suggesting that HF may be related to ADHD traits (though in this sample we did not specifically recruit individuals with ADHD). The AHQ-D demonstrated the hypothesized convergent validity; HF on the AHQ-D was positively correlated with HF measured using a different HF scale (r(344) = 0.69), as well as flow (r(345) = 0.12) and mind wandering (r(345) = 0.39) scores. AHQ-D HF scores showed a weak negative correlation with grit (r(345) = − 0.29). Though there was a weak negative correlation between HF and social desirability response tendency (r(345) = − 0.24), suggesting that those who care more about what others think may report less HF, there was no relationship between HF and extrasensory perception beliefs (r(345) = 0.01), suggesting that participants were not simply biased in their response tendencies. Taken together, we demonstrate strong scale metrics for the AHQ-D, the expected convergent validity, and a general lack of response bias, in addition to replicating our previous association of HF with ADHD traits. We suggest that the AHQ-D can be confidently used in future work as a valid way to measure HF in adults.

An exploratory investigation of the association between severities of the adverse impact of stuttering and co-occurring disorders

ABSTRACT Stuttering is a multi-dimensional disorder that affects diverse life aspects of people who stutter. This study aimed to investigate the association between severities of the adverse impact of stuttering and co-occurring disorders. Thirty adults who stutter (mean age, 37.6 ± 14.1 years; 26 males and four females) participated in this study. The Liebowitz Social Anxiety Scale (LSAS-J), Autism-Spectrum Quotient short form (AQ-10-J), and Conners’ Adult ADHD Rating Scales (CAARS) were used to assess symptoms of social anxiety disorders (SAD), autism spectrum disorder (ASD), and attention-deficit/hyperactivity disorder (ADHD), respectively. The index of ratio of disfluencies (RDF) was calculated to assess cluttering. The Japanese version of the Overall Assessment of the Speaker’s Experience of Stuttering for Adults (OASES-A-J) was used to assess the adverse impact of stuttering. A moderate positive correlation was found between the LSAS-J and OASES-A-J scores. Inattention and ADHD symptoms total scores were significantly correlated with the OASES-A-J scores. The adverse impact of stuttering was associated with symptoms of co-occurring disorders, namely, SAD, ADHD, and cluttering. A negative correlation was observed between the RDF and OASES-A-J Section III score. Cluttering symptoms were associated with less communication impact in daily situations. This study sheds light on the importance of comprehensive assessments from professionals with relevant expertise for adults who stutter.

Towards an increased attention on ADHD symptoms and traits in young adults: prevalence data from screening tools in a psychiatric outpatient clinic

IntroductionAttention–Deficit/Hyperactivity Disorder (ADHD) is a heterogeneous neurodevelopmental disorder encompassing developmentally inappropriate inattentiveness, hyperactivity, and increased impulsivity (DSM-5). Symptoms presentation is different for different stages of life; moreover, individuals with ADHD symptomatology can develop abilities and strategies that help them adapt and mask the distinctive features of the condition, thus reducing the functional impairment usually seen in ADHD subjects, and ultimately not receiving neither a clinical diagnosis nor a proper therapeutic support. They might express their lack of well-being through other transdiagnostic symptoms, and finally reach psychiatric attention for potential comorbidities. Hence, it was argued that the existence of children and adolescents with subthreshold and underrecognized symptoms that subsequently develop into a full diagnosis suggests that ADHD should be significantly more considered in adult mental health settings.ObjectivesHere we aimed to analyse the prevalence of ADHD symptoms and traits in a heterogeneous clinical psychiatric sample of young adults (aged 18 to 24 years old), who referred to a specialized outpatient clinic for various psychiatric and psychological disturbances.Methods259 participants completed three validated self-report screening questionnaires for ADHD: the Wender Utah Rating Scale (WURS), the Adult Attention-Deficit/Hyperactivity Disorder Self-Report Screening Scale for DSM-5 (ASRS-5), and the Conners’ adult ADHD rating scale (CAARS).Results12.4% of our sample scored above the cut-off at both the WURS and the ASRS-5 and was considered at risk of ADHD.Conclusions The prevalence rate in our sample is higher than the one found in the adult general population (6.76%), and in the lower range of the one found in the adult clinical population (6.9% to 38.8%). We discuss the potential role of sociodemographics (age, sex, gender identity, and employment) and comorbidity factors. Differences in the clinical presentation of ADHD according to sex assigned at birth and age should be considered during every psychiatric evaluation to minimize the risk of underdiagnosis. We advocate for further studies investigating the prevalence of ADHD in different psychiatric services for adults, and for a stronger presence of specialistic ADHD services and trained clinicians on the territory: this would increase diagnostic reliability, consequently providing a better treatment for ADHD in adults, and facilitate the transition from pediatric to adult’s services.Disclosure of InterestNone Declared

