Identification Of Attention Deficit Hyperactivity Disorder Research Articles

Measuring adult Attention Deficit Hyperactivity Disorder using the Quantified Behavior Test Plus.

Attention Deficit Hyperactivity Disorder (ADHD) occurs in approximately 5% of the adult population and includes cardinal symptoms of hyperactivity, inattention, and impulsivity that may be difficult to identify with clinical routine methods. Continuous performance tests are objective measures of inattention and impulsivity that, combined with objective measures of motor activity, facilitate identification of ADHD among adults. The aim of the present study was to examine the sensitivity, specificity, and a composite measure of ADHD using objective measures of the ADHD-cardinal symptoms in adult participants with ADHD and non-ADHD normative participants. Cardinal symptoms were measured in 55 participants having ADHD, 202 non-ADHD normative participants, as well as 84 ADHD normative participants using the Quantified Behavior Test Plus. This test measures inattention and impulsivity using a continuous performance test, and hyperactivity using a motion-tracking system. A predictive variable for the detection of ADHD called Prediction of ADHD yielded 86% sensitivity and 83% specificity. A composite measure of ADHD cardinal symptoms was developed using a Weighed Core Symptoms scale that indicated the total amount of ADHD symptoms on a numeric scale from 0 to 100. The total amount of ADHD symptoms was measured on a scale and predicted with the categorical variable in a majority of the cases in the present study. Further studies are needed in order to confirm the results with regard to additional clinical and normative samples. Careful consideration of potential sex and diagnostic subtype differences are noteworthy aspects for future examinations of the new instruments.

Adult ADHD: clinical aspects and therapeutic implications

Attention Deficit Hyperactivity Disorder (ADHD) has been originally described as a disorder of childhood and adolescence. In the last years, a huge amount of evidence supports a syndromal continuity form childhood to adulthood. the identification of ADHD in adults raises several problems of differential diagnosis and the disorder is frequently associated with other mental disorders, at least in patients referred to psychiatric settings. It is not clear if adult ADHD is characterized by a specific pattern of symptoms that include attentive deficits and consequent behavioral manifestations, instead of hyperactivity. Comorbidity with other mental disorders influences clinical picture, severity, course and treatment outcome. In particular comorbid ADHD, bipolar disorder and alcohol/substance abuse disorders coexist in a relevant proportion of cases and it might represent a specific phenoptype, associated with treatment resistance. Substances use, often poly-drug abuse, such as alcohol, cocaine, stimulants and heroin, inevitably complicates course and therapeutic choice. The recognition of ADHD in adults has important implications at therapeutic level, even when present as incomplete and residual forms. Psychostimulants and other compounds with specific efficacy on ADHD symptomatology has been shown to be useful also in adults both in monotherapy and in association with other drugs, such as mood stabilizers. However their use should be cautious when a mood disorder coexists, for the possible induction of manic-switches or rapid cycling. Further research is necessary in order to better characterize the clinical picture of ADHD in adults and to elaborate widely shared treatment guidelines.

Challenges in Identifying and Managing Attention-Deficit/Hyperactivity Disorder in Adults in the Primary Care Setting

To examine how to screen for and establish a correct diagnosis of attention-deficit/hyperactivity disorder (ADHD) in adults and to identify the outcomes associated with untreated ADHD. PubMed was searched using the key words ADHD, adult, diagnosis, and primary care from the years 1999 to 2009. This search produced 50 publications. Publications were screened for data specific to the diagnosis or management of adult patients with ADHD in the primary care setting. The estimated prevalence of ADHD in adults throughout the United States is 4.4% or approximately 10 million adults. Adults with ADHD by definition must experience impairment from the symptoms of ADHD in at least 2 areas of their life. Despite significant impairment, only 1 in 10 adults with ADHD have received ADHD treatment within the past year. Given the high rates of undertreatment, primary care physicians, who provide much of the general adult mental health care in the United States, are increasingly charged with making the diagnosis of ADHD in adults. ADHD symptoms are often masked by comorbid psychiatric conditions or patient adaptations such as choice of occupation. One of the ADHD assessment tools, a short 6-item screener, can simplify identification and management of ADHD in adults and help identify which patients may require further evaluation. Primary care physicians should consult with other members of the health care community such as psychiatrists and psychologists when necessary, but should also develop a level of comfort with diagnosing and treating ADHD.

