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Lenard A Adler - One of the best experts on this subject based on the ideXlab platform.
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the relationship between executive function deficits and dsm 5 defined ADHD symptoms
Journal of Attention Disorders, 2020Co-Authors: Thomas J Spencer, Stephen V Faraone, Michael J Silverstein, Joseph Biederman, Terry L Leon, Lenard A AdlerAbstract:Objectives: To identify the relationship between the core Diagnostic and Statistical Manual of Mental Disorders (5th ed.) ADHD symptoms and executive function deficits (EFDs), to evaluate ADHD characteristics of those with executive dysfunction (ED), and to examine the predictive utility of the Adult ADHD Investigator Symptom Rating Scale (AISRS) in identifying those with Adult ADHD and ED. Method: Two samples (referred and primary care practice) were pooled together for present analysis. Results: Final analysis included 297 respondents, 171 with Adult ADHD. Spearman correlation coefficients and binary logistic regressions demonstrated that ADHD inattentive (IA) and hyperactive-impulsive (H-I) symptoms were moderately to strongly correlated with and highly predictive of EFDs. Receiver operating characteristic curve analysis showed that an AISRS DSM 18-item score of ⩾ 28 was most predictive of clinical ED. Conclusion: ADHD symptoms were strongly correlated with and predictive of EFDs, clinicians should screen Adults with ADHD for EFDs and ADHD treatment providers should track EFD improvement in addition to DSM-5 ADHD symptoms.
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test retest reliability of the Adult ADHD self report scale asrs v1 1 screener in non ADHD controls from a primary care physician practice
Family Practice, 2018Co-Authors: Michael J Silverstein, Ronald C Kessler, Stephen V Faraone, Samuel Alperin, Lenard A AdlerAbstract:Objectives: To examine the test-retest reliability of the DSM-IV Adult ADHD Self-Report Scale (ASRS) v1.1 Screener in Adults without ADHD. Prior studies have not examined test-retest reliability of the Screener in non-ADHD controls. Methods: Subjects completed the Screener in a primary care physician (PCP) waiting room (T1); those who screened negative for ADHD (n = 104) (<4/6 significant Screener items) symptoms were further assessed on the phone (T2). T2 included phone administration of the full ASRS v1.1 Symptom Checklist (which contains the six items from the Screener). Spearman's correlations and intra-class correlation coefficients (ICCs) between T1 and T2 were calculated for the total Screener score and for each Screener item. McNemar-Bowker tests were conducted for the Screener total score and each item to check for significant changes from T1 to T2. Results: Screener T1 and T2 total scores were significantly correlated (Spearman's rho = 0.78, P < 0.0001), as were individual items. Correlations remained significant when controlling for a variety of demographic factors and psychiatric conditions. Confirming the significant Spearman correlations, ICCs for Screener total score and each item were also significant (ICC = 0.75, P < 0.0001). The McNemar-Bowker tests showed no significant differences for Screener total score and for the IA items; however, the H-I items were somewhat higher at T1 versus T2. Conclusions: The DSM-IV ASRS v1.1 Screener has high test-retest reliability in patients without ADHD.
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how informative are self reported Adult attention deficit hyperactivity disorder symptoms an examination of the agreement between the Adult attention deficit hyperactivity disorder self report scale v1 1 and Adult attention deficit hyperactivity disorder investigator symptom rating scale
Journal of Child and Adolescent Psychopharmacology, 2017Co-Authors: Thomas J Spencer, Stephen V Faraone, Michael J Silverstein, Samuel Alperin, Joseph Biederman, Lenard A AdlerAbstract:Abstract Objectives: Assess agreement between self-ratings via the Adult attention-deficit/hyperactivity disorder (ADHD) Self-Report Scale (ASRS)-v1.1 Symptom Checklist and clinician ratings via the Adult ADHD Investigator Symptom Rating Scale (AISRS) expanded version using DSM-5 Adult ADHD patients (referred sample) and ADHD controls (recruited from a primary care physician practice). Methods: The ASRS v1.1 Symptom Checklist was administered to measure self-reported ADHD symptoms and impairment, the Adult ADHD Clinical Diagnostic Scale v1.2 was used to establish an Adult ADHD diagnosis and the childhood and Adult/current sections of the scale were used to provide scores to measure symptoms of childhood ADHD and recent symptoms of Adult ADHD, the AISRS to measure ADHD current symptom severity. Results: Participants (n = 299; range 18–58), of which 171 were ADHD+ and 128 ADHD−. ASRS and AISRS total scores and individual subsections examining inattention, hyperactivity, emotional dysfunction (EF), and emoti...
