Conners' Adult ADHD Rating Scale Research Articles

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.

Attention 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. Participants 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. Weighted 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. No 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.

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.

5.22 Improving the Predictive Value of Self-Report in Adult ADHD Diagnosis

A limited number of studies have assessed the predictive value of self-report questionnaires and items in diagnosing and/or screening for adult ADHD. Recently, for example, a shortened version of the World Health Organization ADHD Screening Scale was developed by selecting items that, taken together, are most predictive of diagnosis. Here, we aim to compare the diagnostic value of multiple self-report and other-report questionnaires commonly used in adult ADHD evaluation and draw on all of these questionnaires to identify a set of items that are mutually most predictive. Analyses drew on a large cohort of adult patients evaluated for ADHD within the Duke University Health System between 2008 and 2019. Each patient completed a subset of the following self-report questionnaires as part of their evaluation: the Barkley Adult ADHD Rating Scale (BAARS) self- and other-report; the Conners’ Adult ADHD Rating Scale (CAARS) self- and other-report; the Conners’ Adult ADHD Diagnostic Interview for DSM-IV Part 1 (CAADID-1); and an additional ADHD screening scale developed at Duke University (DSS). Diagnoses were based on the consensus of a team of ADHD specialists. Predictive models were developed based on: 1) each self-report scale in isolation; and 2) all self-report scales, taken together. Model selection and evaluation were conducted using nested cross-validation, and performance was evaluated using the area under the receiver operating characteristic curve (AUROC). Among the individual questionnaires, prediction performance was highest for the DSS self-report (AUROC = 0.80) followed by the DSS other-report (AUROC = 0.75), CAARS self-report (AUROC = 0.68), BAARS other-report (AUROC = 0.66), and CAADID-1 (AUROC = 0.66). However, combining all available items led to an average prediction performance of AUROC = 0.65 and revealed that the CAADID-1 and CAARS self-report were most predictive across the entire cohort. Moreover, the predictive values of individual items were ranked. Self- and other-report questionnaires used in adult ADHD evaluation vary substantially in their predictive value, and the predictive value of a set of items selected from multiple scales is projected to be higher than that of any individual questionnaire.

ADHD and Academic Success in University Students: The Important Role of Impaired Attention

Objective To improve on several methodological issues regarding current literature investigating the relationship between ADHD symptomatology and academic success in adults and examine the relative contributions of specific dimensions of ADHD symptomatology (i.e., inattention, hyperactivity, and impulsivity) to post-secondary academic success. Method A large sample of 3,688 post-secondary students were examined using a longitudinal design. The Conners’ Adult ADHD Rating Scale (CAARS) was used to assess adult ADHD symptoms and academic success was assessed using students’ official academic records (e.g., final GPAs and degree completion status). Results Students with greater inattention symptomatology at the start of their academic program showed consistently poorer long-term academic success (i.e., lower GPAs, higher dropout rates), regardless of gender. Conclusion Inattention symptoms are the primary driver of the relationship between ADHD symptomatology and academic underachievement in adults. Post-secondary education institutions should target and prioritize educational programming for inattention symptoms of ADHD in at-risk post-secondary students.

High Attention-Deficit/Hyperactivity Disorder Scale Scores Among Patients with Persistent Chronic Nonspecific Low Back Pain

Associations between attention-deficit/hyperactivity disorder (ADHD) and chronic pain disorders, such as fibromyalgia, have been reported. However, associations between persistent chronic nonspecific low back pain (CNLBP) and ADHD have not yet been investigated. This study aimed to investigate the positive rates of possible ADHD, as assessed by self-reported ADHD scales, in patients with persistent CNLBP, using data from self-reported questionnaires completed by patients and their families. This study also aimed to compare the self-reported scores obtained from existing standardized data for healthy individuals, and to examine whether the ADHD scale scores of patients with persistent CNLBP are associated with pain variables. Cross-sectional study. The specialized pain clinic at our university hospital. This cross-sectional study included 60 consecutive patients with persistent CNLBP who were diagnosed with a possible somatic symptom disorder and were referred to a psychiatrist in our pain clinic. The Conners' Adult ADHD Rating Scales (CAARS) self-report (CAARS-S) and observer-rated (CAARS-O) questionnaires were utilized. We investigated the CAARS scores, and the association between the CAARS subscale scores and pain variables (pain duration and pain Numeric Rating Scale) in patients with persistent CNLBP. Of the 60 patients, 19 (31.7%) were positive on both CAARS-S and CAARS-O questionnaires (T-score > 65). The ADHD indices, which comprised subscales of the CAARS estimating the necessity of treatment for ADHD, were significantly higher in both male and female patients with persistent CNLBP than in the Japanese standardized sample (P < 0.005). CAARS-S hyperactivity/restlessness, CAARS-O hyperactivity/restlessness, and the Diagnostic and Statistical Manual of Mental Disorders, fourth edition hyperactive-impulsive symptom subscale scores also correlated with the pain intensity (P < 0.05). In this study, ADHD tendency was evaluated using only a self-reported questionnaire. Hence in the future, accurate and precise assessments of ADHD symptoms using structured clinical interviews conducted by ADHD experts are warranted. Additionally, the study only included patients with persistent CNLBP. Therefore in the future, it will be valuable to investigate ADHD scale scores (e.g., CAARS) among patients with CNLBP and nonspecific low back pain with larger sample sizes. Our findings revealed that the subscale scores on an ADHD scale were considerably high in patients with persistent CNLBP. As a previous study of our clinical experience indicates that persistent CNLBP can be substantially relieved by administering ADHD medications, ADHD screening is warranted in the treatment of persistent CNLBP.

