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Kwan D, Davin N, Harrison AG, Gillie S. Determining cutoff scores on the Conners' adult ADHD rating scales that can definitively rule out the presence of ADHD in a clinical sample. APPLIED NEUROPSYCHOLOGY. ADULT 2024:1-11. [PMID: 38569190 DOI: 10.1080/23279095.2024.2336204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/05/2024]
Abstract
In recent years, the prevalence of Attention Deficit/Hyperactivity Disorder (ADHD) and the number of individuals seeking ADHD assessments has risen significantly, leading to an increased demand for accurate diagnostic tools. This study aimed to identify cutoff scores on the Conners' Adult ADHD Rating Scales (CAARS-S:L) that can definitively rule out the presence of ADHD. Among 102 clinically diagnosed adult ADHD participants and 448 non-ADHD participants who completed the CAARS-S:L, a receiver operating characteristic curve analysis established a perfectly discriminant cutoff T-score of <44 on the ADHD Symptoms Total subscale when looking at any ADHD diagnosis and <54 on the Inattentive Symptoms subscale when looking at individuals diagnosed with the inattentive subtype of ADHD. Alternative cutoffs of <54 (ADHD Symptoms Total subscale) and <63 (Inattentive Symptoms subscale) were also identified, both with a sensitivity of 0.95 or higher. Furthermore, the analysis found the ADHD Index to be a poor predictor of a negative ADHD diagnosis, suggesting against the use of this scale for cutoff determination. Despite this limitation, these findings indicate that with specific cutoffs, the CAARS-S:L may have the potential to conclusively rule out ADHD, effectively streamlining the diagnostic process and reducing unnecessary comprehensive assessments in clear negative cases.
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Affiliation(s)
- Dylan Kwan
- Regional Assessment & Resource Centre, Queens University, Kingston, ON, Canada
| | - Nathaniel Davin
- Regional Assessment & Resource Centre, Queens University, Kingston, ON, Canada
| | - Allyson G Harrison
- Regional Assessment & Resource Centre, Queens University, Kingston, ON, Canada
| | - Sienna Gillie
- Regional Assessment & Resource Centre, Queens University, Kingston, ON, Canada
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2
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Husain SF, Chiang SK, Vasu AA, Goh CP, McIntyre RS, Tang TB, Tran BX, Dang THT, Nguyen TT, Ho RC, Ho CS. Functional Near-Infrared Spectroscopy of English-Speaking Adults With Attention-Deficit/Hyperactivity Disorder During a Verbal Fluency Task. J Atten Disord 2023; 27:1448-1459. [PMID: 37341192 DOI: 10.1177/10870547231180111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/22/2023]
Abstract
OBJECTIVE Functional near-infrared spectroscopy (fNIRS) provides direct and quantitative assessment of cortical hemodynamic response. It has been used to identify neurophysiological alterations in medication-naïve adults with attention-deficit/hyperactivity disorder (ADHD). Hence, this study aimed to distinguish both medication-naïve and medicated adults with ADHD from healthy controls (HC). METHOD 75 HCs, 75 medication-naïve, and 45 medicated patients took part in this study. fNIRS signals during a verbal fluency task (VFT) were acquired using a 52-channel system and relative oxy-hemoglobin changes in the prefrontal cortex were quantified. RESULTS Prefrontal cortex hemodynamic response was lower in patients than HCs (p ≤ ≤.001). Medication-naïve and medicated patients did not differ in hemodynamic response or symptom severity (p > .05). fNIRS measurements were not associated with any clinical variables (p > .05). 75.8% patients and 76% HCs were correctly classified using hemodynamic response. CONCLUSION fNIRS may be a potential diagnostic tool for adult ADHD. These findings need to be replicated in larger validation studies.