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the world health organization Adult attention deficit hyperactivity disorder self report screening scale for dsm 5
JAMA Psychiatry, 2017Co-Authors: Berk Ustun, Lenard A Adler, Thomas J Spencer, Stephen V Faraone, Michael J Gruber, Cynthia Rudin, Patricia A Berglund, Ronald C KesslerAbstract:Importance Recognition that Adult attention-deficit/hyperactivity disorder (ADHD) is common, seriously impairing, and usually undiagnosed has led to the development of Adult ADHD screening scales for use in community, workplace, and primary care settings. However, these scales are all calibrated to DSM-IV criteria, which are narrower than the recently developed DSM-5 criteria. Objectives To update for DSM-5 criteria and improve the operating characteristics of the widely used World Health Organization Adult ADHD Self-Report Scale (ASRS) for screening. Design, Setting, and Participants Probability subsamples of participants in 2 general population surveys (2001-2003 household survey [n = 119] and 2004-2005 managed care subscriber survey [n = 218]) who completed the full 29-question self-report ASRS, with both subsamples over-sampling ASRS-screened positives, were blindly administered a semistructured research diagnostic interview for DSM-5 Adult ADHD. In 2016, the Risk-Calibrated Supersparse Linear Integer Model, a novel machine-learning algorithm designed to create screening scales with optimal integer weights and limited numbers of screening questions, was applied to the pooled data to create a DSM-5 version of the ASRS screening scale. The accuracy of the new scale was then confirmed in an independent 2011-2012 clinical sample of patients seeking evaluation at the New York University Langone Medical Center Adult ADHD Program (NYU Langone) and 2015-2016 primary care controls (n = 300). Data analysis was conducted from April 4, 2016, to September 22, 2016. Main Outcomes and Measures The sensitivity, specificity, area under the curve (AUC), and positive predictive value (PPV) of the revised ASRS. Results Of the total 637 participants, 44 (37.0%) household survey respondents, 51 (23.4%) managed care respondents, and 173 (57.7%) NYU Langone respondents met DSM-5 criteria for Adult ADHD in the semistructured diagnostic interview. Of the respondents who met DSM-5 criteria for Adult ADHD, 123 were male (45.9%); mean (SD) age was 33.1 (11.4) years. A 6-question screening scale was found to be optimal in distinguishing cases from noncases in the first 2 samples. Operating characteristics were excellent at the diagnostic threshold in the weighted (to the 8.2% DSM-5 /Adult ADHD Clinical Diagnostic Scale population prevalence) data (sensitivity, 91.4%; specificity, 96.0%; AUC, 0.94; PPV, 67.3%). Operating characteristics were similar despite a much higher prevalence (57.7%) when the scale was applied to the NYU Langone clinical sample (sensitivity, 91.9%; specificity, 74.0%; AUC, 0.83; PPV, 82.8%). Conclusions and Relevance The new ADHD screening scale is short, easily scored, detects the vast majority of general population cases at a threshold that also has high specificity and PPV, and could be used as a screening tool in specialty treatment settings.
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effectiveness and duration of effect of open label lisdexamfetamine dimesylate in Adults with ADHD
Journal of Attention Disorders, 2017Co-Authors: Lenard A Adler, Lauren R Lynch, David M Shaw, Samantha P Wallace, Katherine E Odonnell, Michael A Ciranni, Alexis M Briggie, Stephen V FaraoneAbstract:Objectives: (a) Evaluate the efficacy and duration of effect of lisdexamfetamine dimesylate (LDX) in Adult ADHD. (b) Assess the reliability and validity of the Adult ADHD Medication Smoothness of E...
Thomas J Spencer - One of the best experts on this subject based on the ideXlab platform.
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the relationship between executive function deficits and dsm 5 defined ADHD symptoms
Journal of Attention Disorders, 2020Co-Authors: Thomas J Spencer, Stephen V Faraone, Michael J Silverstein, Joseph Biederman, Terry L Leon, Lenard A AdlerAbstract:Objectives: To identify the relationship between the core Diagnostic and Statistical Manual of Mental Disorders (5th ed.) ADHD symptoms and executive function deficits (EFDs), to evaluate ADHD characteristics of those with executive dysfunction (ED), and to examine the predictive utility of the Adult ADHD Investigator Symptom Rating Scale (AISRS) in identifying those with Adult ADHD and ED. Method: Two samples (referred and primary care practice) were pooled together for present analysis. Results: Final analysis included 297 respondents, 171 with Adult ADHD. Spearman correlation coefficients and binary logistic regressions demonstrated that ADHD inattentive (IA) and hyperactive-impulsive (H-I) symptoms were moderately to strongly correlated with and highly predictive of EFDs. Receiver operating characteristic curve analysis showed that an AISRS DSM 18-item score of ⩾ 28 was most predictive of clinical ED. Conclusion: ADHD symptoms were strongly correlated with and predictive of EFDs, clinicians should screen Adults with ADHD for EFDs and ADHD treatment providers should track EFD improvement in addition to DSM-5 ADHD symptoms.
