Conners Adult Attention-deficit/hyperactivity Disorder Rating Research Articles

Gaze measurements during viewing human dialogue scenes in adults with ADHD: Preliminary findings.

Eye gaze measurement to human dialogue scenes in adults with attention deficit hyperactivity disorder (ADHD) was investigated. We examined whether eye gaze measurement might be a biological marker of ADHD. Twenty-two individuals with ADHD (mean age, 34.5 years) attending the outpatient clinic of Showa University Karasuyama Hospital were included in the study, and 26 healthy individuals (mean age, 32.6 years) with no history of mental disorders were used as the control group. For the participants, intellectual functioning was estimated using the Japanese Adult Reading Test, and mental symptoms were assessed using the Autism Spectrum Quotient and Conner's Adult ADHD Rating Scale. We extracted human dialogue scenes from two classic movies as visual stimuli and recorded the participant's gaze while watching these scenes using Tobii's eye tracker. For gazing time, repeated measures analysis of variance showed no significant main effect of "group" and no significant interaction effect between "group" and areas of interest "(AOI)." In the normal group, gazing time at the eyes was significantly longer than those at the mouth, body, and background; in the ADHD group, gazing time at the eyes was significantly longer than only that at the background. Given the different results obtained in the past in ASD, these results suggest that it would be necessary to directly compare the two groups to determine whether the gaze measurement shows significant differences in ASD and ADHD.

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.

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.

Development and field testing of a decision aid to facilitate shared decision making for adults newly diagnosed with attention-deficit hyperactivity disorder.

BackgroundThe number of individuals who are diagnosed with attention‐deficit hyperactivity disorder (ADHD) during adulthood has increased in recent years. However, there is still no decision aid (DA) to help adults newly diagnosed with ADHD make decisions regarding further treatments.ObjectiveThis study aimed to describe the development process of a DA for adults newly diagnosed with ADHD and its field testing during the shared decision‐making (SDM) process in a clinical setting.MethodsThe development process involved the creation of a DA prototype using the International Patient Decision Aid Standards criteria and revision of the prototype through the stakeholders' reviews. The field testing of the DA compared scores before and after the SDM process on the service users' knowledge scale, decisional conflict scale and the Conners Adult ADHD Rating Scales.ResultsThe developed DA contained options of watchful waiting with own coping skills and pharmacological treatment, which consisted of several kinds of drug options. Fifteen adults newly diagnosed with ADHD participated in the field testing. The participant decision‐making quality outcomes such as their knowledge and decisional conflict improved after the SDM process. ADHD severity did not change.ConclusionA DA for adults with ADHD was systematically developed following the international criteria. Field testing indicated that the DA could serve as a tool to facilitate the SDM process. Further research on this DA is necessary before its routine implementation.Patient or Public ContributionDuring the development process of the DA, the service users who had already been diagnosed with ADHD reviewed the DA prototype and provided feedback, which improved the final version of the DA.

Examining the validity of the ADHD concept in adults and older adults.

It is crucial to clarify the structure of attention-deficit/hyperactivity disorder (ADHD) symptomatology in all age groups to determine how to best conceptualize this disorder across the lifespan. We tested the ADHD factor structure across adulthood and investigated independent associations with executive functions. Data from 645 adults aged 18-59 and 233 adults aged 60-85 were drawn from the Nathan Kline Institute Rockland Sample. Participants completed the Conners Adult ADHD Rating Scale and tests of executive functioning. Invariance of the ADHD factor structure was investigated using confirmatory factor analyses. Associations with cognition were explored using multiple linear regression. Results confirmed a bifactor model with 3 specific factors (inattention, hyperactivity, and impulsivity). Factor loadings and item intercepts were invariant across ages. Levels of hyperactivity and impulsivity were lower in older adults. Inattentive symptoms in young adults were positively related to cognitive flexibility. In older adults, ADHD symptoms predicted poorer working memory. ADHD symptoms manifest similarly across adulthood. The lack of robust associations between ADHD symptomatology and executive functions raises concerns about the usefulness of neuropsychological measures in diagnosing adult ADHD. These results support the validity of the ADHD concept in older adults but suggest a need for age-appropriate normative criteria.

