Criteria and Concurrent Validity of Adult ADHD Section of the Psychiatry Research Interview for Substance and Mental Disorders

Abstract

Objective: Prevalence of ADHD in adults is around 2% to 4%. Comorbidity is frequent in ADHD; 75% of patients develop a comorbid disorder across life span, substance use disorder (SUD) being one of the most prevalent. Method: A case-control study was performed to check the criteria and concurrent validity of psychiatric research interview for substance and mental disorders (PRISM) adult ADHD section. Validation was done comparing PRISM with the Conners’ Adult ADHD Diagnostic Interview for Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.). A convenient sample (N = 80) participated, 40 had diagnosis of SUD and ADHD and 40 had diagnosis of SUD without ADHD. The statistics hypothesis was bivariant, and the confidence level was 95%. Results: Kappa index concordance was .78, sensitivity of PRISM adult ADHD module was 90%, specificity was 87.5%, positive predictive value was 87.8%, and the negative predictive value was 89.7%. Conclusion: PRISM has good psychometric properties to detect ADHD associated with SUD.

Keywords

ADHD psychometrics comorbidity adult ADHD alcohol dependence

ADHD is one of the most common psychiatric disorders of childhood that persists through adulthood in around two third of the individuals (Faraone et al., 2006; Lara et al., 2009). The prevalence of ADHD in adults is estimated between 2% and 4% (Fayyad et al., 2007; Kessler, Chiu, Demler, Merikangas, & Walters, 2005; J. J. Kooij et al., 2005; Simon, Czobor, Balint, Meszaros, & Bitter, 2009). Expression of ADHD can change with age; hyperactive symptoms appear to be typical of young children, whereas inattention represents a relatively pervasive developmental characteristic (S. J. Kooij et al., 2010). Longitudinal studies have shown that ADHD has long-term disabling consequences, for example, school failure, relational problems such as rejection, and familial conflicts (Biederman et al., 1995; Taylor, Chadwick, Heptinstall, & Danckaerts, 1996). Furthermore, it is a predictor of adult mental health problems (Mannuzza, Klein, & Moulton, 2008). In adulthood, ADHD is associated with work difficulties (Kessler, Adler, et al., 2005), psychosocial impairment (Biederman et al., 1993), and an increased risk of mood, anxiety, and substance use disorders (SUD; Barkley, 2002; Biederman, Petty, Clarke, Lomedico, & Faraone, 2011; Young, Toone, & Tyson, 2003). Comorbidity is a frequent condition in ADHD; 75% of patients develop a comorbid disorder across life span (J. J. Kooij et al., 2005), SUD being one of the most prevalent. Several studies found that more than 30% of ADHD patients present a SUD across life span (Mannuzza, Klein, Truong, et al., 2008; Wilens et al., 2011). One study found that 32% to 53% of adults with ADHD have alcohol use disorders and 8% to 32% of the patients have problems with illegal drugs (Barkley & Gordon, 2002). The most frequent illegal substance abuse for the ADHD patients is cannabis followed by cocaine (Sullivan & Rudnik-Levin, 2001).

On the other hand, the lifetime prevalence rate of SUD reported in the general population is about 15% to 18% (Kessler, Berglund, et al., 2005). The economic impact of SUD demonstrates significant cost implications on the individual, family, and society (Demyttenaere et al., 2004; Khalsa, Treisman, McCance-Katz, & Tedaldi, 2008). In this regard, the economic burden of alcohol was estimated to equate to 0.45% to 5.44% of gross domestic product (Thavorncharoensap, Teerawattananon, Yothasamut, Lertpitakpong, & Chaikledkaew, 2009). Clinical and epidemiological studies have revealed a high co-occurrence of substance abuse and psychiatric disorders, a troublesome phenomenon given the consequences at medical, social, and economical levels (Kessler, Berglund, et al., 2005; Wilens et al., 2011). A reliable and valid diagnosis of a psychiatric disorder in substance abusers is far from being simple (easy) mainly due to the fact that (a) the effects of substance abuse (chronic or acute) can mimic symptoms of many other psychiatric disorders and (b) psychiatric diagnoses are not defined by direct biological markers but by a constellation of symptoms (Torrens, Serrano, Astals, Pérez-Domínguez, & Martín-Santos, 2004).

It is also important to take into account the high rates of ADHD within SUD populations, as reported by several studies that estimate prevalence ranges from 11% (Modestin, Matutat, & Wurmle, 2001) to 54% (Ohlmeier et al., 2008). The prevalence of ADHD can be different regarding the substance of abuse. In this way, patients with alcohol use disorder present a rate of 35% to 71%, patients with cocaine use disorder present a rate of 10% to 35%, and patients in treatment in methadone maintenance programs show a 17% frequency of ADHD (Levin, Evans, & Kleber, 1998; Wilens, 2007).