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Affiliation(s)
| | | | | | | | - Roger S McIntyre
- University Health Network, Toronto, ON, Canada
- University of Toronto, ON, Canada
- Brain and Cognition Discovery Foundation, Toronto, ON, Canada
| | - Tong Boon Tang
- University Teknologi PETRONAS, Seri Iskandar, Perak Darul Ridzuan, Malaysia
| | - Bach X Tran
- Hanoi Medical University, Dong Da, Vietnam
- Johns Hopkins University, Baltimore, MD, USA
| | - Trang H T Dang
- Institute of Health Economics and Technology, Hanoi, Vietnam
| | - Tham T Nguyen
- Duy Tan University, Da Nang, Vietnam
- Nguyen Tat Thanh University, Ho Chi Minh, Vietnam
| | - Roger C Ho
- National University of Singapore, Singapore
| | - Cyrus S Ho
- National University of Singapore, Singapore
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3
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Harrison AG, Edwards MJ. The Ability of Self-Report Methods to Accurately Diagnose Attention Deficit Hyperactivity Disorder: A Systematic Review. J Atten Disord 2023; 27:1343-1359. [PMID: 37366274 DOI: 10.1177/10870547231177470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/28/2023]
Abstract
OBJECTIVE To identify and analyze all studies validating rating scales or interview-based screeners commonly used to evaluate ADHD in adults. METHOD A systematic literature search identified all studies providing diagnostic accuracy statistics, including sensitivity and specificity, supplemented by relevant articles or test manuals referenced in reviewed manuscripts. RESULTS Only 20 published studies or manuals provided data regarding sensitivity and specificity when tasked with differentiating those with and without ADHD. While all screening measures have excellent ability to correctly classify non-ADHD individuals (with negative predictive values exceeding 96%), false positive rates were high. At best, positive predictive values in clinical samples reached 61%, but most fell below 20%. CONCLUSION Clinicians cannot rely on scales alone to diagnose ADHD and must undertake more rigorous evaluation of clients who screen positive. Furthermore, relevant classification statistics must be included in publications to help clinicians make statistically defensible decisions. Otherwise, clinicians risk inappropriately diagnosing ADHD.
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Vizgaitis AL, Bottini S, Polizzi CP, Barden E, Krantweiss AR. Self-Reported Adult ADHD Symptoms: Evidence Supporting Cautious Use in an Assessment-Seeking Sample. J Atten Disord 2023:10870547231172764. [PMID: 37158158 DOI: 10.1177/10870547231172764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
OBJECTIVE Self-report symptom inventories are commonly used in adult ADHD assessment, and research indicates they should be interpreted with caution. This study investigated one self-report symptom inventory for adult ADHD in a clinical sample. METHOD Archival data were used to evaluate diagnostic utility of the Conners Adult ADHD Rating Scale-Self-Report: Long Version (CAARS-S:L) in a sample of 122 adults seeking ADHD assessment. RESULTS Overall, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) estimates for the ADHD Index and other CAARS-S:L scales demonstrated weak accuracy. Anxiety and depression were the most common diagnoses present when a false positive on the ADHD Index was observed. PPV and specificity for the ADHD Index were higher in males compared to females. CONCLUSION The CAARS-S:L may be useful for screening purposes in some cases, but should not be the main method used for diagnostic purposes. Clinical implications of findings are discussed.
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Affiliation(s)
| | | | | | - Eileen Barden
- Boston University School of Medicine, MA, USA
- State University of New York at Binghamton, NY, USA
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5
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Ogrodnik M, Karsan S, Malamis B, Kwan M, Fenesi B, Heisz JJ. Exploring Barriers and Facilitators to Physical Activity in Adults with ADHD: A Qualitative Investigation. JOURNAL OF DEVELOPMENTAL AND PHYSICAL DISABILITIES 2023:1-21. [PMID: 37361454 PMCID: PMC10156575 DOI: 10.1007/s10882-023-09908-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 03/27/2023] [Indexed: 06/28/2023]
Abstract
Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterized by executive dysfunction. Physical activity (PA) may improve executive dysfunction; however, specific barriers and facilitators to PA participation for adults with ADHD have not been formally documented, which was the aim of the present study. Thirty adults with ADHD completed virtual semi-structured interviews, which were analyzed thematically and guided by the Theoretical Domains Framework. Expressions of both barriers and facilitators to PA were identified. Themes such as executive dysfunction (described as forgetfulness, difficulty with sustained focus, and time management), poor self-esteem, and lack of motivation were seen as barriers to PA. Key facilitators were tied to the benefits of being physically active including improvements in executive functioning, mood, and mental health during and after activity, as well as the enjoyment of being active with others. To better support adults with ADHD in initiating physical activity, it is crucial to develop unique resources that are tailored to their specific needs. These resources should be designed to minimize barriers and maximize facilitators, while also supporting the awareness and acceptance of neurodiverse experiences.