Inattention Predicts Increased Thickness of Left Occipital Cortex in Men with Attention-Deficit/Hyperactivity Disorder.

Attention-deficit/hyperactivity disorder (ADHD) in adulthood is a serious and frequent psychiatric disorder with the core symptoms inattention, impulsivity, and hyperactivity. The principal aim of this study was to investigate associations between brain morphology, i.e., cortical thickness and volumes of subcortical gray matter, and individual symptom severity in adult ADHD. Surface-based brain morphometry was performed in 35 women and 29 men with ADHD using FreeSurfer. Linear regressions were calculated between cortical thickness and the volumes of subcortical gray matter and the inattention, hyperactivity, and impulsivity subscales of the Conners Adult ADHD Rating Scales (CAARS). Two separate analyses were performed. For the first analysis, age was included as additional regressor. For the second analysis, both age and severity of depression were included as additional regressors. Study participants were recruited between June 2012 and January 2014. Linear regression identified an area in the left occipital cortex of men, covering parts of the middle occipital sulcus and gyrus, in which the score on the CAARS inattention subscale predicted increased mean cortical thickness [F(1,27) = 26.27, p < 0.001, adjusted R2 = 0.4744]. No significant associations were found between cortical thickness and the scores on CAARS subscales in women. No significant associations were found between the volumes of subcortical gray matter and the scores on CAARS subscales, neither in men nor in women. These results remained stable when severity of depression was included as additional regressor, together with age. Increased cortical thickness in the left occipital cortex may represent a mechanism to compensate for dysfunctional attentional networks in male adult ADHD patients.

Differential diagnosis and comorbidity of ADHD and anxiety in adults.

The aim of this study was to examine symptom profiles of people diagnosed with attention-deficit/hyperactivity disorder (ADHD) and/or anxiety (ANX) in order to determine the validity of widely used ADHD and ANX rating scales for differential diagnostic use and to develop modified measures that take symptom overlap into account. A cross-sectional design was used to assess differences in rating scale scores between clinical (n=52) and control (n=74) samples as well as differences among subgroups of the clinical sample (22 ADHD; 16 ADHD+ANX; 14 ANX). Participants completed an online questionnaire where they responded to the Conners Adult ADHD Rating Scale (CAARS; Conners, Erhardt, & Sparrow, ) and State Trait Anxiety Inventory scales (STAI; Spielberger, Gorsuch, Lushene, Vagg, & Jacobs, ). Results showed that the CAARS and STAI had limited sensitivity and specificity and may lack in ability to differentially diagnose ADHD and/or ANX. Cluster analysis was used to guide the proposal of modifications for the two scales, which were to use inattentive items only for the CAARS and to exclude state ANX-present items on the STAI for use in differential diagnosis. Further parametric analysis supported these proposed modifications. Clinicians should be made aware of the limitations of the CAARS and STAI scales in terms of specificity, when used to inform differential diagnosis of ADHD and ANX. Further analysis on the psychometric properties of these modified scales is needed in order to confirm that they are valid and reliable scales. Clinical implications It is possible that widely used self-report rating scales are not valid for use in the context of assessing adult ADHD when ANX is present. Clinicians should take alternative approaches to measuring ADHD symptoms in the context of ANX. Findings of the present study suggest the use of inattentive items only for the CAARS and to exclude state ANX-present items on the STAI for differential diagnostic use. Limitations of the study The sample sizes of the clinical subgroups were relatively small. Diagnoses were not confirmed using a semi-structured clinical interview. Alternative cluster approaches (e.g., two-step clustering using larger samples) would provide further insight.