Longitudinal Associations Between Symptoms of ADHD and Life Success: From Emerging Adulthood to Early Middle Adulthood

Objective: To expand on current adult ADHD literature by investigating the stability of ADHD symptomatology (i.e., inattention and hyperactivity-impulsivity) across a 15-year period (from emerging adulthood to early middle adulthood) and the relative contributions of ADHD symptomatology to life success. Method: A sample of 320 post-secondary students was initially assessed for ADHD symptomatology using the Conners’ Adult ADHD Rating Scale (CAARS). Fifteen years later, participants were re-assessed using the CAARS and several measures of life success (e.g., relationship satisfaction, career satisfaction, and stress levels). Results: Inattention and hyperactivity-impulsivity symptoms showed strong stability across the 15-year period. Additionally, inattention symptoms during emerging adulthood and early middle adulthood were consistently associated with poorer life success (i.e., lower relationship and career satisfaction), particularly for men. Associations for hyperactivity-impulsivity symptoms were less consistent. Conclusion: ADHD symptomatology can be conceptualized as a stable, dimensional trait across adulthood, with important impacts on life success.

ADHD and Anxiety Symptoms: Does Construct or Assessment Type Matter More?

Objective: This study examined the relationships between self-reported ADHD symptoms, self-reported anxiety, and continuous performance test (CPT) performance. Method: 128 postsecondary students referred for clinical evaluation for possible ADHD and related conditions completed the Conners Adult ADHD Rating Scale, the Behavior Assessment Scale for Children, Third Edition, and either of two CPTs. Results: Multiple regression models found that when self-reported anxiety and CPT performance were used to simultaneously predict self-reported ADHD symptoms, CPT performance was not a significant predictor, whereas self-reported anxiety was. This finding was replicated across two different subsamples that took different CPTs. Conclusion: Self-reported anxiety and ADHD symptoms are strongly related, but neither of these variables is significantly related to CPT performance. Implications for clinical practice and future research are discussed.

Toward an Increased Attention on ADHD Symptoms and Traits in Young Adults: Prevalence Data From Screening Tools in a Psychiatric Outpatient Clinic.

to analyze the prevalence of ADHD symptoms and traits in a heterogeneous clinical psychiatric sample of young adults (aged 18-24 years old), who referred to a specialized outpatient clinic for various psychiatric and psychological disturbances. 259 participants completed three validated self-report screening questionnaires for ADHD: the Wender Utah Rating Scale (WURS), the Adult Attention-Deficit/Hyperactivity Disorder Self-Report Screening Scale for DSM-5 (ASRS-5), and the Conners' adult ADHD rating scale (CAARS). 12.4% of our sample scored above the cut-off at both the WURS and the ASRS-5 and was considered at risk of ADHD. the prevalence rate in our sample is higher than the one found in the adult general population (6.76%), and in the lower range of the one found in the adult clinical population (6.9%-38.8%). The potential role of sociodemographic (age, sex, gender identity, and employment) and comorbidity factors is discussed.

