Diagnosis of ADHD in Adults

Oct 7, 2011Journal of attention disorders

Finding the Right Symptom Cutoff for Hyperactivity-Impulsivity in Adult ADHD Diagnosis

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Abstract

Of 88 participating adults, 48 (55%) had a T-score of at least 65 on the CAARS DSM-IV Hyperactive-Impulsive scale.

Only 25 (52%) of those with elevated scores met the DSM-IV cutoff of six hyperactive-impulsive symptoms.
Approximately half of the adults with elevated complaints did not meet the six-symptom DSM-IV requirement.
An alternative cutoff of four hyperactive-impulsive symptoms identified 39 (81%) of the cases recognized by the CAARS.
Mandating six symptoms may exclude a significant percentage of adults with clinically elevated hyperactive-impulsive traits.
These findings suggest a potential need to lower the hyperactivity-impulsivity symptom threshold for diagnosing adults.

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OBJECTIVE: To empirically identify the appropriate symptom threshold for hyperactivity-impulsivity for diagnosis of ADHD in adults.

METHOD: Participants were 88 adults (M [SD] age = 41.69 [11.78] years, 66% female, 16% minority) meeting formal DSM-IV criteria for ADHD combined or predominantly inattentive subtypes based on a structured diagnostic interview keyed to DSM-IV (Conners' Adult ADHD Diagnostic Interview for DSM-IV [CAADID]). All participants also completed the Conners' Adult ADHD Rating Scale (CAARS), which was normed on the general adult population and includes subscales for DSM-IV inattentive and DSM-IV hyperactive-impulsive symptoms. A T-score threshold of 65 (at least 1.5 SD above population mean) on the CAARS DSM-IV hyperactive-impulsive dimension was used to identify participants with empirically elevated symptom severity.

RESULTS: Of 88 participating adults, 48 (55%) had a T-score of at least 65 (1.5 SD) on the CAARS DSM-IV Hyperactive-Impulsive scale. Of these, only 25 (52%) met the DSM-IV cutoff of six hyperactive-impulsive symptoms on the CAADID. Thus, approximately half of those who reported empirically elevated hyperactive-impulsive complaints on the CAARS did not concurrently meet the six-symptom DSM-IV cutoff on the CAADID. An alternative cutoff of four hyperactive-impulsive symptoms on the CAADID captured 39 (81%) cases identified by the CAARS.

CONCLUSION: In adults, mandating at least six hyperactive-impulsive symptoms excludes a significant percentage (almost half) of adults who are at least 1.5 SD above the population mean on a dimensional measure of hyperactivity-impulsivity. These data provide a compelling basis for lowering the symptom threshold of hyperactivity-impulsivity for adults in the DSM-5.

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Diagnosis of ADHD in Adults

Abstract

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