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how informative are self reported Adult attention deficit hyperactivity disorder symptoms an examination of the agreement between the Adult attention deficit hyperactivity disorder self report scale v1 1 and Adult attention deficit hyperactivity disorder investigator symptom rating scale
Journal of Child and Adolescent Psychopharmacology, 2017Co-Authors: Thomas J Spencer, Stephen V Faraone, Michael J Silverstein, Samuel Alperin, Joseph Biederman, Lenard A AdlerAbstract:Abstract Objectives: Assess agreement between self-ratings via the Adult attention-deficit/hyperactivity disorder (ADHD) Self-Report Scale (ASRS)-v1.1 Symptom Checklist and clinician ratings via the Adult ADHD Investigator Symptom Rating Scale (AISRS) expanded version using DSM-5 Adult ADHD patients (referred sample) and ADHD controls (recruited from a primary care physician practice). Methods: The ASRS v1.1 Symptom Checklist was administered to measure self-reported ADHD symptoms and impairment, the Adult ADHD Clinical Diagnostic Scale v1.2 was used to establish an Adult ADHD diagnosis and the childhood and Adult/current sections of the scale were used to provide scores to measure symptoms of childhood ADHD and recent symptoms of Adult ADHD, the AISRS to measure ADHD current symptom severity. Results: Participants (n = 299; range 18–58), of which 171 were ADHD+ and 128 ADHD−. ASRS and AISRS total scores and individual subsections examining inattention, hyperactivity, emotional dysfunction (EF), and emoti...
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the world health organization Adult attention deficit hyperactivity disorder self report screening scale for dsm 5
JAMA Psychiatry, 2017Co-Authors: Berk Ustun, Lenard A Adler, Thomas J Spencer, Stephen V Faraone, Michael J Gruber, Cynthia Rudin, Patricia A Berglund, Ronald C KesslerAbstract:Importance Recognition that Adult attention-deficit/hyperactivity disorder (ADHD) is common, seriously impairing, and usually undiagnosed has led to the development of Adult ADHD screening scales for use in community, workplace, and primary care settings. However, these scales are all calibrated to DSM-IV criteria, which are narrower than the recently developed DSM-5 criteria. Objectives To update for DSM-5 criteria and improve the operating characteristics of the widely used World Health Organization Adult ADHD Self-Report Scale (ASRS) for screening. Design, Setting, and Participants Probability subsamples of participants in 2 general population surveys (2001-2003 household survey [n = 119] and 2004-2005 managed care subscriber survey [n = 218]) who completed the full 29-question self-report ASRS, with both subsamples over-sampling ASRS-screened positives, were blindly administered a semistructured research diagnostic interview for DSM-5 Adult ADHD. In 2016, the Risk-Calibrated Supersparse Linear Integer Model, a novel machine-learning algorithm designed to create screening scales with optimal integer weights and limited numbers of screening questions, was applied to the pooled data to create a DSM-5 version of the ASRS screening scale. The accuracy of the new scale was then confirmed in an independent 2011-2012 clinical sample of patients seeking evaluation at the New York University Langone Medical Center Adult ADHD Program (NYU Langone) and 2015-2016 primary care controls (n = 300). Data analysis was conducted from April 4, 2016, to September 22, 2016. Main Outcomes and Measures The sensitivity, specificity, area under the curve (AUC), and positive predictive value (PPV) of the revised ASRS. Results Of the total 637 participants, 44 (37.0%) household survey respondents, 51 (23.4%) managed care respondents, and 173 (57.7%) NYU Langone respondents met DSM-5 criteria for Adult ADHD in the semistructured diagnostic interview. Of the respondents who met DSM-5 criteria for Adult ADHD, 123 were male (45.9%); mean (SD) age was 33.1 (11.4) years. A 6-question screening scale was found to be optimal in distinguishing cases from noncases in the first 2 samples. Operating characteristics were excellent at the diagnostic threshold in the weighted (to the 8.2% DSM-5 /Adult ADHD Clinical Diagnostic Scale population prevalence) data (sensitivity, 91.4%; specificity, 96.0%; AUC, 0.94; PPV, 67.3%). Operating characteristics were similar despite a much higher prevalence (57.7%) when the scale was applied to the NYU Langone clinical sample (sensitivity, 91.9%; specificity, 74.0%; AUC, 0.83; PPV, 82.8%). Conclusions and Relevance The new ADHD screening scale is short, easily scored, detects the vast majority of general population cases at a threshold that also has high specificity and PPV, and could be used as a screening tool in specialty treatment settings.
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relationship of dat1 and Adult ADHD to task positive and task negative working memory networks
Psychiatry Research-neuroimaging, 2011Co-Authors: Thomas J Spencer, Joseph Biederman, Ariel Brown, Eve M Valera, Nikos Makris, Alysa E Doyle, Susan Whitfieldgabrieli, Eric Mick, Stephen V FaraoneAbstract:Abstract Alterations in working memory, default-mode network (DMN), and dopamine transporter have all been proposed as endophenotypes for attention-deficit/hyperactivity disorder (ADHD). Despite evidence that these systems are interrelated, their relationship to each other has never been studied in the context of ADHD. In order to understand the potential mediating effects of task-positive and task-negative networks between DAT1 and diagnosis, we tested effects of genotype and diagnosis on regions of positive and negative BOLD signal change (as measured with fMRI) in 53 Adults with ADHD and 38 control subjects during a working memory task. We also examined the relationship of these responses to ADHD symptoms. Our results yielded four principal findings: 1) association of the DAT1 9R allele with Adult ADHD, 2) marginal DAT1 association with task-related suppression in left medial PFC, 3) marginal genotype×diagnosis interaction in the dorsal anterior cingulate cortex, and 4) correlation of DMN suppression to ADHD symptoms. These findings replicate the association of the 9R allele with Adult ADHD. Further, we show that DMN suppression is likely linked to DAT1 and to severity of inattention in ADHD. DMN may therefore be a target of DAT1 effects, and lie on the path between the gene and inattention in ADHD.