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Affiliation(s)
- Michelle Ogrodnik
- McMaster University, 1280 Main Street West, Hamilton, ON L8S 4L8 Canada
- Waterloo University, 200 University Ave W, Waterloo, ON N2L 3G1 Canada
| | - Sameena Karsan
- McMaster University, 1280 Main Street West, Hamilton, ON L8S 4L8 Canada
| | - Brandon Malamis
- McMaster University, 1280 Main Street West, Hamilton, ON L8S 4L8 Canada
| | - Matthew Kwan
- Brock University, 1812 Sir Isaac Brock Way, St. Catherines, ON L2S 3A1 Canada
| | - Barbara Fenesi
- Western University, 1151 Richmond St, London, ON N6A 3K7 Canada
| | - Jennifer J. Heisz
- McMaster University, 1280 Main Street West, Hamilton, ON L8S 4L8 Canada
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6
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Wu JS, Nankoo MMA, Bucks RS, Pestell CF. Short form Conners' Adult ADHD Rating Scales: Factor structure and measurement invariance by sex in emerging adults. J Clin Exp Neuropsychol 2023; 45:345-364. [PMID: 37610373 DOI: 10.1080/13803395.2023.2246213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 08/03/2023] [Indexed: 08/24/2023]
Abstract
INTRODUCTION The short version of the Conners' Adult ADHD Rating Scales (CAARS-S:S) is a self-report measure used to identify symptoms of Attention Deficit/Hyperactivity Disorder (ADHD) during adulthood. However, its psychometric properties specifically in emerging adults, or the transitional age group between adolescence and adulthood, remain understudied. This study aimed to validate the factor structure of the CAARS-S:S in a sample of emerging adults. METHOD The CAARS-S:S measure was completed by adults (n = 591) aged 18 to 29 located in English-speaking countries, including Australia, Canada and the United States. Confirmatory factor analysis was used to test a four-factor model of Inattention/Memory Problems, Hyperactivity/Restlessness, Impulsivity/Emotional Lability and Problems with Self-Concept, as well as the model's invariance by sex. Sex was also included as a covariate in the model to examine differences in males' and females' scores on each factor. RESULTS Overall, the four-factor structure fit the data and was invariant across males and females. All factors demonstrated high internal reliability (average ωt and α = .86). It was observed that males tended to score higher on Inattention/Memory Problems while females scored higher on Problems with Self-Concept. CONCLUSION This research establishes the psychometric properties of the CAARS-S:S, placing greater confidence in using it to screen for ADHD symptoms in emerging adults living in a Westernized cultural context. The detailed findings of this research, implications for the use of the CAARS-S:S in this age group and potential future directions for examining the properties of the measure are discussed.