The more likely reasons for such comorbidity are complex, including common genetic risk factors (Fernàndez-Castillo et al., 2010; Franke et al., 2010), altered reward processing (Frodl, 2010; Volkow et al., 2009), comorbid conduct disorder (Serra-Pinheiro et al., 2012; Tuithof, Ten Have, van den Brink, Vollebergh, & de Graaf, 2011), and increased exposure to psychosocial risk factors and self-treatment (Hennessey, Stein, Rosengard, Rose, & Clarke, 2010; Wilens, 2007). The presence of ADHD in SUD patients has a special importance because it often presents with severe forms of SUD characterized by early onset, extended duration of symptoms, greater impairment, higher risk of suicide, and a shorter transition from substance use to dependence (Kelly, Cornelius, & Clark, 2004; Kolpe & Carlson, 2007; Wilens, 2007).

Diagnosis of adult ADHD is based on a careful and systematic assessment of lifetime history of symptoms and impairment. Central to this process is the assessment of childhood onset, current symptoms, and the presence of impairment in at least two domains (school, work, home, interpersonal contacts), according to the Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.; DSM-IV-TR; American Psychiatric Association, 2000) criteria (S. J. Kooij et al., 2010; Ramos-Quiroga et al., 2006).

Conners’ Adult ADHD Diagnostic Interview for DSM-IV-TR (CAADID) is one of the most frequently used semistructured diagnostic interviews for the assessment of adult ADHD (Arcos-Burgos et al., 2010; Daigre Blanco et al., 2009; Ramos-Quiroga, 2012; Epstein & Kollins, 2006; Medori et al., 2008; Ribasés et al., 2009). The CAADID is useful in clinical and research settings because it is scorable, provides categorical information helpful for defining research groups, and offers a variety of content information that can be used for qualitative analyses (Ramos-Quiroga, 2012). Nevertheless, the CAADID doesn’t systematically evaluate SUD, as it only focuses on ADHD symptoms. In research or clinical settings, other structured interviews (e.g., Structured Clinical Interview for DSM Disorders [SCID-I]) are required to assess SUD.

In the absence of an ADHD-specific measure to validate comorbid psychiatric diagnosis, the adult ADHD section of the psychiatric research interview for substance and mental disorders–IV (PRISM-IV) could serve as a valid alternative. PRISM-IV is a structured interview based on DSM-IV-TR diagnostic criteria and is specifically designed to study comorbidity in substance use subjects. The current version assesses 20 Axis I and 2 Axis II disorders, although other disorders (e.g., ADHD) are in the scope. PRISM showed high test–retest reliability for the majority of dependence, depressive, anxiety, and psychotic disorders, as well as for antisocial and borderline personality disorders (Hasin et al., 2006). In addition, in a validity study diagnoses obtained by PRISM using as “gold standard” the diagnoses obtained through the longitudinal evaluation performed by an expert, using all data available (the longitudinal, expert, all data [LEAD] procedure) showed a good correlation (Kappa index) between diagnoses obtained either by the PRISM or the LEAD procedure in the majority of disorders (Torrens et al., 2004). The concordance for any current affective disorders was fair between PRISM and LEAD (κ = .53), and poor between SCID and LEAD (κ = .36). Concordances for past affective disorders were fair between PRISM–LEAD (κ = .63) and SCID–LEAD pairs (κ = .53) although concordance was better between PRISM and LEAD than between SCID and LEAD in cases of substance-induced depression (κ = .40 vs. κ = .08). For current and past psychotic disorders, the concordance between PRISM and LEAD was excellent to good (κ = .85 and κ = .74), and significantly better than concordance between SCID and LEAD. For panic with or without agoraphobia and any anxiety disorder, the concordance PRISM–LEAD was excellent to good (current κ = .81, κ = .67; past κ = .74, κ = .68). In personality disorders (antisocial personality disorder and borderline personality disorder), concordances PRISM–LEAD were good (κ = .66, κ = .63; Torrens et al., 2004). In the absence of a gold standard to validate the psychiatric diagnosis, we decided to compare PRISM adult ADHD section with the CAADID, which is the most widely used interview for the diagnosis of ADHD in adulthood.

The main objective of this study is to assess the criteria and concurrent validity of the PRISM ADHD section in adulthood. As far as we know, this is the first study aimed to validate the PRISM ADHD section in adults.

Method

A case-control study was performed to check the criteria and concurrent validity of PRISM adult ADHD section.