34 Attention-Deficit/Hyperactivity Disorder, Emotion Regulation, and Executive Functioning Associated with Educational and Occupational Outcomes in Adults

Objective:While attention-deficit/hyperactivity disorder (ADHD) symptoms, including inattention, hyperactivity, and impulsivity, are normally distributed within the population, features of ADHD have been associated with poor functional outcomes across various domains of life, such as academic achievement and occupational status. However, some individuals with even strong ADHD features show normal or above-average success within these functional domains. Executive dysfunction and emotion regulation abilities are associated with educational attainment and occupational status and may therefore explain some of the heterogeneity in functional outcomes in individuals with mild, moderate, and high levels of ADHD symptoms. In this study, we investigated whether emotion regulation strategy use (i.e., emotion suppression or cognitive reappraisal) and executive function abilities moderate the relationship between ADHD symptoms and occupational status and education attainment in adults.Participants and Methods:Data were collected from 109 adults aged 18 - 85 (M = 38.08, SD = 15.54; 70.6% female) from the Nathan Kline Institute Rockland Sample. All participants completed measures of ADHD symptoms (Conners Adult ADHD Rating Scale), emotion regulation strategy use (Emotion Regulation Questionnaire), and executive functioning (composite scores of inhibition, shifting and fluency from the standardized Delis-Kaplan Executive Function System). In this study, executive function abilities and emotion regulation strategy use were tested as potential moderators of the relationship between ADHD symptoms and functional outcomes using hierarchical regression models.Results:Several two- and three-way interactions predicting occupational status and educational attainment were observed. Education attainment was predicted by hyperactivity and reappraisal (ß = -0.26, p = .006); inattention, shifting, and reappraisal (ß = -0.52, p = .029); inattention, shifting, and suppression (ß = -0.40, p = .049); inattention, fluency, and reappraisal (ß = 0.24, p = .038); hyperactivity, fluency, and reappraisal (ß = 0.27, p = .034); and impulsivity, fluency, and reappraisal (ß = 0.44, p = .004). Occupational status was predicted by inattention and reappraisal, (ß = -0.27, p = .032), hyperactivity and reappraisal (ß = -0.26, p = .004); and impulsivity, fluency, and reappraisal (ß = 0.35, p = .031). Fluency was positively associated with educational attainment when controlling for inattention and impulsivity.Conclusions:Consistent with the hypothesis, the association between ADHD symptoms and both occupational status and educational attainment were moderated by the interaction between emotion regulation strategy use, executive function abilities domains. The observed interactions suggest that both occupational status and educational attainment may depend heavily on one’s intrinsic abilities and traits. Contrary to previous literature, we found no evidence that ADHD symptoms, emotional regulation strategies were independently associated with either educational attainment or occupational status, but this should be validated in a sample with greater representation of adults with clinically significant ADHD.

Screening for Attention Deficit Hyperactivity Disorder in Young Autistic Adults: The Diagnostic Accuracy of Three Commonly Used Questionnaires

ObjectiveAttention Deficit Hyperactivity Disorder (ADHD) is a common co-occurring condition in autistic individuals. ADHD is sometimes first recognised in young adulthood because ADHD symptoms may be misattributed to autism due to superficial overlap in presentation and diagnostic overshadowing. It should be investigated whether ADHD questionnaires are accurate in screening symptoms in young adults with autism. The current study examined this.MethodsParticipants were autistic young adults (N = 119) who took part in the Special Needs and Autism Project (SNAP), a population-based cohort. ADHD research diagnoses were obtained through the parent-informed Young Adult Psychiatric Assessment. Parents and young adults (self-report sample N = 71) completed ADHD questionnaires (Aberrant Behavior Checklist hyperactivity/non-compliance subscale, Conners Adult ADHD Rating Scales ADHD Index, and Strengths and Difficulties Questionnaire ADHD subscale). Receiver operating characteristic analyses were conducted to explore if the questionnaires discriminated ADHD cases from non-cases. To assess whether results varied by intellectual functioning, subgroup analyses were completed for those with an IQ ≥ 70 vs. <70.ResultsWeighted ADHD rates were high. Overall although the measures were performing at or close to adequate levels (area under the curve was 0.66 to 0.79 for parent-report and 0.70 to 0.65 for self-report), no single measure met adequate thresholds for sensitivity and specificity simultaneously. Tool performance was not different for those with an IQ ≥ 70 vs. <70.ConclusionNo single measure reported adequate performance for distinguishing ADHD from non-ADHD cases in this sample of young autistic adults. Use of current thresholds may lead to under-diagnosis.