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long term effectiveness and safety of dexmethylphenidate extended release capsules in Adult ADHD
Journal of Attention Disorders, 2009Co-Authors: Lenard A Adler, James J Mcgough, Thomas J Spencer, Hai Jiang, Rafael MunizAbstract:Objective: This study evaluates dexmethylphenidate extended release (d-MPH-ER) in Adults with ADHD. Method: Following a 5-week, randomized, controlled, fixed-dose study of d-MPH-ER 20 to 40 mg/d, 170 Adults entered a 6-month open-label extension (OLE) to assess long-term safety, with flexible dosing of 20 to 40 mg/d. Exploratory effectiveness outcomes included change from Week 5 on ADHD Rating Scale (ADHD-RS) and proportion of responders on Clinical Global Impressions—Improvement (CGI-I) scale. Results: 103 patients completed OLE, and effectiveness was evaluable in 102 patients. d-MPH-ER was well tolerated; the most common adverse events (>15%) were headache, insomnia, and decreased appetite. Mean improvements in ADHD-RS score were −10.2 for patients switched from placebo to d-MPH-ER (n = 20) and −8.4 for those maintained on d-MPH-ER (n = 82). Respective CGI-I responder rates were 95.0% and 95.1%. Conclusion: Once-daily d-MPH-ER 20 to 40 mg is safe and effective for long-term treatment of Adult ADHD. (J. ...
Stephen V Faraone - One of the best experts on this subject based on the ideXlab platform.
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the relationship between executive function deficits and dsm 5 defined ADHD symptoms
Journal of Attention Disorders, 2020Co-Authors: Thomas J Spencer, Stephen V Faraone, Michael J Silverstein, Joseph Biederman, Terry L Leon, Lenard A AdlerAbstract:Objectives: To identify the relationship between the core Diagnostic and Statistical Manual of Mental Disorders (5th ed.) ADHD symptoms and executive function deficits (EFDs), to evaluate ADHD characteristics of those with executive dysfunction (ED), and to examine the predictive utility of the Adult ADHD Investigator Symptom Rating Scale (AISRS) in identifying those with Adult ADHD and ED. Method: Two samples (referred and primary care practice) were pooled together for present analysis. Results: Final analysis included 297 respondents, 171 with Adult ADHD. Spearman correlation coefficients and binary logistic regressions demonstrated that ADHD inattentive (IA) and hyperactive-impulsive (H-I) symptoms were moderately to strongly correlated with and highly predictive of EFDs. Receiver operating characteristic curve analysis showed that an AISRS DSM 18-item score of ⩾ 28 was most predictive of clinical ED. Conclusion: ADHD symptoms were strongly correlated with and predictive of EFDs, clinicians should screen Adults with ADHD for EFDs and ADHD treatment providers should track EFD improvement in addition to DSM-5 ADHD symptoms.
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test retest reliability of the Adult ADHD self report scale asrs v1 1 screener in non ADHD controls from a primary care physician practice
Family Practice, 2018Co-Authors: Michael J Silverstein, Ronald C Kessler, Stephen V Faraone, Samuel Alperin, Lenard A AdlerAbstract:Objectives: To examine the test-retest reliability of the DSM-IV Adult ADHD Self-Report Scale (ASRS) v1.1 Screener in Adults without ADHD. Prior studies have not examined test-retest reliability of the Screener in non-ADHD controls. Methods: Subjects completed the Screener in a primary care physician (PCP) waiting room (T1); those who screened negative for ADHD (n = 104) (<4/6 significant Screener items) symptoms were further assessed on the phone (T2). T2 included phone administration of the full ASRS v1.1 Symptom Checklist (which contains the six items from the Screener). Spearman's correlations and intra-class correlation coefficients (ICCs) between T1 and T2 were calculated for the total Screener score and for each Screener item. McNemar-Bowker tests were conducted for the Screener total score and each item to check for significant changes from T1 to T2. Results: Screener T1 and T2 total scores were significantly correlated (Spearman's rho = 0.78, P < 0.0001), as were individual items. Correlations remained significant when controlling for a variety of demographic factors and psychiatric conditions. Confirming the significant Spearman correlations, ICCs for Screener total score and each item were also significant (ICC = 0.75, P < 0.0001). The McNemar-Bowker tests showed no significant differences for Screener total score and for the IA items; however, the H-I items were somewhat higher at T1 versus T2. Conclusions: The DSM-IV ASRS v1.1 Screener has high test-retest reliability in patients without ADHD.