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Affiliation(s)
- Jasmine S Wu
- School of Psychological Science, University of Western Australia, Perth, WA, Australia
| | - Marie M A Nankoo
- School of Psychological Science, University of Western Australia, Perth, WA, Australia
| | - Romola S Bucks
- School of Psychological Science, University of Western Australia, Perth, WA, Australia
| | - Carmela F Pestell
- School of Psychological Science, University of Western Australia, Perth, WA, Australia
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7
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Yeung A, Ng E, Abi-Jaoude E. TikTok and Attention-Deficit/Hyperactivity Disorder: A Cross-Sectional Study of Social Media Content Quality. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2022; 67:899-906. [PMID: 35196157 PMCID: PMC9659797 DOI: 10.1177/07067437221082854] [Citation(s) in RCA: 42] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVES Social media platforms are increasingly being used to disseminate mental health information online. User-generated content about attention-deficit/hyperactivity disorder (ADHD) is one of the most popular health topics on the video-sharing social media platform TikTok. We sought to investigate the quality of TikTok videos about ADHD. METHOD The top 100 most popular videos about ADHD uploaded by TikTok video creators were classified as misleading, useful, or personal experience. Descriptive and quantitative characteristics of the videos were obtained. The Patient Education Materials Assessment Tool for Audiovisual Materials (PEMAT-A/V) and Journal of American Medical Association (JAMA) benchmark criteria were used to assess the overall quality, understandability, and actionability of the videos. RESULTS Of the 100 videos meeting inclusion criteria, 52% (n = 52) were classified as misleading, 27% (n = 27) as personal experience, and 21% (n = 21) as useful. Classification agreement between clinician ratings was 86% (kappa statistic of 0.7766). Videos on the platform were highly understandable by viewers but had low actionability. Non-healthcare providers uploaded the majority of misleading videos. Healthcare providers uploaded higher quality and more useful videos, compared to non-healthcare providers. CONCLUSIONS Approximately half of the analyzed TikTok videos about ADHD were misleading. Clinicians should be aware of the widespread dissemination of health misinformation on social media platforms and its potential impact on clinical care.
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Affiliation(s)
- Anthony Yeung
- Department of Psychiatry, 12358University of British Columbia, Vancouver, British Columbia, Canada.,Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada
| | - Enoch Ng
- Department of Psychiatry, 12366University of Toronto, Toronto, Ontario, Canada
| | - Elia Abi-Jaoude
- Department of Psychiatry, 12366University of Toronto, Toronto, Ontario, Canada.,Department of Psychiatry, The Hospital for Sick Children, 12366University of Toronto, Toronto, Ontario, Canada
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9
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Ginapp CM, Macdonald-Gagnon G, Angarita GA, Bold KW, Potenza MN. The lived experiences of adults with attention-deficit/hyperactivity disorder: A rapid review of qualitative evidence. Front Psychiatry 2022; 13:949321. [PMID: 36032220 PMCID: PMC9403235 DOI: 10.3389/fpsyt.2022.949321] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 07/27/2022] [Indexed: 12/04/2022] Open
Abstract
Attention-deficit/hyperactivity disorder (ADHD) is a common condition that frequently persists into adulthood, although research and diagnostic criteria are focused on how the condition presents in children. We aimed to review qualitative research on lived experiences of adults with ADHD to characterize potential ADHD symptomatology in adulthood and provide perspectives on how needs might be better met. We searched three databases for qualitative studies on ADHD. Studies (n = 35) in English that included data on the lived experiences of adults with ADHD were included. These studies covered experiences of receiving a diagnosis as an adult, symptomatology of adult ADHD, skills used to adapt to these symptoms, relationships between ADHD and substance use, patients' self-perceptions, and participants' experiences interacting with society. Many of the ADHD symptoms reported in these studies had overlap with other psychiatric conditions and may contribute to misdiagnosis and delays in diagnosis. Understanding symptomatology of ADHD in adults may inform future diagnostic criteria and guide interventions to improve quality of life.