Participants

Study participants were recruited from the outpatient clinic and from the detoxification unit in the Psychiatry Department of Hospital Universitari Vall d’Hebron in Barcelona, Spain. A convenience sample of 84 participants was selected to participate in the study. Of these, 3 individuals refused to participate and 1 participant was excluded due to intoxication symptoms (cannabis and alcohol) at the moment of the assessment. Of this total sample, 40 participants had a previously established diagnosis of SUD and ADHD and 40 had a diagnosis of SUD with no ADHD; diagnoses where established by a clinical expert (J. Antoni Ramos-Quiroga, Carlos Roncero, Gloria Palomar). Kappa coefficients of agreement were computed between raters and two board-certified psychiatrists who listened to the audiotaped interviews conducted by the raters. The median kappa was 0.98 for ADHD. The average age at assessment was 35.79 years (SD = 11.86) for the 80 participants included in the study.

Inclusion criteria for the ADHD + SUD group were diagnosis of ADHD according to DSM-IV-TR confirmed by CAADID and diagnosis of SUD (DSM-IV-TR criteria) confirmed by SCID-I. Inclusion criteria for the SUD group were as follows: no diagnosis of ADHD according to DSM-IV-TR criteria confirmed by CAADID and diagnosis of SUD (DSM-IV-TR criteria) confirmed by SCID-I. Exclusion criteria for both groups were intelligence quotient below 70 and presence of substance intoxication or abstinence symptoms at the moment of interview. The research protocol was approved by the ethics committee of Vall d’Hebron Research Institute, and all the participants signed an informed consent.

Research Diagnostic Assessments

Research diagnosis was made using the PRISM that was developed to assess psychiatric and substance use comorbidity using DSM-IV-TR criteria. PRISM interview has a validated Spanish version for several psychiatric disorders other than ADHD, but a translation and retro-translation for the ADHD section is available. We used this new Spanish translation of ADHD section of the PRISM.

The diagnosis of ADHD was made using the Spanish validated the CAADID interview version (Ramos-Quiroga et al., 2012). The purpose of CAADID is to determine if the patient meets the first four DSM-IV-TR criteria (Criteria A-D). The first section assesses the presence of the DSM-IV-TR inattention symptoms at childhood and adulthood, followed by questions about onset of the inattention symptoms and pervasiveness of the inattention symptoms. The second section assesses the criteria for the hyperactivity-impulsive symptoms. This is followed by a section that assesses impairment for all symptoms. In the last section of this article, there is a summary sheet and a scoring algorithm of the CAADID to appraise DSM-IV-TR diagnoses. The level of impairment was measured with the Clinical Global Impression Scale, included in the CAADID Part II.

The severity of childhood ADHD symptoms was assessed by Wender Utah Rating Scale (WURS; Ward, Wender, & Reimherr, 1993), which is a self-administered scale with 61 items that have good internal consistency and temporal stability. Severity of ADHD symptoms in the last month previous to the visit was assessed by the ADHD Rating Scale (ADHD-RS; DuPaul, Power, Anastopoulos, & Reid, 1998), which assesses all the ADHD symptoms included at DSM-IV-TR criteria. Full-Scale IQ was estimated with the Vocabulary and Block Design subtests of the Weschler Adult Intelligent Scale–III. The diagnoses of SUD and antisocial personality disorder were performed by SCID-I.

Procedure

Phase 1

ADHD diagnosis was made according to the clinical protocol for the assessment of ADHD in adults that has been approved previously by the ethics committee of Vall d’Hebron Research Institute (more details at Ribasés et al., 2009). The CAADID was administered during the first visit; during the second visit, the WURS and ADHD-RS were applied, and at the third visit, SCID-I was administered to assess SUD and other comorbid disorders. At least 1 hr per visit was required.

Phase 2

An interviewer, blinded to participants’ diagnoses, administered the PRISM Spanish version to all participants.

Statistical Analysis

Criteria validity analysis of the PRISM adult ADHD section was carried out by a study of sensitivity, specificity, positive predictive value (PPV, probability that a patient has the characteristic if the probe is positive) and negative predictive value (NPV, probability that a patient doesn’t have the characteristic if the probe is negative). All these estimations were accompanied with each confidence interval (CI). All information was completed with the Kappa calculus as global measure of concordance. Analysis of the concurrent validity was performed by bivariant correlations. The statistics hypothesis was bivariant, and the confidence level was 95%.

Results

The final sample was composed of 80 participants (76.3% men, mean age = 35.79 years, age range = 18-61); other sociodemographic and clinical characteristics are depicted in Table 1.

Table 1.

Sociodemographic and Clinical Characteristics.