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how informative are self reported Adult attention deficit hyperactivity disorder symptoms an examination of the agreement between the Adult attention deficit hyperactivity disorder self report scale v1 1 and Adult attention deficit hyperactivity disorder investigator symptom rating scale
Journal of Child and Adolescent Psychopharmacology, 2017Co-Authors: Thomas J Spencer, Stephen V Faraone, Michael J Silverstein, Samuel Alperin, Joseph Biederman, Lenard A AdlerAbstract:Abstract Objectives: Assess agreement between self-ratings via the Adult attention-deficit/hyperactivity disorder (ADHD) Self-Report Scale (ASRS)-v1.1 Symptom Checklist and clinician ratings via the Adult ADHD Investigator Symptom Rating Scale (AISRS) expanded version using DSM-5 Adult ADHD patients (referred sample) and ADHD controls (recruited from a primary care physician practice). Methods: The ASRS v1.1 Symptom Checklist was administered to measure self-reported ADHD symptoms and impairment, the Adult ADHD Clinical Diagnostic Scale v1.2 was used to establish an Adult ADHD diagnosis and the childhood and Adult/current sections of the scale were used to provide scores to measure symptoms of childhood ADHD and recent symptoms of Adult ADHD, the AISRS to measure ADHD current symptom severity. Results: Participants (n = 299; range 18–58), of which 171 were ADHD+ and 128 ADHD−. ASRS and AISRS total scores and individual subsections examining inattention, hyperactivity, emotional dysfunction (EF), and emoti...
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the world health organization Adult attention deficit hyperactivity disorder self report screening scale for dsm 5
JAMA Psychiatry, 2017Co-Authors: Berk Ustun, Lenard A Adler, Thomas J Spencer, Stephen V Faraone, Michael J Gruber, Cynthia Rudin, Patricia A Berglund, Ronald C KesslerAbstract:Importance Recognition that Adult attention-deficit/hyperactivity disorder (ADHD) is common, seriously impairing, and usually undiagnosed has led to the development of Adult ADHD screening scales for use in community, workplace, and primary care settings. However, these scales are all calibrated to DSM-IV criteria, which are narrower than the recently developed DSM-5 criteria. Objectives To update for DSM-5 criteria and improve the operating characteristics of the widely used World Health Organization Adult ADHD Self-Report Scale (ASRS) for screening. Design, Setting, and Participants Probability subsamples of participants in 2 general population surveys (2001-2003 household survey [n = 119] and 2004-2005 managed care subscriber survey [n = 218]) who completed the full 29-question self-report ASRS, with both subsamples over-sampling ASRS-screened positives, were blindly administered a semistructured research diagnostic interview for DSM-5 Adult ADHD. In 2016, the Risk-Calibrated Supersparse Linear Integer Model, a novel machine-learning algorithm designed to create screening scales with optimal integer weights and limited numbers of screening questions, was applied to the pooled data to create a DSM-5 version of the ASRS screening scale. The accuracy of the new scale was then confirmed in an independent 2011-2012 clinical sample of patients seeking evaluation at the New York University Langone Medical Center Adult ADHD Program (NYU Langone) and 2015-2016 primary care controls (n = 300). Data analysis was conducted from April 4, 2016, to September 22, 2016. Main Outcomes and Measures The sensitivity, specificity, area under the curve (AUC), and positive predictive value (PPV) of the revised ASRS. Results Of the total 637 participants, 44 (37.0%) household survey respondents, 51 (23.4%) managed care respondents, and 173 (57.7%) NYU Langone respondents met DSM-5 criteria for Adult ADHD in the semistructured diagnostic interview. Of the respondents who met DSM-5 criteria for Adult ADHD, 123 were male (45.9%); mean (SD) age was 33.1 (11.4) years. A 6-question screening scale was found to be optimal in distinguishing cases from noncases in the first 2 samples. Operating characteristics were excellent at the diagnostic threshold in the weighted (to the 8.2% DSM-5 /Adult ADHD Clinical Diagnostic Scale population prevalence) data (sensitivity, 91.4%; specificity, 96.0%; AUC, 0.94; PPV, 67.3%). Operating characteristics were similar despite a much higher prevalence (57.7%) when the scale was applied to the NYU Langone clinical sample (sensitivity, 91.9%; specificity, 74.0%; AUC, 0.83; PPV, 82.8%). Conclusions and Relevance The new ADHD screening scale is short, easily scored, detects the vast majority of general population cases at a threshold that also has high specificity and PPV, and could be used as a screening tool in specialty treatment settings.
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effectiveness and duration of effect of open label lisdexamfetamine dimesylate in Adults with ADHD
Journal of Attention Disorders, 2017Co-Authors: Lenard A Adler, Lauren R Lynch, David M Shaw, Samantha P Wallace, Katherine E Odonnell, Michael A Ciranni, Alexis M Briggie, Stephen V FaraoneAbstract:Objectives: (a) Evaluate the efficacy and duration of effect of lisdexamfetamine dimesylate (LDX) in Adult ADHD. (b) Assess the reliability and validity of the Adult ADHD Medication Smoothness of E...