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Affiliation(s)
- Callie M Ginapp
- Yale School of Medicine, Yale University, New Haven, CT, United States
| | | | - Gustavo A Angarita
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States.,Connecticut Mental Health Center, New Haven, CT, United States
| | - Krysten W Bold
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States
| | - Marc N Potenza
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States.,Connecticut Mental Health Center, New Haven, CT, United States.,Connecticut Council on Problem Gambling, Wethersfield, CT, United States.,Child Study Center, Yale School of Medicine, New Haven, CT, United States.,Department of Neuroscience, Yale University, New Haven, CT, United States.,Wu Tsai Institute, Yale University, New Haven, CT, United States
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10
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Lovett BJ, Ferrier DE, Wang T, Jordan AH. Adult ADHD Self-Report Scale Screener Ratings in College Students: Concurrent Validity and Test–Retest Reliability. JOURNAL OF PSYCHOEDUCATIONAL ASSESSMENT 2021. [DOI: 10.1177/07342829211034367] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The Adult ADHD Self-Report Scale screener is commonly used to determine if further evaluation of ADHD is required. However, despite use in college settings, the ASRS was not developed for this population, and limited relevant psychometric data exist. In this study, 190 college students completed the ASRS screener as well as a lengthier measure of the 18 DSM symptoms of ADHD. A subgroup ( n = 141) completed the ASRS twice, with at least 1 week in between measures. Concurrent validity of ASRS scores was substantial ( r = 0.73 with DSM inattentive symptoms and r = 0.57 with DSM hyperactive/impulsive symptoms) and test–retest reliability was adequate ( r = 0.69 with an average interval of 42 days). However, the sensitivity of the screener was only moderate (66%), and approximately one-fifth of the students changed screening status (positive vs. negative) across the time interval. Implications for future research and practice are discussed.
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Affiliation(s)
| | | | - Tina Wang
- Columbia University, New York, NY, USA
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11
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Affiliation(s)
- Benjamin J Lovett
- School Psychology Program,Teachers College, Columbia University, New York, NY, USA
| | - Allyson G Harrison
- Regional Assessment and Resource Centre, Queen's University, Kingston, Canada
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12
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Akabri M, Sarikhani Y, Khatami K, Ardalan A, Safarpour H, Imanieh MH, Ostovar T, Tabrizi R, Mani A, Heydari ST, Bagheri Lankarani K. The association between the score of adult attention-deficit/hyperactivity traits and risky driving behaviors with alcohol intake and narcotics consumption among Iranian motorcyclists. TRAFFIC INJURY PREVENTION 2021; 22:189-194. [PMID: 33661079 DOI: 10.1080/15389588.2021.1877278] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Motorcycle drivers are among the most vulnerable road users, accounting for a large proportion of global traffic accidents. This study aimed to investigate the association between the score of adult attention-deficit/hyperactivity (ADHD) traits and risky driving behaviors (RDB) with alcohol intake (AI) and narcotics consumption (NC) among motorcyclists in Iran. METHODS This multi-center cross-sectional study encompassed 1747 motorcyclists from three cities in Iran. A random sampling method was applied in this study, and the required data was collected using three standard questionnaires on ADHD, substance abuse, and RDB. Independent sample t-test, covariance analysis, and quantile regression (QR) were used to analyze the data. RESULTS The results of t-test and analysis of covariance indicated that AI and NC were significantly associated with ADHD score and RDB among the motorcycle drivers. Additionally, the QR models showed that these effects were significant at all quantiles of ADHD and RDB, even for individuals who were at lower quantiles. CONCLUSIONS Considering the potential dangers of driving after AI and NC, appropriate measures should be adopted before certifying a driving license to screen ADHD as a predisposing factor for substance abuse and RDB. Furthermore, it is essential to equip traffic police with adequate diagnosis kits and establish heavy penalties for the offenders. In this regard, all interventions aimed to reduce traffic accidents among motorcycle drivers should be done considering the interrelationship between ADHD, RDB, and substance abuse.