The Utility of Home Problem Pervasiveness and Severity in Classifying Children Identified with Attention-Deficit/Hyperactivity Disorder

Given the propensity for clinical assessment of Attention-Deficit/Hyperactivity Disorder (ADHD) to focus on core behavioral symptoms, the current study examined how well other predictors classified children who were diagnosed with ADHD by licensed practitioners. Participants were 91 children (39 ADHD-identified, 52 without ADHD), aged 8 to 13 years. In addition to significantly more ADHD symptoms, the ADHD-identified group exhibited significantly more externalizing problems and internalizing symptoms, less adaptive functioning, and greater problem pervasiveness and severity. Binary logistic regression analyses indicated that problem pervasiveness and severity significantly predicted diagnostic group membership when controlling for other predictors, and pervasiveness added unique variance beyond measures of core ADHD symptoms. Diagnostic utility analyses showed measurement of problem pervasiveness and severity to be a useful tool in the identification of ADHD. Findings provide support for the practical use of a parent-report measure of impairment in the home as part of evidence-based assessment of ADHD.

Critique of the article by Visser and Jehan (2009): ‘ADHD: a scientific fact or a factual opinion? A critique of the veracity of Attention Deficit Hyperactivity Disorder’

This article seeks to evaluate and take further the discussion put forward by Visser and Jehan (Emotional and Behavioural Difficulties 14, no. 2: 127–40). It begins by focusing on the biomedical discourse, its dominance in the academic and professional literature and why the existence of Attention Deficit Hyperactivity Disorder (ADHD) as a medical category is questionable. This is followed by a discussion of other discourses including the sociological discourse and the bio-psychosocial discourse. The importance of multi-professional approaches in the identification, assessment and management of ADHD is highlighted, followed by an examination of what part the educational environment might play with regard to behaviours associated with ADHD. Attention is drawn to the need for continuing research and debate on this evolving concept.

The Conners' 10‐item scale: findings in a total population of Swedish 10–11‐year‐old children

To present normative data for the Swedish version of the Conners' 10-item scale, to validate the scale by comparing children with and without attention deficit/hyperactivity disorder (ADHD), to explore the factor structure of this scale and to investigate behavioural characteristics and gender differences among 10- to 11-year-old children, as rated by parents and teachers respectively. Parents and teachers rated 509 10- to 11-year-old children (261 boys and 248 girls) from a population-based cohort in a Swedish municipality. The Conners' 10-item scale discriminated very well between children with and without ADHD. Confirmatory factor analyses confirmed a two-dimensional structure of the scale with items measuring restless/impulsive behaviour in one factor and items measuring emotional lability in another. An ANOVA revealed that parents and teachers reported different behavioural characteristics in boys as compared to girls. The Conners' 10-item scale is a valid screening instrument for identification of ADHD. The two subscales can be used separately, in addition to the total score, to get a more detailed picture of the child's behaviour. Parents and teachers pay attention to different aspects of problem behaviour in boys and girls. The less disruptive behaviour of girls needs to be highlighted.

Screening for attention-deficit/hyperactivity disorder in a select sample of injured and uninjured pediatric patients

Purpose Injury is the leading cause of morbidity and mortality to children. The purpose of this study is to compare attention-deficit/hyperactivity disorder (ADHD) screening results in a select group of injured pediatric patients to noninjured patients. Methods Parents of patients 6 to 12 years of age were enrolled in the study. Patients were either admitted for specific injury mechanisms (n = 133) or appendicitis (n = 157). Demographic and medical data were collected, and an ADHD screening tool was administered. Logistic regression models were used to compare screening results between groups. Results The injured patient group was 3.25 times more likely to screen positive for ADHD (odds ratio, 3.25; 95% confidence interval, 1.57-6.72; P = .002) than the appendicitis group. Among the injured patients who screened positive for ADHD, only 34.0% reported currently receiving treatment. Conclusions Our results suggest that pediatric patients with certain injury mechanisms may warrant screening and referral for ADHD. Appropriate identification and treatment of undiagnosed ADHD may reduce the burden of injury recidivism. Screening and referral for ADHD within a trauma service should be evaluated for effectiveness as an injury prevention initiative.