Ronald C Kessler - One of the best experts on this subject based on the ideXlab platform.
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test retest reliability of the Adult ADHD self report scale asrs v1 1 screener in non ADHD controls from a primary care physician practice
Family Practice, 2018Co-Authors: Michael J Silverstein, Ronald C Kessler, Stephen V Faraone, Samuel Alperin, Lenard A AdlerAbstract:Objectives: To examine the test-retest reliability of the DSM-IV Adult ADHD Self-Report Scale (ASRS) v1.1 Screener in Adults without ADHD. Prior studies have not examined test-retest reliability of the Screener in non-ADHD controls. Methods: Subjects completed the Screener in a primary care physician (PCP) waiting room (T1); those who screened negative for ADHD (n = 104) (<4/6 significant Screener items) symptoms were further assessed on the phone (T2). T2 included phone administration of the full ASRS v1.1 Symptom Checklist (which contains the six items from the Screener). Spearman's correlations and intra-class correlation coefficients (ICCs) between T1 and T2 were calculated for the total Screener score and for each Screener item. McNemar-Bowker tests were conducted for the Screener total score and each item to check for significant changes from T1 to T2. Results: Screener T1 and T2 total scores were significantly correlated (Spearman's rho = 0.78, P < 0.0001), as were individual items. Correlations remained significant when controlling for a variety of demographic factors and psychiatric conditions. Confirming the significant Spearman correlations, ICCs for Screener total score and each item were also significant (ICC = 0.75, P < 0.0001). The McNemar-Bowker tests showed no significant differences for Screener total score and for the IA items; however, the H-I items were somewhat higher at T1 versus T2. Conclusions: The DSM-IV ASRS v1.1 Screener has high test-retest reliability in patients without ADHD.
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the world health organization Adult attention deficit hyperactivity disorder self report screening scale for dsm 5
JAMA Psychiatry, 2017Co-Authors: Berk Ustun, Lenard A Adler, Thomas J Spencer, Stephen V Faraone, Michael J Gruber, Cynthia Rudin, Patricia A Berglund, Ronald C KesslerAbstract:Importance Recognition that Adult attention-deficit/hyperactivity disorder (ADHD) is common, seriously impairing, and usually undiagnosed has led to the development of Adult ADHD screening scales for use in community, workplace, and primary care settings. However, these scales are all calibrated to DSM-IV criteria, which are narrower than the recently developed DSM-5 criteria. Objectives To update for DSM-5 criteria and improve the operating characteristics of the widely used World Health Organization Adult ADHD Self-Report Scale (ASRS) for screening. Design, Setting, and Participants Probability subsamples of participants in 2 general population surveys (2001-2003 household survey [n = 119] and 2004-2005 managed care subscriber survey [n = 218]) who completed the full 29-question self-report ASRS, with both subsamples over-sampling ASRS-screened positives, were blindly administered a semistructured research diagnostic interview for DSM-5 Adult ADHD. In 2016, the Risk-Calibrated Supersparse Linear Integer Model, a novel machine-learning algorithm designed to create screening scales with optimal integer weights and limited numbers of screening questions, was applied to the pooled data to create a DSM-5 version of the ASRS screening scale. The accuracy of the new scale was then confirmed in an independent 2011-2012 clinical sample of patients seeking evaluation at the New York University Langone Medical Center Adult ADHD Program (NYU Langone) and 2015-2016 primary care controls (n = 300). Data analysis was conducted from April 4, 2016, to September 22, 2016. Main Outcomes and Measures The sensitivity, specificity, area under the curve (AUC), and positive predictive value (PPV) of the revised ASRS. Results Of the total 637 participants, 44 (37.0%) household survey respondents, 51 (23.4%) managed care respondents, and 173 (57.7%) NYU Langone respondents met DSM-5 criteria for Adult ADHD in the semistructured diagnostic interview. Of the respondents who met DSM-5 criteria for Adult ADHD, 123 were male (45.9%); mean (SD) age was 33.1 (11.4) years. A 6-question screening scale was found to be optimal in distinguishing cases from noncases in the first 2 samples. Operating characteristics were excellent at the diagnostic threshold in the weighted (to the 8.2% DSM-5 /Adult ADHD Clinical Diagnostic Scale population prevalence) data (sensitivity, 91.4%; specificity, 96.0%; AUC, 0.94; PPV, 67.3%). Operating characteristics were similar despite a much higher prevalence (57.7%) when the scale was applied to the NYU Langone clinical sample (sensitivity, 91.9%; specificity, 74.0%; AUC, 0.83; PPV, 82.8%). Conclusions and Relevance The new ADHD screening scale is short, easily scored, detects the vast majority of general population cases at a threshold that also has high specificity and PPV, and could be used as a screening tool in specialty treatment settings.