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Affiliation(s)
- Maryam Akabri
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Yaser Sarikhani
- Research Center for Social Determinants of Health, Jahrom University of Medical Sciences, Jahrom, Iran
| | - Kiana Khatami
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Arash Ardalan
- Department of Mathematics, Yasouj University, Yasouj, Iran
| | - Heidar Safarpour
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Hadi Imanieh
- Department of Pediatrics, Namazee Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Tahereh Ostovar
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Reza Tabrizi
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Arash Mani
- Research Center for Psychiatry and Behavioral Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Seyed Taghi Heydari
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Kamran Bagheri Lankarani
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
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Kosky KM, Lace JW, Austin TA, Seitz DJ, Clark B. The utility of the Wisconsin card sorting test, 64-card version to detect noncredible attention-deficit/hyperactivity disorder. APPLIED NEUROPSYCHOLOGY-ADULT 2020; 29:1231-1241. [DOI: 10.1080/23279095.2020.1864633] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Karen M. Kosky
- Department of Health Psychology, University of Missouri, Columbia, MO, USA
| | - John W. Lace
- Department of Neurology, Cleveland Clinic, Cleveland, OH, USA
| | - Tara A. Austin
- University of Texas at Austin Dell Medical School, Austin, TX, USA
| | - Dylan J. Seitz
- Department of Neurology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Brook Clark
- Department of Health Psychology, University of Missouri, Columbia, MO, USA
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14
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Kleimaker M, Kleimaker A, Weissbach A, Colzato LS, Beste C, Bäumer T, Münchau A. Non-invasive Brain Stimulation for the Treatment of Gilles de la Tourette Syndrome. Front Neurol 2020; 11:592258. [PMID: 33244309 PMCID: PMC7683779 DOI: 10.3389/fneur.2020.592258] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 10/26/2020] [Indexed: 12/23/2022] Open
Abstract
Gilles de la Tourette Syndrome is a multifaceted neuropsychiatric disorder typically commencing in childhood and characterized by motor and phonic tics. Its pathophysiology is still incompletely understood. However, there is convincing evidence that structural and functional abnormalities in the basal ganglia, in cortico-striato-thalamo-cortical circuits, and some cortical areas including medial frontal regions and the prefrontal cortex as well as hyperactivity of the dopaminergic system are key findings. Conventional therapeutic approaches in addition to counseling comprise behavioral treatment, particularly habit reversal therapy, oral pharmacotherapy (antipsychotic medication, alpha-2-agonists) and botulinum toxin injections. In treatment-refractory Tourette syndrome, deep brain stimulation, particularly of the internal segment of the globus pallidus, is an option for a small minority of patients. Based on pathophysiological considerations, non-invasive brain stimulation might be a suitable alternative. Repetitive transcranial magnetic stimulation appears particularly attractive. It can lead to longer-lasting alterations of excitability and connectivity in cortical networks and inter-connected regions including the basal ganglia through the induction of neural plasticity. Stimulation of the primary motor and premotor cortex has so far not been shown to be clinically effective. Some studies, though, suggest that the supplementary motor area or the temporo-parietal junction might be more appropriate targets. In this manuscript, we will review the evidence for the usefulness of repetitive transcranial magnetic stimulation and transcranial electric stimulation as treatment options in Tourette syndrome. Based on pathophysiological considerations we will discuss the rational for other approaches of non-invasive brain stimulation including state informed repetitive transcranial magnetic stimulation.
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Affiliation(s)
- Maximilian Kleimaker
- Institute of Systems Motor Science, University of Lübeck, Lübeck, Germany.,Department of Neurology, University Hospital Schleswig-Holstein, Lübeck, Germany
| | - Alexander Kleimaker
- Institute of Systems Motor Science, University of Lübeck, Lübeck, Germany.,Department of Neurology, University Hospital Schleswig-Holstein, Lübeck, Germany
| | - Anne Weissbach
- Institute of Systems Motor Science, University of Lübeck, Lübeck, Germany
| | - Lorenza S Colzato
- Cognitive Neurophysiology, Department of Child and Adolescent Psychiatry, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Christian Beste
- Cognitive Neurophysiology, Department of Child and Adolescent Psychiatry, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Tobias Bäumer
- Institute of Systems Motor Science, University of Lübeck, