Dx criteria for ADHD Symptoms have to have appeared early in life (usually before age 7, certainly before age 12) Symptoms have been chronic Symptoms cause significant impairment in at least TWO major life areas Symptoms are not the result of co-existing disorders (rule out clause)
ADHD epidemic? Concern about dramatic rise in number of adults presenting to professionals for primary investigation of possible ADHD No one definitive test for ADHD Question of whether & to what extent DSM symptoms of ADHD, especially inattentive, are common Retrospective dx often difficult-memory is fallible
How common are inattentive symptoms? Adults commonly describe their childhood behaviors as ADHD–like (Murphy, Gordon, and Barkley, 2000) 80% of adults report six or more of the DSM–IV symptoms occasionally, & 25% of adults report such symptoms very often. Over 30% of college students complain of significant problems remembering things, paying attention, concentrating, being irritable & impatient, having sleep problems, procrastinating… Wong et al. (1994) ? Stressful, competitive, busy life with many new changes may lead to development of ADHD-like symptoms?
Problems with prior research Most studies only attempt to discriminate between well-validated ADHD and normals In practice, rarely have to determine if a normal person has a disorder Inattentive symptoms are common to a number of disorders, including: –PTSD, Depression, DID, substance abuse, anxiety disorder, Chronic Pain Overreliance on checklists can lead to misdiagnosis
Brown Attention Activation Disorders (BAADS) Brown (1996) developed own method to identify people with inattentive ADHD. Based on his own notion of core symptoms of ADHD-I Scales do not have objective anchors to denote frequency or intensity (very subjective ratings). No data to indicate extent to which these symptoms are common in students
Present study 224 students presenting to Health/ Counselling Service first 2 weeks January Exclusion criteria was prior dx ADHD 180 students from Health 32 Counselling & Academic skills 12 Psychiatry Median age 21 65% female, but no difference by sex
TABLE 1. Number and Frequency of BADDS Adult Scores with Cutoff Scores of 50 and 55 BAADS score HealthCounsellingPsychTotal N=180N= 32N= 12N= 224 %% 5072.831.233.364.7 >50 ADD probable 27.268.866.735.3 5578.837.533.370.5 >55 ADD Highly probable21.262.566.729.5
Cut off? Cut off score of 84 required to obtain false positive rate of 4%! This is 34 points higher than manuals cut off for probable ADD, and 29 points above the HIGHLY PROBABLE label.
Results continued Significantly more students attending Counselling & Psychiatry endorsed symptoms typical of ADHD (63-67%) None had prior diagnoses of ADHD. Difficult to believe all these students being followed by professionals could have undiagnosed ADHD Possible there are some with undiagnosed disorder, but hard to believe 21% of students going in for routine medical c/o have undiagnosed ADHD when base rate is 1%.
Conclusions Findings raise serious concerns about potential overidentification of ADHD in students if relying solely on BAADS Suggest self-report scales should include scale anchors for more objective reporting Cut off score need to be re-examined, comparing scores of known ADHD with clinical controls. Imperative that clinicians obtain objective information about long-time history of impairments across settings before diagnosing ADHD.
Conclusions Misdiagnosis puts clients at risk for inappropriate and potentially harmful treatment (cf. Adderall) Possible development of tic disorder Possible exacerbation of anxiety in PTSD Real cause of problems left untreated Overdiagnosis leads to loss of credibility, both for the disorder and the clinicians!
Conclusion DONT DIAGNOSE ADHD BASED SOLELY ON SELF-REPORTED SYMPTOMS