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structure and diagnosis of Adult attention deficit hyperactivity disorder analysis of expanded symptom criteria from the Adult ADHD clinical diagnostic scale
Archives of General Psychiatry, 2010Co-Authors: Ronald C Kessler, Lenard A Adler, Stephen V Faraone, Russell A Barkley, Laurence L Greenhill, Jennifer Greif Green, Somnath Chatterji, Matthew Finkelman, Michael J Gruber, Mark JewellAbstract:Context Controversy exists about the appropriate criteria for a diagnosis of Adult attention-deficit/hyperactivity disorder (ADHD). Objective To examine the structure and symptoms most predictive of DSM-IV Adult ADHD. Design The data are from clinical interviews in enriched subsamples of the National Comorbidity Survey Replication (n = 131) and a survey of a large managed health care plan (n = 214). The physician-administered Adult ADHD Clinical Diagnostic Scale (ACDS) was used to assess childhood ADHD and expanded symptoms of current Adult ADHD. Analyses examined the stability of symptoms from childhood to Adulthood, the structure of Adult ADHD, and the Adult symptoms most predictive of current clinical diagnoses. Setting The ACDS was administered telephonically by clinical research interviewers with extensive experience in the diagnosis and treatment of Adult ADHD. Participants An enriched sample of community respondents. Main Outcome Measure Diagnoses of DSM-IV /ACDS Adult ADHD. Results Almost half of the respondents (45.7%) who had childhood ADHD continued to meet the full DSM-IV criteria for current Adult ADHD, with 94.9% of these patients having current attention-deficit disorder and 34.6% having current hyperactivity disorder. Adult persistence was much greater for inattention than for hyperactivity/impulsivity. Additional respondents met the full criteria for current Adult ADHD despite not having met the full childhood criteria. A 3-factor structure of Adult symptoms included executive functioning (EF), inattention/hyperactivity, and impulsivity. Stepwise logistic regression found EF problems to be the most consistent and discriminating predictors of Adult DSM-IV /ACDS ADHD. Conclusions These findings document the greater persistence of inattentive than of hyperactive/impulsive childhood symptoms of ADHD in Adulthood but also show that inattention is not specific to ADHD because it is strongly associated with other Adult mental disorders. In comparison, EF problems are more specific and consistently important predictors of DSM-IV Adult ADHD despite not being in the DSM-IV , suggesting that the number of EF symptoms should be increased in the DSM-V/ICD-11 .
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the prevalence and workplace costs of Adult attention deficit hyperactivity disorder in a large manufacturing firm
Psychological Medicine, 2009Co-Authors: Ronald C Kessler, Michael Lane, Paul E Stang, D L Van BruntAbstract:Background Little is known about the effects of Adult attention deficit hyperactivity disorder (ADHD) on work performance or accidents-injuries. Method A survey was administered in 2005 and 2006 to employees of a large manufacturing firm to assess the prevalence and correlates of Adult ADHD. Respondents (4140 in 2005, 4423 in 2006, including 2656 in both surveys) represented 35–38% of the workforce. ADHD was assessed with the World Health Organization (WHO) Adult ADHD Self-Report Scale (ASRS), a validated screening scale for DSM-IV Adult ADHD. Sickness absence, work performance and workplace accidents-injuries were assessed with the WHO Health and Work Performance Questionnaire (HPQ). Results The estimated current prevalence (standard error) of DSM-IV ADHD was 1.9% (0.4). ADHD was associated with a 4–5% reduction in work performance (χ 1 2 =9.1, p =0.001), a 2.1 relative-odds of sickness absence (χ 1 2 =6.2, p =0.013), and a 2.0 relative-odds of workplace accidents-injuries (χ 1 2 =5.1, p =0.024). The human capital value (standard error) of the lost work performance associated with ADHD totaled US$4336 (676) per worker with ADHD in the year before interview. No data were available to monetize other workplace costs of accidents-injuries (e.g. destruction of equipment). Only a small minority of workers with ADHD were in treatment. Conclusions Adult ADHD is a significantly impairing condition among workers. Given the low rate of treatment and high human capital costs, in conjunction with evidence from controlled trials that treatment can reduce ADHD-related impairments, ADHD would seem to be a good candidate for workplace trials that evaluate treatment cost-effectiveness from the employer's perspective.
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validity of the world health organization Adult ADHD self report scale asrs screener in a representative sample of health plan members
International Journal of Methods in Psychiatric Research, 2007Co-Authors: Ronald C Kessler, Lenard A Adler, Thomas J Spencer, Michael J Gruber, Chaitanya A Sarawate, David L Van BruntAbstract:The validity of the 6-question World Health Organization Adult ADHD Self-Report Scale (ASRS) Screener was assessed in a sample of subscribers to a large health plan in the US. A convenience sub-sample of 668 subscribers was administered the ASRS Screener twice to assess test-retest reliability and then a third time in conjunction with a clinical interviewer for DSM-IV Adult ADHD. The data were weighted to adjust for discrepancies between the sample and the population on socio-demographics and past medical claims. Internal consistency reliability of the continuous ASRS Screener was in the range .63–.72 and test-retest reliability (Pearson correlations) in the range .58–.77. A four-category version The ASRS Screener had strong concordance with clinician diagnoses, with an area under the receiver operating characteristic curve (AUC) of .90. The brevity and ability to discriminate DSM-IV cases from non-cases make the 6-question ASRS Screener attractive for use both in community epidemiological surveys and in clinical outreach and case-finding initiatives.
