Journal of Attention Disorders

Objective: The objective of this study is to investigate the discriminative validity of neuropsychological tests and diagnostic assessment instruments in diagnosing adult ADHD in a clinical psychiatric population. Method: Of 108 patients, 60 were diagnosed with ADHD. The Diagnostic Interview for ADHD in adults (DIVA 2.0) and Adult ADHD Self-Report Scale (ASRS) v.1.1 together with eight neuropsychological tests were investigated. Results: All instruments showed poor discriminative ability except for the DIVA, which showed a relatively good ability to discriminate between the groups (sensitivity = 90.0; specificity = 72.9). A logistic regression analysis model with the DIVA and measures of inattention, impulsivity, and activity from continuous performance tests (CPTs) showed a sensitivity of 90.0 and a specificity of 83.3. Conclusion: Neuropsychological tests have a poor ability to discriminate between patients diagnosed with ADHD and patients not diagnosed with ADHD, but variables from CPT tests can contribute to increasing the specificity by 10% if used in combination with the DIVA.

Objective: To examine the screening ability of the Strengths and Difficulties Questionnaire (SDQ) for ADHD subtypes in a clinical sample. Method: Parents of 523 children (3 to 17 years old) referred to Child and Adolescent Mental Health Services completed the Spanish version of the SDQ and the ADHD Rating Scale–IV. Receiver operating curve (ROC) curve analyses and likelihood ratios (LRs) were conducted. Results: The LR results indicated that the 8/10 cutoff showed the highest diagnostic accuracy. The sensitivity of the SDQ 8/10 cutoff for the three subtypes was significantly different: 84.0% (95% confidence interval [CI] = [75.58, 89.90]) of ADHD combined subtype (ADHD-Co), 25.0% (95% CI = [17.55, 34.30]) of ADHD predominantly inattentive subtype (ADHD-I), and 77.8% (95% CI = [68.71, 84.83]) of ADHD predominantly hyperactive/impulsive subtype (ADHD-H). Sex and age differences were found. These screening differences were also found when using the 7/10 cutoff or the SDQ predictive algorithm. Conclusion: Our study supports the use of the SDQ in the screening for ADHD. However, not all ADHD subtypes are equally screened.

Objective: Children with ADHD frequently manifest behavioral difficulties in the morning prior to school. We sought to assess the reliability and validity of the Before-School Functioning Questionnaire (BSFQ) as a measure of morning behaviors impaired by ADHD. Method: We used pre-treatment data from a randomized crossover study of 6- to 12-year-old participants comparing the methylphenidate transdermal delivery system (MTS) with a placebo transdermal system (PTS) for a total of 4 weeks. Results: The BSFQ investigator–rated scale shows very good internal homogeneity (Cronbach’s α = .91), good test–retest reliability (r = .60), good concurrent validity (r range = .42-.86), and a strong treatment effect (effect size = −.93). The self-rated BSFQ showed lower levels of reliability and validity. Conclusion: The investigator-rated BSFQ should be used in future trials of ADHD medications aimed at assessing efficacy in the morning before school.

Objective: The purpose of this study was to investigate the possibility of creating a new scale on the Personality Assessment Inventory (PAI) to assess for ADHD-like symptomatology. Method: Two approaches to scale development were compared: (a) stepwise regression using PAI scales and subscales as predictors and the CAARS-H index as the dependent variable and (b) a MANOVA using discharge diagnosis as the grouping variable and PAI scales and subscales as the dependent variables. Results: Stepwise regression identified six PAI scales and subscales (PIM, RXR, SOM-S, ARD-T, MAN-A, and SCZ-T) that were responsible for a large proportion of variance (39%) in the CAARS-H index, and the MANOVA also identified six subscales that significantly differed between those clients eventually diagnosed with ADHD and those not diagnosed (ANT-S, SCZ-T, MAN-A, ANX-C, BOR-S, and MAN-G). Conclusion: Although each set produced statistically significant findings, neither produced high correct classification rates in the eventual diagnosis of ADHD.

Objective: To explore the relationship between the Conners’ Kiddie Continuous Performance Test (K-CPT) performance and parent-report measures of child behavior and executive functioning, and clarify the role of sex in K-CPT performance in preschoolers. Method: Mothers and children recruited to the Health Outcomes and Measures of the Environment Study with complete 5-year assessment data relevant to the analyses were included (N = 127). We examined the association between K-CPT scores and Behavior Assessment System for Children–Second Edition (BASC-2) and Behavior Rating Inventory of Executive Function (BRIEF) scores, with covariate adjustment. Results: We found no significant associations between K-CPT, BASC-2, and BRIEF scores in the full sample. In sex-stratified analyses, we found unusually fast reaction time on K-CPT was related to executive control difficulties in girls, whereas unusually slow reaction time was related to the same difficulties in boys. Omission errors were associated with executive difficulties only in boys. Conclusion: The K-CPT may prove to be a useful indicator for early onset of executive control difficulties in preschool-aged children.

Objective: Children with ADHD frequently manifest behavioral difficulties in the morning prior to school. We sought to assess the reliability and validity of the Daily Parent Rating of Evening and Morning Behavior Scale, Revised (DPREMB-R) morning score as a measure of morning behaviors impaired by ADHD. Method: We used data from a clinical trial of HLD200 treatment in pediatric participants with ADHD to address our objectives. Results: The DPREMB-R morning score showed significant internal homogeneity, test–retest reliability (r = .52-.45), and good concurrent validity (r = .50-.71). Conclusion: The DPREMB-R morning score could be a useful instrument for assessing treatment efficacy in the morning before school.

Objective: We assess the diagnostic accuracy of the QbTest, which measures the cardinal symptoms of ADHD. Method: The study group comprised 182 children (mean age about 10 years), of whom 124 had ADHD and 58 had other clinical diagnosis of which 81% had ASD. Results: Only QbTest parameters for inattention and hyperactivity differentiated between ADHD and other clinical diagnoses at the p ≤ .01 level, not for measures of impulsivity. Sensitivity ranged from 47% to 67% and specificity from 72% to 84%. Positive predictive value ranged from 41% to 86%, and negative predictive value from 43% to 86%. Area under the curve varied from .70 to .80. Conclusion: The ability of the individual QbTest parameters to identify ADHD was moderate. The test’s ability to discriminate between ADHD subtypes was unsatisfactory.

Objective: To analyze the diagnostic effectiveness of the AULA Nesplora test to discriminate the different ADHD presentations: impulsive/hyperactive (I/H), inattentive, and combined.Method: A total of 117 students (76.9% male and 23.1% female) between 5 and 16 years of age (M = 11.18 years, SD = 3.10 years) participated, and were divided into three groups with ADHD according to their presentation, and a control group. Results: Each of the test conditions allowed the discrimination between the I/H and combined presentations with respect to the control group, and between the I/H and inattentive presentations. However, differences among ADHD presentations were only evident when the results were separately analyzed for the visual and auditory modalities. Conclusion: This study showed that the indicators offered by the AULA Nesplora test (omissions, commissions, response times, and motor activity) make it possible to establish a differential diagnosis of ADHD presentations when analyzed under different contextual conditions.