ASD symptoms in adults with ADHD: a preliminary study using the ADOS-2.

Attention-deficit/hyperactivity disorder (ADHD) has long been regarded as disparate and mutually exclusive to autism spectrum disorder (ASD) in the Diagnostic and Statistical Manual of Mental Disorders (DSM)-III-R and DSM-IV. However, this idea has become obsolete due to a growing body of evidence suggesting numerous phenotypic and genetic similarities between ADHD and ASD. ASD symptoms or autistic traits in individuals with ADHD have been examined; however, most studies were conducted on children and relied on self- or parent- reports. ASD symptoms assessed with more direct, objective measures, such as the Autism Diagnostic Observation Schedule, Second Edition (ADOS-2) in adults with ADHD, remain understudied. In the present study, we used the ADOS-2 to evaluate ASD symptoms in adults with ADHD who were not clinically diagnosed with ASD. Fifty-six adults (mean age 33.9years, 35 males, intelligence quotient ≥ 85), who were diagnosed with ADHD based on the DSM-5 criteria, completed Module 4 of the ADOS-2. Autism Spectrum Quotient (AQ), Conners' Adult ADHD Rating Scale (CAARS), and Wechsler Adult Intelligence Scale (WAIS)-III were also administered to assess self-rated ASD symptoms, ADHD symptoms, and intelligence, respectively. Overall, 23.3% of participants met the ASD diagnostic classification on the ADOS-2. Social reciprocal interaction scores tended to be higher, while restricted and repetitive behavior scores were low. The scoring patterns and possible overlapping and differing phenotypic characteristics of ADHD and ASD are discussed.

Non-credible symptom report in the clinical evaluation of adult ADHD: development and initial validation of a new validity index embedded in the Conners’ adult ADHD rating scales

As attention-deficit/hyperactivity disorder (ADHD) is a feasible target for individuals aiming to procure stimulant medication or accommodations, there is a high clinical need for accurate assessment of adult ADHD. Proven falsifiability of commonly used diagnostic instruments is therefore of concern. The present study aimed to develop a new, ADHD-specific infrequency index to aid the detection of non-credible self-report. Disorder-specific adaptations of four detection strategies were embedded into the Conners’ Adult ADHD Rating Scales (CAARS) and tested for infrequency among credible neurotypical controls (n = 1001) and credible adults with ADHD (n = 100). The new index’ ability to detect instructed simulators (n = 242) and non-credible adults with ADHD (n = 22) was subsequently examined using ROC analyses. Applying a conservative cut-off score, the new index identified 30% of participants instructed to simulate ADHD while retaining a specificity of 98%. Items assessing supposed symptoms of ADHD proved most useful in distinguishing genuine patients with ADHD from simulators, whereas inquiries into unusual symptom combinations produced a small effect. The CAARS Infrequency Index (CII) outperformed the new infrequency index in terms of sensitivity (46%), but not overall classification accuracy as determined in ROC analyses. Neither the new infrequency index nor the CII detected non-credible adults diagnosed with ADHD with adequate accuracy. In contrast, both infrequency indices showed high classification accuracy when used to detect symptom over-report. Findings support the new indices’ utility as an adjunct measure in uncovering feigned ADHD, while underscoring the need to differentiate general over-reporting from specific forms of feigning.

A functional magnetic resonance imaging investigation of prefrontal cortex deep transcranial magnetic stimulation efficacy in adults with attention deficit/hyperactive disorder: A double blind, randomized clinical trial

ADHD is one of the most prevalent neurocognitive disorders. Deep Transcranial Magnetic Stimulation (dTMS) is a non-invasive neuromodulation tool that holds promise in treatment of neurocognitive disorders. Hypoactivity of the prefrontal cortex (PFC) has been observed in ADHD. This study examined the clinical, cognitive, and neural effects of dTMS to the PFC in adults with ADHD by using functional magnetic resonance imaging (fMRI). High frequency repetitive dTMS was applied to either the right or left PFC in 62 adults with ADHD in a randomized, double blind, placebo controlled protocol with 3 study groups: 2 treatment arms (rPFC, or lPFC) and a Sham arm. The study included 15 dTMS/cognitive training treatment sessions. Clinical effects were assessed with the Conners Adult ADHD Rating Scale (CAARS) self-report and the Clinical Global Impression score (CGI) as primary outcome measures. Self-report/observer questionnaires and computerized cognitive testing were also performed to assess clinical and cognitive effects. Neural effects were assessed with fMRI using working-memory (WM) and resting-state paradigms. While the study did not show improvement in the primary endpoints, significant improvements were observed in the CAARS (self-report) inattention/memory sub-scale, as well as increased activations in the rDLPFC, right parietal-cortex and right insula/IFG during WM conditions after treatment in the right stimulation group. Increased rDLPFC activation was associated with larger symptom improvement in the right stimulation group. This study indicates that dTMS is effective in modulating attention related brain networks, and is a feasible technique that may improve attention symptoms in adults with ADHD.