A - 177 The Self-Concept Scale of Conners Adult Rating Scale in the Diagnosis of Autism Spectrum Disorder in Adults.

Self-report scales are beneficial in identifying symptoms of Autism Spectrum Disorder (ASD) in adults (Hayashi et al., 2021; Hull et al., 2019). Symptoms of ASD and attention-deficit/hyperactivity disorder (ADHD) overlap significantly even without dual-diagnosis (Nakagawa et al., 2021). The Conners Adult ADHD Rating Scale (CAARS) is a reliable and valid screening tool when identifying ADHD in adults, 78% sensitivity and 56% specificity (Abbass et al., 2021). Distinguishing features of ASD include restricted repetitive behaviors (RRB) and social interaction and communication deficits (SIC) (American Psychiatric Association, 2022). In adults, CAARS has shown a moderate correlation of RRB with the inattention (IA) and hyperactivity/impulsivity (HI) of ADHD; SIC moderately correlates with IA and mildly with HI. This study explores group differences when comparing Self-Concept (SC) Scale of CAARS in those diagnosed with ASD from clinical comparisons. Data composed of 93 adult participants, 7 diagnosed with ASD, were extracted from a midwest neuropsychological outpatient clinic and analyzed to determine the sensitivity of CAARS-SC in diagnosing ASD. Independent t-Test identified no significant effect for diagnosis, t(91) = -0.301, p = 0.764, despite those in the ASD group (M = 62.00, SD = 12.432) endorsing more concerns than those without the diagnosis (M = 60.47, SD = 12.996). This study did not identify significant group differences on the CAARS-SC when comparing those diagnosed with ASD to the clinical comparisons. Further implications and limitations will be explored to distinguish ASD from overlapping diagnoses to employ appropriate treatment and future psychometric research directions.

Estimating the Risk of Attention Deficit Hyperactivity Disorder (ADHD) in Parents of Children with ADHD and the Association with Their Children's Disease Severity and Adherence to Medication.

Attention deficit hyperactivity disorder (ADHD) is characterised by inattentiveness, hyperactivity, and impulsivity. Up to half of the affected children have a parent with ADHD. In this study, the risk of ADHD among parents of ADHD children was estimated. The associations between parental ADHD and child ADHD severity and medication adherence were determined. Parents of children and adolescents diagnosed with ADHD attending the University Kebangsaan Malaysia Medical Centre (UKMMC) were recruited between June to August 2022 and the administered Conners' Adult ADHD Rating Scale (CAARS) self-report short form, Vanderbilt ADHD Parent Rating Scale (performance section), and Medication Adherence Report Scale (MARS). Forty-five children with ADHD were recruited and 15 out of 45 (33%) parents were detected to have ADHD. ADHD severity was worse in children with ADHD parents for total severity (mean of 34.67 vs. 29.13, p = 0.047) and difficult behaviours at home (mean of 7.87 vs. 6.27, p = 0.036). The children's academic performance and behavioural challenges at home and school were positively correlated with the parental ADHD scores for 'inattention' and 'problems with self-care' subscales. A total of 33% of ADHD children had parents with ADHD. ADHD children with ADHD parents were more likely to have behavioural problems at home and more severe ADHD. However, no statistical significance was noted with medication adherence.

From neurodevelopmental to neurodegenerative disorders: Investigating symptoms of attention deficit hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) in patients with dementia

Dementia is characterized by a progressive cognitive decline that could be caused by several disorders. Autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD) are two prevalent neurodevelopmental disorders that might overlap with dementia symptoms. Hence, this study aimed to evaluate the ASD and ADHD symptoms in dementia patients referred to a memory clinic in Iran. We recruited 65 dementia patients and instructed them to fill out the autism quotient (AQ) and the Conners’ Adult ADHD Rating Scales (CAARS) questionnaires. Considering the cutoff points of AQ and CAARS questionnaires, 18.5% of participants were at higher risk of ASD, and 35.4% were at higher risk of ADHD. The results indicated that ADHD and ASD symptoms might be common comorbidities in patients with dementia which can increase the disease burden. Specialized ADHD and ASD screening tools in the elderly population with dementia are needed to prevent misdiagnoses due to symptom overlaps.