Variables	N = 80
Age (years)	M = 35.79 (range = 18-61)
Gender	76.3% (n = 61) males
IQ	M = 103 (SD = 12.8)
Academic graduation
Non studies	3.75% (n = 3)
Primary studies	52.50% (n = 42)
Secondary studies	23.70% (n = 19)
Universitary studies	20.00 % (n = 16)
Laboral status
Employed	52.50% (n = 42)
Unemployed	22.50% (n = 18)
Social support	6.25% (n = 5)
Retired	3.75% (n = 3)
Student	2.50% (n = 2)
Type of SUD (n = 80)
Alcohol dependence	66.3% (n = 53)
Cocaine dependence	60.0% (n = 48)
Cannabis dependence	37.5% (n = 30)
Antisocial personality disorder	17.5% (n = 14)
ADHD subtype (n = 40)
ADHD combined	33
ADHD inattentive	3
ADHD hyperactive/impulsive	4
WURS
SUD + ADHD (n = 40)	53.31 (SD = 18.19)
SUD without ADHD (n = 40)	39.87 (SD = 20.26)
ADHD Rating Scale
SUD + ADHD (n = 40)	32.06 (SD = 9.51)
SUD without ADHD (n = 40)	17.13 (SD = 9.33)

Note. SUD = substance use disorder; WURS = Wender Utah Rating Scale; SD= standard deviation.

After the administration of PRISM, 41 participants (51.3%) were classified as SUD + ADHD and 39 (48.8%) as SUD. Kappa index showed a concordance between the PRISM adult ADHD module and our gold standard criteria used for ADHD diagnosis (CAADID) of 0.78 (95% CI = [0.64-0.91]). The proportion of concordance observed was 0.89 and 0.50 for the proportion expected randomly. Sensitivity of the PRISM adult ADHD module (proportion of participants with ADHD) was 90% (95% CI = [76.9-96.0]). With regard to specificity (proportion of participants without ADHD) was 87.5% (95% CI = [73.9-94.5]). PPV was 87.8% (95% CI = 74.5-94.7), and the NPV was 89.7% (95% CI = [76.4-95.9]).

The adult ADHD symptoms detected by PRISM were statistically significant for both cluster of correlation between WURS ratings and inattention and hyperactivity reported symptoms (inattention symptoms, r = .47, p < .01; hyperactivity symptoms, r = .56, p < .01; and total symptoms, r = .62, p < .01). At the same line, PRISM showed a significant correlation between inattention and hyper-activity symptoms and the results of ADHD-RS (inattention symptoms, r = .69, p < .01; hyperactivity symptoms, r = .80, p < .01; and total symptoms, r = .77, p < .01).

Discussion

This is the first study that validates the PRISM adult ADHD section for the diagnosis of adult ADHD in patients with SUD. The results show that PRISM has good psychometric properties to detect ADHD in adult patients with SUD. The PPV and NPV were superior to 85% as well as the sens-itivity and specificity. On the other hand, the concurrent validity analysis showed that the PRISM ADHD module for adults has a significant correlation with WURS and ADHD-RS.

These results are in line with previous studies that evaluated the validity of PRISM to detect depressive disorders, anxiety disorders, psychotic disorders, or antisocial personality disorder (Astals et al., 2008, 2009; Herrero, Domingo-Salvany, Torrens, Brugal, & ITINERE Investigators, 2008; Rodríguez-Llera et al., 2006; Torrens, Gilchrist, Domingo-Salvany, & psyCoBarcelona Group, 2011). Kappa index showed a concordance between the PRISM adult ADHD module and the CAADID of .78. Previous studies showed a kappa index between the PRISM and the LEAD procedures for affective disorders of .53 to .63, for anxiety disorders of .67 to .68, for psychotic disorders of .85 to .74, and for antisocial personality disorders of .63 to .66. Following DSM-IV-TR criteria, the most widely used interviews for psychiatric diagnosis are SCID-I and PRISM. We found that PRISM has shown better reliability and validity in comparison with the combined use of SCID-I and LEAD as a gold standard in substance abusers (Torrens et al., 2004). In clinical practice is very useful to dispose of a tool that allows to diagnose SUD and other related psychiatric disorders. PRISM should be this tool given its characteristics.

The diagnosis of ADHD in adulthood requires the correct assessment of comorbid disorders, especially SUD because of the high frequency between both disorders. Current diagnostic interviews for adult ADHD do not assess this comorbidity, which makes it mandatory to include another interview (e.g., SCID-I) in the assessment. This situation is time-consuming and limits the use of these instruments in daily clinical practice. PRISM presents a good capacity to detect ADHD and also the most common psychiatric disorders associated with ADHD (i.e., SUD, depression, anxiety, and antisocial personality disorder). Because of this, it is a perfect tool for detection of adult ADHD in patients with SUD. PRISM should be incorporated in the regular clinical practice when the participant has a positive screening of adult ADHD with any other short instrument (e.g., Adult ADHD Self-Report Scale). In conclusion, we believe that because of its good psychometric properties to detect ADHD in adult patients with SUD and ease of use, PRISM should be the tool used in clinical settings to diagnose SUD related to ADHD and other psychiatric diagnoses.

The results of the study should be understood on the light of limitations. The first limitation is that the study was performed in a university hospital setting. As this study was done in clinical population, we cannot make asseverations of the psychometric properties of the adult ADHD module in general population. Nevertheless, the psychometric properties of other modules of the PRISM have good reliability in several settings.