Blinded, multi-center validation of EEG and rating scales in identifying ADHD within a clinical sample

Previous validation studies of attention deficit/hyperactivity disorder (ADHD) assessment by rating scales or EEG have provided Class-IV evidence per standards of the American Academy of Neurology. To investigate clinical applications, we collected Class-I evidence, namely from a blinded, prospective, multi-center study of a representative clinical sample categorized with a clinical standard. Participating males (101) and females (58) aged 6 to 18 had presented to one of four psychiatric and pediatric clinics because of the suspected presence of attention and behavior problems. DSM-IV diagnosis was performed by clinicians assisted with a semi-structured clinical interview. EEG (theta/beta ratio) and ratings scales (Conners Rating Scales-Revised and ADHD Rating Scales-IV) were collected separately in a blinded protocol. ADHD prevalence in the clinical sample was 61%, whereas the remainder had other childhood/adolescent disorders or no diagnosis. Comorbidities were observed in 66% of ADHD patients and included mood, anxiety, disruptive, and learning disorders at rates similar to previous findings. EEG identified ADHD with 87% sensitivity and 94% specificity. Rating scales provided sensitivity of 38–79% and specificity of 13–61%. While parent or teacher identification of ADHD by rating scales was reduced in accuracy when applied to a diverse clinical sample, theta/beta ratio changes remained consistent with the clinician's ADHD diagnosis. Because theta/beta ratio changes do not identify comorbidities or alternative diagnoses, the results do not support the use of EEG as a stand-alone diagnostic and should be limited to the interpretation that EEG may complement a clinical evaluation for ADHD.

Sex differences in tactile defensiveness in children with ADHD and their siblings

Tactile defensiveness (TD) is a disturbance in sensory processing and is observed in some children with attention-deficit-hyperactivity disorder (ADHD). TD has been examined in male children with ADHD and in children with ADHD without differentiating by sex. As males and females with ADHD may differ in the clinical expression of the disorder and associated deficits, the aim of this study was to examine sex differences in TD in males and females with ADHD. Non-affected siblings were also examined to investigate familiality of TD. The Touch Inventory for Elementary-School-Aged Children was administered to 47 children with ADHD (35 males, 12 females; mean age 9y 8mo [SD 1y 11mo]), 36 non-affected siblings (21 males, 15 females; mean age 8y 10mo [SD 2y 4mo]), and 35 control children (16 males, 19 females; mean age 9y 5mo [SD 6mo]). Results indicated that females with ADHD displayed higher levels of TD than males with ADHD (who did not differ from control males). This suggests that TD is sex specific and may contribute to the identification of ADHD in females, thus improving diagnostic and therapeutic strength in this under-referred group. Non-affected siblings were unimpaired, regardless of sex, which suggests that TD is specific to the disorder and not part of a familial risk for ADHD.

Comparison of a Parent-Rated DSM-IV Measure of Attention-Deficit/Hyperactivity Disorder and Quantitative EEG Parameters in an Outpatient Sample of Children

Attention-deficit/hyperactivity disorder (ADHD) was investigated using the parent-as-respondent, 200-item, Coolidge Personality and Neuropsychology Inventory (CPNI) and a quantitative electroencephalograph (QEEG). Parents of 183 children (mean age = 12.2 years) brought to an outpatient private clinic for behavioral and/or emotional problems completed the CPNI including the 18-item DSM-IV-based ADHD scale and their children were also evaluated by QEEG. The correlation between the CPNI ADHD scale T score and the categorical QEEG parameter (based on the beta-theta power ratio) for the identification of ADHD was r = -0.15. Using a dichotomous ADHD CPNI measure (positive/negative) and the QEEG beta-theta power ratio resulted in an r value of -0.09. The sensitivity of the QEEG ADHD parameter and the CPNI ADHD scale was 50% and the specificity was 36%. The results stand in contrast to those of who found 90% sensitivity and 94% specificity between behavioral measures of ADHD and the QEEG scanning procedure. The lack of correspondence between the two measures is discussed.