Investigating ADHD and ASD features in dementia patients referred to a memory clinic in Iran

AbstractBackgroundDementia is a clinical syndrome characterized by a progressive cognitive decline interfering with the function of activity of daily living in patients (1). Autism spectrum disorder (ASD) and Attention deficit hyperactivity disorder (ADHD) are two prevalent neurodevelopmental disorders affecting different brain functions manifesting mostly with impaired communication and behavior (3). These disorders initiate in childhood but usually persist into adulthood (3, 4). These disorders might overlap with dementia symptoms, as they might share common genetic and environmental backgrounds (5‐7). ASD and ADHD in dementia patients may complicate the timely diagnosis of each disorder leading to more pronounced dysfunction. Hence, this study aimed to evaluate ASD and ADHD symptoms in dementia patients referred to a memory clinic in Iran.MethodWe recruited 65 dementia patients in this study. Firstly, a cognitive neurologist diagnosed dementia’s subtypes by a precise clinical examination, cognitive assessment by applying the Montreal cognitive Assessment (MoCA). The severity of dementia was determined using the Functional Assessment Staging Tool (FAST). Consequently, we instructed the participants to fill out the autism quotient (AQ) and the Conners' Adult ADHD Rating Scales (CAARS) questionnaires for investigating their ASD and ADHD symptoms.ResultConsidering the cut‐off points of AQ and CAARS questionnaires, 18.5% of participants were diagnosed with ASD, and 35.4% were diagnosed with ADHD. Besides, we found a significant positive relationship between all subscales of CAARS and the FAST score (P &lt; 0.05). In other words, patients with more severe dementia were more likely to have increased ADHD symptoms.ConclusionThe results indicated that ADHD and ASD symptoms might be common manifestations in patients with dementia. This finding was in line with the previous research findings regarding the high co‐occurrence of ADHD and dementia (8). This comorbidity can further prohibit function and further worsen the prognosis. Given that there is scarce evidence on the association between ADHD and dementia in Iran, the findings of this study can pave the way for future research to elaborate more precisely on the etiological backgrounds of this association.

Self-Reported Adult ADHD Symptoms: Evidence Supporting Cautious Use in an Assessment-Seeking Sample

Objective: Self-report symptom inventories are commonly used in adult ADHD assessment, and research indicates they should be interpreted with caution. This study investigated one self-report symptom inventory for adult ADHD in a clinical sample. Method: Archival data were used to evaluate diagnostic utility of the Conners Adult ADHD Rating Scale—Self-Report: Long Version (CAARS-S:L) in a sample of 122 adults seeking ADHD assessment. Results: Overall, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) estimates for the ADHD Index and other CAARS-S:L scales demonstrated weak accuracy. Anxiety and depression were the most common diagnoses present when a false positive on the ADHD Index was observed. PPV and specificity for the ADHD Index were higher in males compared to females. Conclusion: The CAARS-S:L may be useful for screening purposes in some cases, but should not be the main method used for diagnostic purposes. Clinical implications of findings are discussed.

Adult attention-deficit hyperactivity disorder among patients with substance use disorders