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common psychiatric and metabolic comorbidity of Adult attention deficit hyperactivity disorder a population based cross sectional study
PLOS ONE, 2018Co-Authors: Qi Chen, Jan Haavik, Catharina A Hartman, Jaanus Harro, Kari Klungsoyr, Torarne Hegvik, Rob B K WandersAbstract:Attention-deficit/hyperactivity disorder (ADHD) is often comorbid with other psychiatric conditions in Adults. Yet, less is known about its relationship with common metabolic disorders and how sex and ageing affect the overall comorbidity patterns of Adult ADHD. We aimed to examine associations of Adult ADHD with several common psychiatric and metabolic conditions. Through the linkage of multiple Swedish national registers, 5,551,807 Adults aged 18 to 64 years and living in Sweden on December 31, 2013 were identified and assessed for clinical diagnoses of Adult ADHD, substance use disorder (SUD), depression, bipolar disorder, anxiety, type 2 diabetes mellitus (T2DM), and hypertension. Logistic regression models and regression standardization method were employed to obtain estimates of prevalence, prevalence difference (PD), and prevalence ratio (PR). All comorbid conditions of interest were more prevalent in Adults with ADHD (3.90% to 44.65%) than in those without (0.72% to 4.89%), with the estimated PRs being over nine for psychiatric conditions (p < 0.001) and around two for metabolic conditions (p < 0.001). Sex differences in the prevalence of comorbidities were observed among Adults with ADHD. Effect modification by sex was detected on the additive scale and/or multiplicative scale for the associations of Adult ADHD with all comorbidities. ADHD remained associated with all comorbidities in older Adults aged 50 to 64 when all conditions were assessed from age 50 onwards. The comorbidity patterns of Adult ADHD underscore the severity and clinical complexity of the disorder. Clinicians should remain vigilant for a wide range of psychiatric and metabolic problems in ADHD affected Adults of all ages and both sexes.
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long term efficacy and safety of treatment with stimulants and atomoxetine in Adult ADHD a review of controlled and naturalistic studies
European Neuropsychopharmacology, 2013Co-Authors: Mats Fredriksen, Stephen V Faraone, Anne Halmoy, Jan HaavikAbstract:Abstract Attention-deficit/hyperactivity disorder (ADHD) is a common disorder of childhood that often persists into Adulthood. Although stimulant medications are recommended as the first-line treatment for ADHD because of their documented short-term effects in children and Adults, less is known about their effects on long-term outcome in Adults. Here we review the long-term efficacy and safety of the stimulant drugs methylphenidate and amphetamine, as well as the related compound atomoxetine. We performed a systematic review to identify direct and indirect effects of stimulant therapy on long-term outcome in Adults. Five randomized controlled trials (RCTs), and 10 open-label extension studies of initial short-term RCTs, with total follow-up of at least 24 weeks, were identified. All these RCTs found that medication was significantly more efficacious than placebo in treating ADHD in Adults, and the extension studies showed that this favorable effect of medication was maintained during the open-label follow-up period. However, since the maximum duration of these pharmacological trials was 4 years, we also reviewed 18 defined naturalistic longitudinal and cross-sectional studies, to provide more information about longer term functional outcomes, side effects and complications. These observational studies also showed positive correlations between early recognition of the disorder, stimulant treatment during childhood and favorable long-term outcome in Adult ADHD patients. In conclusion, stimulant therapy of ADHD has long-term beneficial effects and is well tolerated. However, more longitudinal studies of long duration should be performed. In addition, the ethical issues involved in performing double blind RCTs of many years duration should be further explored.
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occupational outcome in Adult ADHD impact of symptom profile comorbid psychiatric problems and treatment a cross sectional study of 414 clinically diagnosed Adult ADHD patients
Journal of Attention Disorders, 2009Co-Authors: Anne Halmoy, Ole Bernt Fasmer, Christopher Gillberg, Jan HaavikAbstract:Objective: To determine the effects of symptom profile, comorbid psychiatric problems, and treatment on occupational outcome in Adult ADHD patients. Method: Adult ADHD patients (N = 414) responded to questionnaires rating past and present symptoms of ADHD, comorbid conditions, treatment history, and work status. Results: Of the patients, 24% reported being in work, compared to 79% in a population-based control group (N = 359). Combined subtype of ADHD, substance abuse, and a reported history of depression or anxiety were correlated with being out of work. Current and past medical treatment of ADHD was correlated with being in work. Logistic regression analyses showed that stimulant therapy during childhood was the strongest predictor for being in work as Adults (odds ratio = 3.2, p = .014). Conclusion: Early recognition and treatment of ADHD is a strong predictor of being in work as an Adult, independently of comorbidity, substance abuse, and current treatment. (J. of Att. Dis. 2009; 13(2) 175-187)