In conclusion, the PRISM adult ADHD section has good psychometric properties to detect ADHD in adults with SUD. PRISM can be a useful tool in clinical settings, for primary settings as well as in other level of attention to assess ADHD in adults with SUD.

Footnotes

Acknowledgements

The authors would like to thank all the staff at Adult ADHD Program and patients who participated in this project. Thanks to Yolanda Santaella and Yemima Villegas for their administrative support.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the authorship and/or publication of this article.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: Funding for this study was provided by Instituto de Salud Carlos III (ISCIII)-Fondos; Fondo Europeo de Desarrollo Regional l; Red de Trastornos Adictivos; RTA (FEDER; Red de Trastornos Adictivos [RTA] RD06/001/1009 to M.T.). The ISCIII had no further role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the article for publication.

Author Biographies

J. Antoni Ramos-Quiroga, MD, PhD, is an associate professor of Department of Psychiatry and Legal Medicine at Universitat Autònoma de Barcelona, Spain and Coordinator of ADHD Program of Department of Psychiatry at Vall d’Hebron University Hospital. His research interests include the study of ADHD across life span.

Laura Díaz-Digón, PhD, is psychologist of Institute of Neuropsychiatry and Addictions at Parc de Salut Mar of Barcelona. Her research is focus on addictions and comorbidity.

Marina Comín, PhD, is psychologist of Department of Psychiatry at Vall d’Hebron University Hospital. Her research interest is the study of substance use disorders in dual pathology.

Rosa Bosch, PhD, is psychologist of Department of Psychiatry at Vall d’Hebron University Hospital. Her research interests include the study of ADHD across life span.

Gloria Palomar, MD, is psychiatrist of Department of Psychiatry at Vall d’Hebron University Hospital. Her research interests include the study of ADHD in adulthood.

J. Pablo Chalita, MD, is psychiatrist of Department of Psychiatry at Vall d’Hebron University Hospital. His research interests include the study of ADHD in adulthood.

Carlos Roncero, MD, PhD, is an associate professor of Department of Psychiatry and Legal Medicine at Universitat Autònoma de Barcelona, Spain. Dr. Roncero is leading the outpatient clinic for drug-dependent patients of the Hospital Universitari Vall d’Hebron in Barcelona. at of Department of Psychiatry at Vall d’Hebron University Hospital. His research interests include the study of substance use disorders in dual pathology.

Mariana Nogueira, PhD, is psychologist of Department of Psychiatry at Vall d’Hebron University Hospital. Her research interests include the study of ADHD in adulthood.

Marta Torrens, MD, PhD, is an titular professor of Department of Psychiatry and Legal Medicine at Universitat Autònoma de Barcelona, Spain and member of Institute of Neuropsychiatry and Addictions at Parc de Salut Mar of Barcelona. His research interests include the study of instruments for diagnosis of psychiatric disorders in substance abusers.

Miguel Casas, MD, PhD, is an full professor of Department of Psychiatry and Legal Medicine at Universitat Autònoma de Barcelona, Spain and Head of Deparment of Psychiatry at Vall d’Hebron University Hospital. His research interests include the study of ADHD and substance use disorders.

References

American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author.

Arcos-Burgos

Jain

Acosta

M. T.

Shively

Stanescu

Wallis

. . .Muenke

(2010). A common variant of the latrophilin 3 gene, LPHN3, confers susceptibility to ADHD and predicts effectiveness of stimulant medication. Molecular Psychiatry, 15, 1053-1066. doi:10.1038/mp.2010.6

Astals

Díaz

Domingo-Salvany

Martín-Santos

Bulbena

Torrens

(2009). Impact of co-occurring psychiatric disorders on retention in a methadone maintenance program: An 18-month follow-up study. International Journal of Environmental Research and Public Health, 6, 2822-2832. doi:10.3390/ijerph6112822

Astals

Domingo-Salvany

Buenaventura

C. C.

Tato

Vazquez

J. M.

Martín-Santos

Torrens

(2008). Impact of substance dependence and dual diagnosis on the quality of life of heroin users seeking treatment. Substance Use and Misuse, 43, 612-632. doi:10.1080/10826080701204813

Barkley

R. A.

(2002). Major life activity and health outcomes associated with attention-deficit/hyperactivity disorder. Journal of Clinical Psychiatry, 63(12), 10-15. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/12562056

Barkley

R. A.

Gordon

(2002). Research on comorbidity, adaptative functioning, and cognitive impairments in adults with ADHD: Implication for a clinical practice. In Goldstein

Ellison

A. T.

(Eds.), Clinician’s guide to adult ADHD: Assessment and intervention (pp. 43-69). San Diego, CA: Academic Press.