BackgroundAttention-deficit/hyperactivity disorder (ADHD) is a childhood neurodevelopmental disorder that persists into adulthood. ADHD is a well-known risk factor for substance use disorder (SUD). However, the actual contribution of comorbidity is largely unknown. The current study investigated the prevalence of ADHD in a sample of abstinent patients compared to healthy controls.Compared to 51 healthy controls, 51 patients seeking medical treatment for SUD were abstinent from any substance for at least 1 month, interviewed by the use of the ICD-10 symptom checklist, the Social Classification Scale, the Addiction Severity Index, Conners adult ADHD Rating Scales Self-Report (CAARS-S:L), and the Kiddie-Sads-Present and Lifetime Version (K-SADS-PL).ResultsUsing CAARS-S:L, the ADHD index showed that 9 subjects (17.6%) were diagnosed with adult ADHD. Using K-SADS-PL, 8 of the participants (15.7%) were found to have an adult ADHD diagnosis. Lower scores of the ADHD index are related to increased patients’ age, while increased scores of the ADHD index are related to more alcohol-related problems of the patients. The strongest predicting factors of increased ADHD index were drug problems and legal status.ConclusionsThe current study provides evidence of an increased diagnosis of adult ADHD in patients with substance use disorder, regardless of the type of substance abuse.

Mind wandering in adults with attention deficit hyperactivity disorder: Preliminary evaluation using the Mind Excessively Wandering Scale in a Japanese clinical population.

Mind wandering (MW) has been closely associated with attention deficit hyperactivity disorder (ADHD); however, the field remains understudied in Japan. The present study examined MW in adults with ADHD using the Mind Excessively Wandering Scale (MEWS) in a Japanese clinical population. Fifty-two adults with ADHD (mean age, 33.0 years; 33 men), diagnosed per the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria, completed the MEWS, Mind Wandering Questionnaire, Conners' Adult ADHD Rating Scale (CAARS), Autism Spectrum Quotient (AQ), and Japanese Adult Reading Test-25. The mean MEWS score was 18.8 (standard deviation, 7.6). MEWS scores showed significant correlations with the CAARS Inattention/Memory Problems, Problems with Self-Concept, DSM-IV ADHD Symptoms Total, ADHD Index, and AQ scores. Higher MEWS scores were associated with greater ADHD and autism spectrum disorder symptoms in patients with ADHD. Our results not only provide supporting evidence of the presence of excessive MW in adults with ADHD, but also indicate the heterogeneous nature of MW in ADHD.

Joint Consideration of Validity Indicators Embedded in Conners’ Adult ADHD Rating Scales (CAARS)

A decade of research has both illustrated the need for accurate clinical assessment of adult ADHD and brought forward a series of validity indicators assisting this diagnostic process. Several of these indicators have been embedded into Conners’ Adult ADHD Rating Scales (CAARS). As their different theoretical underpinnings offer the opportunity of possible synergy effects, the present study sought to examine whether the item- or index-wise combination of multiple validity indicators benefits classification accuracy. A sample of controls (n = 856) and adults with ADHD (n = 72) answered the CAARS, including the ADHD Credibility Index (ACI) honestly, while a group of instructed simulators (n = 135) completed the instrument as though they had ADHD. First, original CAARS items, which are part of the CAARS Infrequency Index (CII), and items drawn from the ACI were combined into a new CII-ACI-Compound Index. Secondly, existing validity indicators, including suspect T-score elevations and the CII, were considered in combination. Both approaches were evaluated in terms of sensitivity and specificity. The combination of four CII and five ACI items into the CII-ACI-Compound Index yielded a sensitivity between 41 and 51% and an estimated specificity above 87%. Suspect T-score elevations on all three DSM scales emerged as another potentially useful validity indicator with a sensitivity of 45 to 46% and a specificity > 90%. Deeming examinees non-credible whenever two or more validity indicators showed suspect results ensured low false-positive rates (< 10%), but reduced sensitivity significantly. Classifying respondents as non-credible as soon as any given indicator fell into the suspect range resulted in frequent false positives (> 11% of misclassified adults with ADHD). Depending on whether high specificity or high sensitivity is prioritized, such combined considerations offer valuable additions to individual validity indicators. High sensitivity provided by “either/or” combinations could prove useful in screening settings, whereas high stakes settings could benefit from “and” combinations.