Assessing impulsivity: Relationships between behavioral and self-report measures in individuals with and without self-reported ADHD

The present study examined relationships between self-report and behavioral measures of impulsivity, a personality characteristic linked to diagnostic criteria for multiple psychological disorders, in individuals who either self-reported (n=28) or did not self-report (n=147) a history of Attention-Deficit/Hyperactivity Disorder (ADHD) diagnosis. Undergraduate student participants completed several self-report measures of impulsivity (Barratt Impulsiveness Scale, Impulsive Sensation Seeking subscale, BIS/BAS Scale, Conner's Adult ADHD Rating Scale, and Frontal Systems Behavior Rating Scale) and three behavioral measures of impulsivity (Balloon Analogue Risk Task, Delay Discounting Task, Stroop). A principal components analysis indicated three components encompassing attentional impulsiveness, reward sensitivity, and behavioral and motor impulsiveness; however, none of the behavioral measures factored with the self-report measures. Logistic regressions found attentional impulsiveness to distinguish between individuals with and without a self-reported history of ADHD diagnosis. Impulsivity is a multi-faceted construct, and the utilization of multiple measures, both self-report and behavioral, can aid to more fully and accurately assess the construct in both research and clinical settings.

Inattention, Working Memory, and Goal Neglect in a Community Sample.

Executive function deficits have been linked to attention deficit hyperactivity disorder (ADHD), but it has been theorized that the symptom inattention is specifically related to problems with complex verbal working memory (WM). Using the Conners Adult ADHD rating scale, adults aged 18–35 were assessed for ADHD symptoms, and completed tasks designed to tap verbal and spatial aspects of WM (Experiment 1). Results showed that high inattention predicted poor performance on both simple and complex verbal WM measures. Results relating to spatial WM were inconclusive. In a follow up experiment based on the theory that those with inattention have problems receiving verbal instructions, a measure of goal neglect assessing integration of information into a task model in WM was employed (Experiment 2). Results showed that high inattention uniquely predicted performance on this task, representing the first reported association between inattention and the phenomenon of goal neglect. The results from both experiments lend support to the WM theory of inattention.

Further Validation of the Conner's Adult Attention Deficit/Hyperactivity Rating Scale Infrequency Index (CII) for Detection of Non-Credible Report of Attention Deficit/Hyperactivity Disorder Symptoms.

Attention deficit/hyperactivity disorder (ADHD) can be easily presented in a non-credible manner, through non-credible report of ADHD symptoms and/or by non-credible performance on neuropsychological tests. While most studies have focused on detection of non-credible performance using performance validity tests, there are few studies examining the ability to detect non-credible report of ADHD symptoms. We provide further validation data for a recently developed measure of non-credible ADHD symptom report, the Conner's Adult ADHD Rating Scales (CAARS) Infrequency Index (CII). Using archival data from 86 adults referred for concerns about ADHD, we examined the accuracy of the CII in detecting extreme scores on the CAARS and invalid reporting on validity indices of the Minnesota Multiphasic Personality Inventory-2 Restructured Format (MMPI-2-RF). We also examined the accuracy of the CII in detecting non-credible performance on standalone and embedded performance validity tests. The CII was 52% sensitive to extreme scores on CAARS DSM symptom subscales (with 97% specificity) and 20%-36% sensitive to invalid responding on MMPI-2-RF validity scales (with near 90% specificity), providing further evidence for the interpretation of the CII as an indicator of non-credible ADHD symptom report. However, the CII detected only 18% of individuals who failed a standalone performance validity test (Word Memory Test), with 87.8% specificity, and was not accurate in detecting non-credible performance using embedded digit span cutoffs. Future studies should continue to examine how best to assess for non-credible symptom report in ADHD referrals.

Effects of Group Psychotherapy, Individual Counseling, Methylphenidate, and Placebo in the Treatment of Adult Attention-Deficit/Hyperactivity Disorder

Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder with high prevalence in adulthood. There is a recognized need to assess the efficacy of psychotherapy in adult ADHD. To evaluate the efficacy of cognitive behavioral group psychotherapy (GPT) compared with individual clinical management (CM) and that of methylphenidate hydrochloride compared with placebo. Prospective, multicenter, randomized clinical trial of 18- to 58-year-old outpatients with ADHD from 7 German study centers. Patients were recruited between January 2007 and August 2010, treatment was finalized in August 2011, and final follow-up assessments occurred in March 2013. Sessions of GPT and CM were held weekly for the first 12 weeks and monthly thereafter (9 months). Patients received either methylphenidate or placebo for 1 year. The primary outcome was the change in the ADHD Index of the Conners Adult ADHD Rating Scale from baseline to the end of the 3-month intensive treatment (blinded observer ratings). Secondary outcomes included ADHD ratings after 1 year, blinded observer ratings using the Clinical Global Impression Scale, and self-ratings of depression. Among 1480 prescreened patients, 518 were assessed for eligibility, 433 were centrally randomized, and 419 were analyzed as randomized. After 3 months, the ADHD Index all-group baseline mean of 20.6 improved to adjusted means of 17.6 for GPT and 16.5 for CM, with no significant difference between groups. Methylphenidate (adjusted mean, 16.2) was superior to placebo (adjusted mean, 17.9) (difference, -1.7; 97.5% CI, -3.0 to -0.4; P = .003). After 1 year, treatment effects remained essentially stable. Descriptive analyses showed that methylphenidate was superior to placebo in patients assigned to GPT (difference, -1.7; 95% CI, -3.2 to -0.1; P = .04) or CM (difference, -1.7; 95% CI, -3.3 to -0.2; P = .03). Regarding depression, no significant differences were found. In contrast, GPT was superior to CM for all visits in the Clinical Global Impression global assessment of effectiveness. Highly structured group intervention did not outperform individual CM with regard to the primary outcome. Psychological interventions resulted in better outcomes during a 1-year period when combined with methylphenidate as compared with placebo. isrctn.org Identifier: ISRCTN54096201.

Adult attention-deficit hyperactivity disorder, risky behaviors, and motorcycle injuries: a case-control study.

BackgroundThe aim of this study was to assess the association of motorcycle traffic injuries with motorcycle riding behavior and subtypes of attention-deficit hyperactivity disorder (ADHD) while controlling for individual correlates of motorcycle traffic injuries.MethodsA case-control study was carried out in 298 patients with motorcycle trauma along with 151 control patients admitted to the Shohada and Imam Reza university hospitals as the two referral specialty centers in the East Azarbyjan Province of Iran in 2013. The Persian version of the Motorcycle Riding Behavior Questionnaire and the Persian version of Conner’s Adult ADHD Rating Scales (the self-report short version) were used to assess riding behavior and screen for adult ADHD, respectively. The scale has four subscales, comprising subscale A (inattention), subscale B (hyperactivity, impulsivity), subscale C (A + C), and subscale D (ADHD index). The statistical analysis was done using Stata version 11.ResultsAll subjects were male and aged 13–79 years. Approximately 54% of the participants were married and 13% had academic education. Approximately 18% of the motorcycle riders stated that their motorcycle riding was only for fun purposes. More than two thirds of the participants did not have a motorcycle riding license. Variables found to be significantly associated with motorcycle injuries in bivariate analysis included age, marital status, educational level, having a motorcycle riding license, using a helmet while riding, daily amount of riding, riding just for fun, riding behavior score, and ADHD scale scores. It was found in multivariate analysis that if the ADHD index (subscale D) score was used to assess the association of ADHD with motorcycle injuries, a protective role for ADHD was observed. However, the two other subscales showed a different predictive pattern for subscale A versus subscale B, with only subscale B increasing the likelihood of motorcycle traffic injuries. The score based on motorcycle rider behavior was found to be associated with motorcycle injuries. Other variables that were significant in multivariate models were the purpose of riding, educational level, economic status, and marital status.ConclusionADHD and riding behavior scores affect the likelihood of motorcycle traffic injuries among motorcycle riders independent of other injury indicators, and include education, purpose of riding, and economic status.