Biederman

Faraone

S. V.

Mick

Spencer

Wilens

Kiely

Warburton

(1995). High risk for attention deficit hyperactivity disorder among children of parents with childhood onset of the disorder: A pilot study. American Journal of Psychiatry, 152, 431-435. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/7864271

Biederman

Faraone

S. V.

Spencer

Wilens

Norman

Lapey

K. A.

Doyle

(1993). Patterns of psychiatric comorbidity, cognition, and psychosocial functioning in adults with attention deficit hyperactivity disorder. American Journal of Psychiatry, 150, 1792-1798. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/8238632

Biederman

Petty

C. R.

Clarke

Lomedico

Faraone

S. V.

(2011). Predictors of persistent ADHD: An 11-year follow-up study. Journal of Psychiatric Research, 45, 150-155. doi:10.1016/j.jpsychires.2010.06.009

10.

Daigre Blanco

Ramos-Quiroga

J. A.

Valero

Bosch

Roncero

Gonzalvo

Nogueira

(2009). Adult ADHD Self-Report Scale (ASRS-v1.1) Symptom checklist in patients with substance use disorders. Actas Españolas de Psiquiatría, 37, 299-305. Retrieved from http://www.ncbi.lm.nih.gov/pubmed/20066581

11.

Demyttenaere

Bruffaerts

Posada-Villa

Gasquet

Kovess

Lepine

J. P.

, . . . WHO World Mental Health Survey Consortium. (2004). Prevalence, severity, and unmet need for treatment of mental disorders in the World Health Organization World Mental Health Surveys. Journal of the American Medical Association, 291, 2581-2590. doi:10.1001/jama.291.21.2581

12.

DuPaul

Power

Anastopoulos

Reid

(1998). ADHD Rating Scale–IV: Checklists, norms, and clinical interpretation. New York, NY: Guilford.

13.

Epstein

J. N.

Kollins

S. H.

(2006). Psychometric properties of an Adult ADHD Diagnostic Interview. Journal of Attention Disorders, 9, 504-514. doi:10.1177/1087054705283575

14.

Faraone

S.V.

Biederman

Mick

(2006). The age-dependent decline of attention deficit hyperactivity disorder: A meta-analysis of follow-up studies. Psychological medicine, 36(2), 159-165. doi: 10.1017/S003329170500471X

15.

Fayyad

De Graaf

Kessler

Alonso

Angermeyer

Demyttenaere

. . .Jin

(2007). Cross-national prevalence and correlates of adult attention-deficit hyperactivity disorder. British Journal of Psychiatry, 190, 402-429. doi:10.1192/bjp.bp.106.034389

16.

Fernàndez-Castillo

Ribasés

Roncero

Casas

Gonzalvo

Cormand

(2010). Association study between the DAT1, DBH and DRD2 genes and cocaine dependence in a Spanish sample. Psychiatric Genetics, 20, 317-320. doi:10.1097/YPG.0b013e32833b6320

17.

Franke

Vasquez

A. A.

Johansson

Hoogman

Romanos

Boreatti-Hümmer

. . .Reif

(2010). Multicenter analysis of the SLC6A3/DAT1 VNTR haplotype in persistent ADHD suggests differential involvement of the gene in childhood and persistent ADHD. Neuropsychopharmacology, 35, 656-664. doi:10.1038/npp.2009.170

18.

Frodl

(2010). Comorbidity of ADHD and substance use disorder (SUD): A neuroimaging perspective. Journal of Attention Disorders, 14, 109-120. doi:10.1177/1087054710365054

19.

Hasin

Samet

Nunes

Meydan

Matseoane

Waxman

(2006). Diagnosis of comorbid psychiatric disorders in substance users assessed with the Psychiatric Research Interview for Substance and Mental Disorders for DSM-IV. American Journal of Psychiatry, 163, 689-696. doi:10.1176/appi.ajp.163.4.689

20.

Hennessey

K. A.

Stein

M. D.

Rosengard

Rose

J. S.

Clarke

J. G.

(2010). Childhood attention deficit hyperactivity disorder, substance use, and adult functioning among incarcerated women. Journal of Attention Disorders, 14, 273-280. doi:10.1177/1087054709347185

21.

Herrero

M. J.

Domingo-Salvany

Torrens

Brugal

M. T.

, & ITINERE Investigators. (2008). Psychiatric comorbidity in young cocaine users: Induced versus independent disorders. Addiction, 103, 284-293. doi:10.1111/j.1360-0443.2007.02076.x

22.

Kelly

T. M.

Cornelius

J. R.

Clark

D. B.

(2004). Psychiatric disorders and attempted suicide among adolescents with substance use disorders. Drug and Alcohol Dependence, 73, 87-97. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/14687963

23.