Efficacy and safety of saffron as adjunctive therapy in adults with attention-deficit/hyperactivity disorder: A randomized, double-blind, placebo-controlled clinical trial

ObjectiveAround 30% of patients with Attention-Deficit/Hyperactivity Disorder (ADHD) do not respond to Ritalin or cannot tolerate its side effects, which necessitates the consideration of alternative options. Previous studies have shown the beneficial effects of Crocus sativus (saffron) in children with ADHD. However, its potential therapeutic effects in adults with ADHD is unknown. This study aimed to evaluate the efficacy and safety of saffron as an adjuvant to Ritalin for improving symptoms in adults with ADHD. DesignThis was a randomized, double-blind, placebo-controlled clinical trial. MethodsFifty-six patients diagnosed with ADHD were assigned into two parallel groups to receive Ritalin (30 mg/day) plus placebo or Ritalin plus saffron (15 mg twice daily) for six weeks. The patients were assessed with Conners' Adult ADHD Rating Scales (CAARS) and the Adult ADHD Self-Report Scale (ASRS) at baseline, week 3 and week 6. ResultsForty-four patients completed the trial. GLM repeated-measure analysis demonstrated significant time × treatment interaction effect for ASRS (df=2, F=3.455, and P-value=0.036) and CAARS (df=1.584, F=3.939, and P-value=0.033) score from baseline to the study endpoint. We found a significantly greater reduction in ASRS scores in the saffron group compared with the placebo group from baseline to the study endpoint (week 6) (P-value=0.024). However, the change score from baseline to week 3 was not significantly different between trial groups (P-value=0.269). There was no significant difference in the improvement of CAARS scores between saffron and placebo from baseline to week 3 or 6 (P-value=0.564 and 0.089, respectively). There was no significant difference between the two groups in baseline parameters and frequency of side effects. ConclusionsSaffron combination therapy with Ritalin can effectively improve symptoms of patients with ADHD. However, further studies with larger sample sizes and longer follow-up treatment are needed to confirm our findings.This trial was registered with the Iranian Registry of Clinical Trials (www.irct.ir; No IRCT20090117001556N111).

14.2 FEASIBILITY, ACCEPTABILITY, AND EFFECTIVENESS OF A NEW COGNITIVE-BEHAVIORAL INTERVENTION FOR COLLEGE STUDENTS WITH ADHD

This study assessed the feasibility, acceptability, and effectiveness of a group CBT intervention to enhance executive function (EF) in college students with ADHD. The treatment addressed time-awareness, distractibility, procrastination, poor planning, failure to complete academic tasks in a timely and effective manner, and the negative automatic thoughts that engender anxiety/depression and further impair academic functioning. Home exercise facilitated practice of the strategies between sessions. The intervention was delivered in 12 weekly 2-hour sessions at a major university in the Netherlands. Two parallel-group series each enrolled 9 undergraduate or graduate students meeting rigorous DSM-5 criteria for ADHD, who comprised the sample. Outcome measures included a clinician-administered structured interview of ADHD symptoms (Adult Investigator Symptom Rating Scale, AISRS), as well as self-report measures of inattentive symptoms (Conners Adult ADHD Rating Scales, CAARS), executive functions (Barkley Deficits in Executive Function Scale, BDEFS), and learning and study skills (Learning and Study Strategies Inventory, LASSI). Students rated program components on a scale from 0 (“not helpful”) to 3 (“very helpful”). Fifteen students (83%) attended 9 or more sessions. There were no study dropouts. Overall program helpfulness was rated as 2.27. The following strategies received the highest mean ratings: planner use (2.83), breaking down aversive tasks into smaller parts (2.56), and identifying (2.22) and challenging (2.00) negative automatic thoughts. Repeated measures analyses of change from pre- to posttreatment yielded improvement in clinician-rated inattentive symptoms (AISRS) (frequency: 6.78 vs 4.22, p = 0.000; effect size (ES) = 0.646), and self-ratings (CAARS) of inattentive symptoms (t scores = 80.22 vs 70.28, p = 0.000; ES = 0.640). Also significantly improved were scores on the BDEFS subscales of Self-Management to Time, Organization, and Total Executive Function, as well as the LASSI subscale of Concentration. Results support the feasibility, acceptability, and effectiveness of a CBT program in reducing inattentive symptoms and enhancing EFs in college students with ADHD and warrant examination in a randomized controlled trial.