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Screening for adult ADHD using brief rating tools: what can we conclude from a positive screen? Some caveats

Screening for adult ADHD using brief rating tools: what can we conclude from a positive screen? Some caveats
Screening for adult ADHD using brief rating tools: what can we conclude from a positive screen? Some caveats
Adult Attention-Deficit/Hyperactivity Disorder (ADHD) is prevalent but often overlooked and undertreated. Left untreated, it is linked to increased risk of untoward outcomes including unemployment, relationship breakups, substance use, driving accidents and other mental health conditions. Several brief screening tools have been developed for adult ADHD. The most frequently used is the World Health Organization’s Adult ADHD Self-Report Scale (ASRS V1.1). Here, we show in two independent population samples (UK: N=642, USA: N=579) that the tool resulted in considerable overestimation of ADHD, indicating probable ADHD in 26.0% and 17.3% of participants, as compared to expected prevalence of 2.5%. The estimated positive predictive value was only ~11.5%. Both samples had normal levels of trait impulsivity as assessed using the Barratt Impulsiveness Scale. The data indicate that using the ASRS in general population samples will result in 7-10 times over-identification of ADHD. We use these results to highlight how such tools should most appropriately be used. When being used to determine possible cases (such as for onward referral to an ADHD specialist) they should be complement by clinical assessment – we give examples of how non-specialists might determine this. When measuring ADHD symptoms dimensionally, researchers should be mindful that the ASRS captures impulsive symptoms other than those due to ADHD. Lastly, we note the need to screen for impulse control disorders (e.g., gambling disorder) when using such tools to measure ADHD, be it for onward referral, or for dimensional research studies.
0010-440X
Chamberlain, Samuel
f24aa9bf-6201-4cc8-a25c-2c1e3fcb47f7
Cortese, Samuele
53d4bf2c-4e0e-4c77-9385-218350560fdb
Grant, Jon E
124df183-de64-4990-8181-66a6121236c6
Chamberlain, Samuel
f24aa9bf-6201-4cc8-a25c-2c1e3fcb47f7
Cortese, Samuele
53d4bf2c-4e0e-4c77-9385-218350560fdb
Grant, Jon E
124df183-de64-4990-8181-66a6121236c6

Chamberlain, Samuel, Cortese, Samuele and Grant, Jon E (2021) Screening for adult ADHD using brief rating tools: what can we conclude from a positive screen? Some caveats. Comprehensive Psychiatry, 106. (doi:10.1016/j.comppsych.2021.152224).

Record type: Article

Abstract

Adult Attention-Deficit/Hyperactivity Disorder (ADHD) is prevalent but often overlooked and undertreated. Left untreated, it is linked to increased risk of untoward outcomes including unemployment, relationship breakups, substance use, driving accidents and other mental health conditions. Several brief screening tools have been developed for adult ADHD. The most frequently used is the World Health Organization’s Adult ADHD Self-Report Scale (ASRS V1.1). Here, we show in two independent population samples (UK: N=642, USA: N=579) that the tool resulted in considerable overestimation of ADHD, indicating probable ADHD in 26.0% and 17.3% of participants, as compared to expected prevalence of 2.5%. The estimated positive predictive value was only ~11.5%. Both samples had normal levels of trait impulsivity as assessed using the Barratt Impulsiveness Scale. The data indicate that using the ASRS in general population samples will result in 7-10 times over-identification of ADHD. We use these results to highlight how such tools should most appropriately be used. When being used to determine possible cases (such as for onward referral to an ADHD specialist) they should be complement by clinical assessment – we give examples of how non-specialists might determine this. When measuring ADHD symptoms dimensionally, researchers should be mindful that the ASRS captures impulsive symptoms other than those due to ADHD. Lastly, we note the need to screen for impulse control disorders (e.g., gambling disorder) when using such tools to measure ADHD, be it for onward referral, or for dimensional research studies.

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Accepted/In Press date: 31 December 2020
e-pub ahead of print date: 1 February 2021
Published date: 10 February 2021

Identifiers

Local EPrints ID: 445914
URI: http://eprints.soton.ac.uk/id/eprint/445914
ISSN: 0010-440X
PURE UUID: 2cc12f3f-f1d2-41e0-ad85-febd882a041c
ORCID for Samuele Cortese: ORCID iD orcid.org/0000-0001-5877-8075

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Date deposited: 13 Jan 2021 17:31
Last modified: 28 Apr 2022 02:12

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Contributors

Author: Samuel Chamberlain
Author: Samuele Cortese ORCID iD
Author: Jon E Grant

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