Kessler

R. C.

Adler

L. E.

Ames

Barkley

R. A.

Birnbaum

Greenberg

. . .Ustun

T. B.

(2005). The prevalence and effects of adult attention deficit/hyperactivity disorder on work performance in a nationally representative sample of workers. Journal of Occupational and Environmental Medicine, 47, 565-572. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/15951716

24.

Kessler

R. C.

Berglund

Demler

Jin

Merikangas

K. R.

Walters

E. E.

(2005). Lifetime prevalence and age of onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry, 62, 593-602. doi:10.1001/archpsyc.62.6.593

25.

Kessler

R. C.

Chiu

W. T.

Demler

Merikangas

K. R.

Walters

E. E.

(2005). Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry, 62, 617-627. doi:10.1001/archpsyc.62.6.617

26.

Khalsa

J. H.

Treisman

McCance-Katz

Tedaldi

(2008). Medical consequences of drug abuse and co-occurring infections: Research at the National Institute on Drug Abuse. Substance Abuse, 29(3), 5-16. doi:10.1080/08897070802218661

27.

Kolpe

Carlson

G. A.

(2007). Influence of attention-deficit/hyperactivity disorder symptoms on methadone treatment outcome. American Journal on Addictions, 16, 46-48. doi:10.1080/10601330601080073

28.

Kooij

J. J.

Buitelaar

J. K.

van den Oord

E. J.

Furer

J. W.

Rijnders

C. A.

Hodiamont

P. P.

(2005). Internal and external validity of attention-deficit hyperactivity disorder in a population-based sample of adults. Psychological Medicine, 35, 817-827. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/15997602

29.

Kooij

S. J.

Bejerot

Blackwell

Caci

Casas-Brugué

Carpentier

P. J.

. . .Asherson

(2010). European consensus statement on diagnosis and treatment of adult ADHD: The European Network Adult ADHD. BMC Psychiatry, 10, 67. doi:10.1186/1471-244X-10-67

30.

Lara

Fayyad

de Graaf

Kessler

R. C.

Aguilar-Gaxiola

Angermeyer

. . .Sampson

(2009). Childhood predictors of adult attention-deficit/hyperactivity disorder: results from the World Health Organization World Mental Health Survey Initiative. Biological Psychiatry, 65(1), 46-54. doi: 10.1016/j.biopsych.2008.10.005

31.

Levin

F. R.

Evans

S. M.

Kleber

H. D.

(1998). Prevalence of adult attention-deficit hyperactivity disorder among cocaine abusers seeking treatment. Drug and Alcohol Dependence, 52(1), 15-25. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/9788002

32.

Mannuzza

Klein

R. G.

Moulton

J. L.

III. (2008). Lifetime criminality among boys with attention deficit hyperactivity disorder: A prospective follow-up study into adulthood using official arrest records. Psychiatry Research, 160, 237-246. doi:10.1016/j.psychres.2007.11.003

33.

Mannuzza

Klein

R. G.

Truong

N. L.

Moulton

J. L.

III Roizen

E. R.

Howell

K. H.

Castellanos

F. X.

(2008). Age of methylphenidate treatment initiation in children with ADHD and later substance abuse: Prospective follow-up into adulthood. American Journal of Psychiatry, 165, 604-609. doi:10.1176/appi.ajp.2008.07091465

34.

Medori

Ramos-Quiroga

J. A.

Casas

Kooij

J. J.

Niemelä

Trott

G. E.

Buitelaar

J. K.

(2008). A randomized, placebo-controlled trial of three fixed dosages of prolonged-release OROS methylphenidate in adults with attention-deficit/hyperactivity disorder. Biological Psychiatry, 63, 981-989. doi:10.1016/j.biopsych.2007.11.008

35.

Modestin

Matutat

Wurmle

(2001). Antecedents of opioid dependence and personality disorder: Attention-deficit/hyperactivity disorder and conduct disorder. European Archives of Psychiatry & Clinical Neuroscience, 251, 42-47. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/11315518

36.

Ohlmeier

M. D.

Peters

Te Wildt

B. T.

Zedler

Ziegenbein

Wiese

Schneider

(2008). Comorbidity of alcohol and substance dependence with attention-deficit/hyperactivity disorder (ADHD). Alcohol and Alcoholism, 43, 300-304. doi:10.1093/alcalc/agn014

37.

Ramos-Quiroga

J. A.

Bosch

Richarte

Valero

Gómez-Barros

Nogueira

. . .Casas

(2012). Validez de criterio y concurrente de la versión española de la Conners Adult ADHD Diagnostic Interview for DSM-IV (CAADID). Revista de Psiquiatría y Salud Mental. Advance online publication. https://dx-doi-org.web.bisu.edu.cn/10.1016/j.rpsm.2012.05.004

38.