Distribution and Within-Family Specificity of Quantitative Autistic Traits in Patients with Neurofibromatosis Type I

To examine the distribution of quantitative autistic traits (QATs) in an independent neurofibromatosis type I (NF1) sample, the relationships between QAT, sex, and attention deficit hyperactivity disorder (ADHD) symptomatology, and to explore evidence for QAT mutational specificity within families. Age-appropriate versions of the Social Responsiveness Scale, second edition and the Conners Adult ADHD Rating Scales were completed for 103 patients with NF1 from the Washington University Neurofibromatosis Center. Patients with NF1 exhibited a pathologically shifted unimodal distribution for QAT. Forty-four percent of the subjects exhibited a QAT burden at or above 1 SD from the population mean; 13% scored at or above the extreme first percentile of the general population distribution. Elevations in ADHD symptomatology exhibited a distinct bimodal distribution; however, mean ADHD index scores were equivalent in patients who had been diagnosed in the community with ADHD compared with those who had not. We observed striking within-family associations for QAT, reflected by an Social Responsiveness Scale, second edition intraclass correlation of 0.77 in pairings of first degree relatives with NF1. Impairments in reciprocal social behavior and attention affect a large proportion of patients with NF1 throughout life and are often clinically unrecognized. Further exploration of genotype-phenotype correlation is strongly warranted for the purpose of gaining insights into mechanisms by which specific mutational variations in the NF1 gene may influence autistic trait severity.

대학생의 주의력결핍과잉행동장애 증상 출현율과 우울과의 관계 -보건계열 학생을 중심으로-

본 논문은 대학생들의 과잉행동성충동장애 증상 출현율과 우울과의 관계를 알아보고자 하였다. 대학생 350명을 대상으로 Conners 과잉행동성충동장애 평정척도와 Beck 우울척도를 이용한 조사를 실시하였다. 대학생들의 과잉행동성충동장애 증상 출현율은 5.1%이였고 그 중 부주의형이 가장 높았다. 우울 정도는 <TEX>$8.38{\pm}6.86$</TEX>점이었고 여학생이 남학생보다 우울정도가 높았으며, 보통 우울증상과 심한 우울증상자는 2.1%이었다. 과잉행동성충동장애가 우울에 영향을 주는 모형 설명력은 33.5%로 다소 높았으며, 과잉행동성충동장애 증상과 우울 증상의 공존율은 전체 학생 중 3.1%로 나타나서, 대학생들의 성인 과잉행동성충동장애 증상 출현율과 우울은 관계가 있는 것으로 보인다. 성인 과잉행동성충동장애로 인한 다양한 문제를 고려하면 이에 대한 사회적 차원의 대책 수립이 필요한 것으로 보인다. This study was conducted to investigate the relationship between depression and adult attention deficit hyperactivity disorder(ADHD) of college students. Collage students up to 350 people self-report survey was conducted using the Conners ADHD Rating Scale Korean version and Beck Depression Inventory. Adult ADHD symptoms prevalence was 5.1 % and the highest form of carelessness. Depression grade was <TEX>$8.38{\pm}6.86$</TEX> points of college students and female students was higher than male students is depression grade, severe depression and modurate depressive symptoms were 2.1 %. Model of explanatory were slightly higher in 33.5%, adult ADHD affects depression and coexistence rate of adult ADHD symptoms and depressive symptoms was found to be 3.1%. Therefore, adult ADHD symptoms prevalence and depression of collage students seems to be relationship. Given the wide range of social and emotional problems due to adult ADHD seems necessary measures to establish a social dimension to adult ADHD.

The Relationship between ADHD Symptoms and Big Five Personality in University Students

Attention-deficit/hyperactivity disorder (ADHD) is often diagnosed in childhood but persists into adulthood in many cases. This disorder, which is defined by the core symptoms of inattention (IA) and hyperactivity/impulsivity (HI), is also associated with impairment in academic settings, interpersonal relationships, and behavioural risk taking. This study examined the relationship between ADHD symptoms and basic personality in a sample of university students (123 men and 252 women). Participants were selected by multistage sampling from Golestan Payam Noor University and completed the DSM-IV ADHD Scales from the Conner's Adult ADHD Rating Scale (CAARS) as well as the Five Factor Inventory (FFI). This research is correlational study. Results showed that there are significant positive relationship between Neuroticism and inattention, hyperactivity/impulsivity, ADHD, ADHD index and negative relationship find between Extraversion with inattention, Agreeableness, Conscientiousness and Openness to experience with inattention, hyperactivity/impulsivity, ADHD, ADHD index. t-tests showed that are gender difference between men and women in ADHD in few aspects. The results of the present work are in line with previous evidence of a significant correlation between ADHD and some personality traits in university students.