How Common are Symptoms of ADHD in Typically Developing Preschoolers? a Study on Prevalence Rates and Prenatal/Demographic Risk Factors

According to the Diagnostic and Statistical Manual of Mental Disorders - Fourth Edition (DSM-IV - American Psychiatric Association, 1994), one of the diagnostic criteria for attention deficit hyperactivity disorder (ADHD) is the presence of symptoms of inattention and/or hyperactivity-impulsivity before the age of 7 years. In contrast to studies with older children, relatively little is known about ADHD symptoms in preschoolers. In order to address this issue, the present study was designed to investigate to what extent ADHD behaviors exist in a large community based group of preschoolers in the Netherlands. A second aim of this study was to shed light on the etiology of ADHD, by examining if and how a range of prenatal and demographic factors contribute to the prediction of ADHD behaviors in young children. Participants included 652 parents of children between the ages of 3 and 6 years. Parents were asked to complete two questionnaires: the Preschool Behavior Questionnaire (Smidts and Oosterlaan, 2005) and a background information questionnaire, specifically designed for this study. Findings from the present study show that ADHD symptoms are quite common in preschoolers, with approximately one-third of all ADHD behaviors listed in the Preschool Behavior Questionnaire being highly frequent in early childhood. It appears that hyperactive-impulsive symptoms are more common in preschoolers than inattentive behavior. For the purpose of an early identification of ADHD, this finding is particularly important, as it may be argued that inattentive behavior in preschoolers may be indicative of psychopathology. Significant predictors of ADHD behaviors included maternal smoking and alcohol, and illness of the mother during pregnancy; however, together these

A School-Based Approach to Early Identification and Management of Students With ADHD

Attention-deficit/hyperactivity disorder (ADHD) is one of the most challenging chronic conditions for children, families, schools, and physicians. Because symptoms of ADHD can be mistaken for other health conditions and misdiagnosis can occur, accurate diagnosis and treatment require comprehensive evaluation. This article introduces a school-based framework—ADHD Identification and Management in Schools (AIMS)—developed by a multidisciplinary team composed of a pediatrician, school nurses, and school psychologists that sought to improve communication between school personnel and physicians, standardize practice, and improve the quality of care for children with ADHD. The framework provides school nurses with an evidence-based, systematic method for early identification and management of children with ADHD.

Identification of children at risk of Attention Deficit/Hyperactivity Disorder

In many countries, the majority of children who have Attention Deficit/Hyperactivity Disorder (ADHD) are undiagnosed and there is limited recognition of child mental health problems in primary care. Teachers may be well placed to identify unrecognised children and to facilitate their referral to specialist services. Despite this, there has been limited intervention research addressing teacher identification of ADHD. This study aims to examine whether an educational intervention about ADHD for teachers improves their recognition of children at risk of ADHD. A before and after investigation of an educational intervention about ADHD for teachers took place in 6 primary schools (involving 96 class teachers and 2672 pupils). Teacher recognition was compared against a diagnostic algorithm for ADHD caseness that utilised both parent and teacher ratings. Changes in teacher recognition of children with probable ADHD, as well as predictors of recognition, were examined. Following the intervention, there was an increase in the proportion of children regarded by teachers as having probable ADHD. There was also improved agreement between teacher recognition and the diagnostic algorithm. Teacher views that a child had probable ADHD were based on both the severity of symptoms and the impact of these problems on the teacher and the class. It is feasible to deliver an educational intervention addressing teacher identification of ADHD in routine practice. This was associated with an improvement in the ability of teachers to more accurately identify children at risk of ADHD. The provision of a brief educational intervention for teachers could assist in improving the identification of undiagnosed children with ADHD in the community.

Parental beliefs about the nature of ADHD behaviours and their relationship to referral intentions in preschool children

Parental beliefs about child problem behaviour have emerged as closely related to referral intentions to mental health services. This study compared beliefs of severity, impact and advice seeking for attention deficit/hyperactivity disorder (ADHD) behaviours of parents whose preschool children present ADHD behaviours with those of parents whose children do not display such behaviours. Both parents of 295 preschoolers, aged 4-6 years, enrolled in kindergartens in Athens, filled in: (i) a questionnaire composed by a vignette describing a hypothetical 5-year-old child presenting ADHD symptoms followed by rating scales assessing dimensions of severity, impact and referral intention, and (ii) the 'Strengths and Difficulties Questionnaire' for screening ADHD behaviours in their own child. Results showed that almost half of the parents who reported ADHD behaviours in their own child replied that they had never met a child exhibiting such behaviours. These parents also perceived such behaviours as being less severe and with less negative family impact than parents who did not report such behaviours in their own child. Parents whose preschool child displays ADHD behaviours tend to perceive them as normal developmental patterns and may suspend the referral of the child. Implications of these findings for early identification of ADHD are discussed.

Attention Deficit Hyperactivity Disorder Comorbid With Emotional and Behavioral Disorders and Learning Disabilities in Adolescents

This study examined in depth a group of adolescents (n = 12) who were identified as having attention deficit hyperactivity disorder (ADHD). The group was identified as part of a longitudinal study of students who were screened in primary school as at risk for developing emotional and behavioral disorders (EBD) and peers who were identified as not at risk in secondary school (N = 165). The prevalence of ADHD comorbid with EBD and learning disabilities (LD) was investigated. Teacher ratings of behavior on the Behavior Assessment System for Children (Reynolds & Kamphaus, 1992) were used to identify students with ADHD and/or EBD. For LD identification, students met criteria on at least 1 of 5 models for identifying LD. The study also investigated gender differences as well as differences between students with and without ADHD on several school variables (e.g., achievement, ability). Results indicated that 12 students (7.3%) of the sample met the criteria for ADHD identification. More girls than boys with ADHD were identified (a ratio of 3:1). Within the ADHD group, 7 students met criteria for comorbid ADHD/EBD, and a range of 1 to 6 students met criteria for comorbid ADHD/EBD/LD, depending on the model used to identify LD. Students with ADHD scored more poorly than students without ADHD across all school variables. Implications for early and appropriate identification and intervention for students with ADHD are discussed, particularly for girls with ADHD who may be underidentified.

Empirically Informed Attention-Deficit/Hyperactivity Disorder Evaluation With College Students

Attention-deficit/hyperactivity disorder (ADHD) is both an underdiagnosed and a misdiagnosed problem on college campuses, leading to pronounced academic and psychosocial difficulties. Counselors encounter diagnostic criteria that are child oriented, long lists of differential diagnoses, high rates of coexisting disorders, and no definitive tests for ADHD. This article reviews research findings concerning adults with ADHD, outlines empirical solutions for meeting diagnostic challenges, and provides new effect size data for selecting screening instruments. ********** Attention problems are frequent complaints of college students presenting for counseling. Isolating the magnitude, range, and basis of student inattention is critical for effective therapeutic intervention but is frequently complicated. College maladjustment may result in transient attention problems that are specific to the classroom. Longer lasting and more pervasive attention difficulties may emerge as secondary features of psychiatric or medical conditions, or these difficulties may reflect a chronic attention syndrome, attentiondeficit/hyperactivity disorder (ADHD). Undiagnosed ADHD is a significant problem on college campuses and, paradoxically, is one that is compounded by erroneous self-diagnoses by students seeking treatment (Roy-Byrne et al., 1997; Searight, Burke, & Rottneck, 2000). In the pages to follow, a primer on adult ADHD evaluation is presented as a resource for college counselors. Counselors, like other helping professionals, frequently lack advanced training in adult ADHD. A variety of factors, including paperwork and case management demands, frequently preclude extensive reading in this area. The primary aim of this primer is to enhance counselors' awareness of the types of difficulties encountered when evaluating college students for possible ADHD. A secondary aim is to offer empirically based suggestions drawn from ADHD studies of community and college adults to enhance the evaluation process, including selection of ADHD rating scales and behavioral measures. An Overview of Adult ADHD and the DSM-IV-TR Criteria ADHD is a neuropsychological disorder with sets of hyperactive-impulsive and/ or inattentive symptoms. This disorder is one of the most common mental health illnesses among children, with a 3% to 5% prevalence rate (American Psychiatric Association [APA], 2000). Of children with ADHD, 60% to 70% continue to have significant attention problems as adults, and 30% to 50% continue to meet criteria in the Diagnostic and Statistical Manual for Mental Disorders, text revision (DSM-IV-TR; APA, 2000) for ADHD (Searight et al., 2000; Wender, 1995). Many practitioners believe the vast majority of adults with ADHD are undiagnosed (Adler & Cohen, 2003). At a college level, epidemiological data are lacking. Retrospective, clinic-based chart reviews and surveys of ADHD symptoms yield prevalence estimates ranging from 2% to 11% of the college population (DuPaul et al., 2001; Heiligenstein, Conyers, Berns, Miller, & Smith, 1998; Weyandt, Linterman, & Rice, 1995). The exact prevalence number is difficult to calculate given methodological differences in identification of ADHD in these studies. In addition, Roy-Byrne et al. (1997) indicated that approximately one half to two thirds of adults with self-diagnosed ADHD failed to meet DSM-IV-TR criteria. Therefore, counselors contend with significant rates of erroneous self-diagnoses as well as high rates of undiagnosed ADHD in a college population. As a consequence, counselors' mastery of the DSM-IV-TR criteria is essential for successfully navigating an ADHD evaluation (Attention Deficit Disorder Association, 2000; Dulcan & Workgroup on Quality Issues, 1997). Within the DSM-IV-TR typology, an ADHD diagnosis is tenable if developmentally inappropriate attention problems meet the following criteria: (a) had onset before age 7, (b) have persisted in a maladaptive form in at least two settings for 6 months, and (c) are not better accounted for by another disorder. …

Absence of Gender Effects on Attention Deficit Hyperactivity Disorder: Findings in Nonreferred Subjects

In a previous study, the authors found that, compared with referred boys with attention deficit hyperactivity disorder (ADHD), girls are less likely to manifest comorbid disruptive behavior disorders and learning disabilities--characteristics that could adversely affect identification of ADHD in girls. However, because referral bias can affect outcome, these findings require replication in nonreferred groups of ADHD subjects. The authors evaluated gender effects in a large group of nonreferred siblings (N=577) of probands with ADHD and non-ADHD comparison subjects. Ninety-eight of the nonreferred siblings (N=73 males, N=25 females) met the criteria for diagnosis of ADHD, and 479 (N=244 males, N=235 females) did not meet those criteria. All siblings were systematically and comprehensively assessed with measures of emotional, school, intellectual, interpersonal, and family functioning. The assessment battery used for the siblings was the same as that used for the probands. The nonreferred males and females with ADHD did not differ in DSM-IV subtypes of ADHD, psychiatric comorbidity, or treatment history. They also showed similar levels of cognitive, psychosocial, school, and family functioning. These findings suggest that the clinical correlates of ADHD are not influenced by gender and that gender differences reported in groups of subjects seen in clinical settings may be caused by referral biases.

Diagnosis and Treatment of Adults With Attention Deficit Hyperactivity Disorder

It is estimated that between 30% and 50% of children diagnosed with attention deficit hyperactivity disorder (ADHD) will continue to exhibit symptomatology that is disruptive throughout their adult lives. Identification and diagnosis of adult ADHD, as well as primary and secondary characteristics and comorbid disorders, are discussed in this article. Counseling strategies are suggested to help clinicians treat adults with ADHD, such as educating the client about the disorder and providing training in attention management techniques, self‐management skills, interpersonal and social skills, stress and time management, anger management, and problem‐solving skills. Clinicians are encouraged to prepare themselves for understanding, identifying, diagnosing, and treating the adult population with ADHD.