Ramos-Quiroga

J. A.

Bosch-Munsó

Castells-Cervelló

Nogueira-Morais

García-Gimenez

Casas-Brugué

(2006). Attention deficit hyperactivity disorder in adults: A clinical and therapeutic characterization. Revista de Neurología, 42, 600-606. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/16703528

39.

Ribasés

Ramos-Quiroga

J. A.

Hervás

Bosch

Bielsa

Gastaminza

. . .Bayés

(2009). Exploration of 19 serotoninergic candidate genes in adults and children with attention deficit/hyperactivity disorder identifies association for 5HT2A, DDC and MAOB. Molecular Psychiatry, 14, 71-85. doi:10.1038/sj.mp.4002100

40.

Rodríguez-Llera

M. C.

Domingo-Salvany

Brugal

M. T.

Silva

T. C.

Sánchez-Niubó

Torrens

, & ITINERE Investigators. (2006). Psychiatric comorbidity in young heroin users. Drug and Alcohol Dependence, 84, 48-55. doi:10.1016/j.drugalcdep.2005.11.025

41.

Serra-Pinheiro

M. A.

Coutinho

E. S.

Souza

I. S.

Pinna

Fortes

Araújo

Mattos

(2012). Is ADHD a risk factor independent of conduct disorder for illicit substance use? A meta-analysis and metaregression investigation. Journal of Attention Disorders. Advance online publication. doi:10.1177/1087054711435362

42.

Simon

Czobor

Balint

Meszaros

Bitter

(2009). Prevalence and correlates of adult attention-deficit hyperactivity disorder: Meta-analysis. British Journal of Psychiatry, 194, 204-211. doi:10.1192/bjp.bp.107.048827

43.

Sullivan

M. A.

Rudnik-Levin

(2001). Attention deficit/hyperactivity disorder and substance abuse: Diagnostic and therapeutic considerations. Annals of the New York Academy of Sciences, 931, 251-270. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/11462745

44.

Taylor

Chadwick

Heptinstall

Danckaerts

(1996). Hyperactivity and conduct problems as risk factors for adolescent development. Journal of the American Academy of Child & Adolescent Psychiatry, 35, 1213-1226. doi:10.1097/00004583-199609000-00019

45.

Thavorncharoensap

Teerawattananon

Yothasamut

Lertpitakpong

Chaikledkaew

(2009). The economic impact of alcohol consumption: A systematic review. Substance Abuse Treatment, Prevention, and Policy, 25(4), 20. doi:10.1186/1747-597X-4-20

46.

Torrens

Gilchrist

Domingo-Salvany

, & psyCo-Barcelona Group. (2011). Psychiatric comorbidity in illicit drug users: Substance-induced versus independent disorders. Drug and Alcohol Dependence, 113, 147-156. doi:10.1016/j.drugalcdep.2010.07.013

47.

Torrens

Serrano

Astals

Pérez-Domínguez

Martín-Santos

(2004). Diagnosing comorbid psychiatric disorders in substance abusers: Validity of the Spanish versions of the Psychiatric Research Interview for Substance and Mental Disorders and the Structured Clinical Interview for DSM-IV. American Journal of Psychiatry, 161, 1231-1237. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/15229056

48.

Tuithof

Ten Have

van den Brink

Vollebergh

de Graaf

(2011). The role of conduct disorder in the association between ADHD and alcohol use (disorder). Results from the Netherlands Mental Health Survey and Incidence Study-2. Drug and Alcohol Dependence, 123, 115-121. doi:10.1016/j.drugalcdep.2011.10.030

49.

Volkow

N. D.

Wang

G. J.

Kollins

S. H.

Wigal

T. L.

Newcorn

J. H.

Telang

Swanson

J. M.

(2009). Evaluating dopamine reward pathway in ADHD: Clinical implications. Journal of the American Medical Association, 302, 1084-1091. doi:10.1001/jama.2009.1308

50.

Ward

M. F.

Wender

P. H.

Reimherr

F. W.

(1993). The Wender Utah Rating Scale: An aid in the retrospective diagnosis of childhood attention deficit hyperactivity disorder. American Journal of Psychiatry, 150, 885-890. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/8494063

51.

Wilens

T. E.

(2007). The nature of the relationship between attention deficit/hyperactivity disorder and substance use. Journal of Clinical Psychiatry, 68(Suppl. 11), 4-8. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/18307375

52.

Wilens

T. E.

Martelon

Joshi

Bateman

Fried

Petty

Biederman

(2011). Does ADHD predict substance-use disorders? A 10-year follow-up study of young adults with ADHD. Journal of the American Academy of Child & Adolescent Psychiatry, 50, 543-553. doi:10.1016/j.jaac.2011.01.021

53.

Young

Toone

Tyson

(2003). Comorbidity and psychosocial profile in adults with attention deficit hyperactivity disorder. Personality and Individual Differences, 35, 743-755. doi:10.1016/S0191-8869(02)00267-2