Association of Attention Deficit Hyperactivity Disorder with Heroin Addiction

Objectives: To study the association of attention-deficit hyperactivity disorder (ADHD) with heroin addiction. Study design: A cross-sectional, hospital based study. Place and duration of study: The study was carried out at Lady Reading Hospital and Khyber Teaching Hospital, Peshawar, Pakistan from 4th April 2012 to 13th September 2012. Subjects and Methods: A sample of 137 adult heroin addicts were analyzed that whether they were ADHD and that childhood problem continues to manifest symptoms in adults. For retrospective assessment of childhood ADHD, the Wender Utah Rating Scale (WURS) as well as the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) symptom checklist for ADHD was used. The Conners’ Adult ADHD Rating Scales (CAARS) was used to assess the persisting symptoms of ADHD in adults. Inclusion criteria: Patient diagnosed with heroin addiction according to ICD-9 and DSM-IV. Exclusion criteria: Patient has co-morbid with any other mental illnesses. Results: The difference between the mean score of WURS and CAARS of ADHD patients were significantly greater than the normal patients. Heroin addicts showed 41.6% (WURS) and 38.6% (DSM-IV diagnostic criteria) that indicated evidence of retrospective ADHD affliction in childhood. 22.6% were IV users. CAARS was presented in 37.9% heroin addicts who exhibited a substantiation of ADHD persistent in adulthood. The difference between the mean score of WURS and CAARS of ADHD patients were significantly greater (P = 0.003), than the normal patients. Conclusions: These results revealed that addiction is associated with co-morbidity with ADHD, expressed in the form of heroin addiction. DOI: http://dx.doi.org/10.3329/bjms.v13i2.18294 Bangladesh Journal of Medical Science Vol.13(2) 2014 p.128-134

Detecting Feigned ADHD in Later Adolescence: An Examination of Three PAI–A Negative Distortion Indicators

The validity of various indicators of response distortion on the Personality Assessment Inventory–Adolescent (PAI–A; Morey, 2007a) and its potential usefulness to detect malingering were evaluated by having 17- and 18-year-old students complete the PAI–A attempting to simulate Attention-Deficit/Hyperactivity Disorder (ADHD) under coached or noncoached conditions. Scores for these respondents on the Negative Impression and Positive Impression scales, the Malingering Index, and the Rogers Discriminant Function (RDF) were compared to those of 17- and 18-year-old patients receiving clinical diagnoses of ADHD. Simulating respondents also completed the Conners Adult ADHD Rating Scale (CAARS) to determine if they could successfully simulate self-reported symptoms of ADHD. A total of 45% of simulating participants obtained CAARS scores reflecting clinically significant symptoms of ADHD. All indicators demonstrated the ability to distinguish between actual patients and feigned responses of successful simulators, with the RDF demonstrating the greatest accuracy in distinguishing these groups.

Higher Reported Levels of Depression, Stress, and Anxiety Are Associated With Increased Endorsement of ADHD Symptoms by Postsecondary Students

This study examined the extent to which postsecondary students endorse symptoms of Attention Deficit/Hyperactivity Disorder (ADHD) and whether experienced level of stress, depression, or anxiety are associated with higher reporting of ADHD symptoms. Students attending a combined health and counseling service completed the Conners Adult ADHD Rating Scale (CAARS), the Depression Anxiety and Stress Scale (DASS), and the Life Experiences Survey (LES). A subset also completed the Brown Attention Deficit Disorder Scale (BADDS). Findings demonstrate that the BADDS had weak specificity; 35% of never-diagnosed postsecondary students were classified as probably or very probably having ADHD based on their BAADS score. Lower false positive rates were found on the CAARS. Misdiagnosis of ADHD seems especially likely in students experiencing high levels of stress, depression, or anxiety, as these psychological conditions were associated with elevated reporting of ADHD symptoms; such conditions must therefore be considered when assessing for possible ADHD in young adults.

The Utility of Attention-Deficit/Hyperactivity Disorder Screening Instruments in Individuals Seeking Treatment for Substance Use Disorders

Several screening tools for attention-deficit/hyperactivity disorder (ADHD) have been validated in non-substance-abusing populations, but limited data are available regarding their utility in adults with current substance use disorders. The aim of this study was to determine the sensitivity, specificity, and positive and negative predictive values of 3 commonly used ADHD screening instruments in cocaine-dependent individuals. Adults seeking treatment for cocaine dependence (N = 102) were administered 3 self-report instruments between May 2009 and April 2011: the Conners Adult ADHD Rating Scale (CAARS), the Wender Utah Rating Scale (WURS), and the Adult ADHD Self-Report Scale-Version 1.1 (ASRS-V1.1). They then met with master's-level clinicians who administered the Conners Adult ADHD Diagnostic Interview for DSM-IV (CAADID). With the CAADID serving as the gold standard, the validity of the screening instruments was determined, both singly and in combination. Twenty-five (25%) of the 102 patients met DSM-IV criteria for ADHD or ADHD not otherwise specified (NOS) based on the CAADID. Kappa scores determining agreement between the screening tools and the CAADID (with ADHD NOS labeled as ADHD or labeled as not ADHD) ranged from 0.37 to 0.69. Sensitivity scores for the broadest range of ADHD cases were 80.0%, 87.5%, and 60.9% for the CAARS, WURS, and ASRS-V1.1, respectively. Positive predictive value was highest for the CAARS, at 74.1%, and negative predictive value was highest for the WURS, at 95.1%. The highest sensitivity (96.0%) was found with coadministration of the WURS and CAARS. While all of the screening instruments were found to have adequate sensitivity and specificity, the CAARS outperformed the other instruments in regard to agreement with the CAADID and positive predictive values. However, the WURS, with the highest sensitivity in regard to the broadest range of ADHD cases, may be the single best instrument for preliminary screening purposes. Further, because the ASRS-V1.1 is the simplest and shortest instrument to administer, it may have advantages when a large number of patients need to be screened.

Randomized Controlled Study of the Histamine H3 Inverse Agonist MK-0249 in Adult Attention-Deficit/Hyperactivity Disorder

It has been suggested that the histamine subtype 3 receptor inverse agonists such as MK-0249 might be effective in treating attention-deficit/hyperactivity disorder (ADHD). We evaluated the effects of MK-0249 in adults with ADHD. A randomized, double-blind, placebo-controlled, incomplete block, 2-period crossover study of MK-0249 5-10 mg/d and osmotic-release oral system (OROS) methylphenidate 54-72 mg/d (active comparator) was performed in 72 men and women aged ≥ 18 to ≤ 55 years who met DSM-IV criteria for ADHD of either inattentive or combined subtype and who had a chronic course of behavior disorder. The study was conducted from August 2007 through April 2008 at 6 US sites. Primary efficacy was assessed by the mean change from baseline in the Adult ADHD Investigator Symptom Rating Scale (AISRS) total score after 4 weeks of treatment. Change from baseline in AISRS at week 4 for MK-0249 was not different from placebo (P = .341), whereas a significant benefit was seen for OROS methylphenidate versus placebo (P < .001). Analysis of secondary end points, including the Conners Adult ADHD Rating Scales, showed results consistent with the AISRS. A similar percentage of patients reported adverse events for MK-0249 compared with placebo (73% versus 69%, respectively). However, a greater percentage of patients reported insomnia as an adverse event with MK-0249 treatment compared with placebo (32% versus 11%, respectively). MK-0249 10 mg/d is not effective for the treatment of adult ADHD. ClinicalTrials.gov identifier: NCT00475735.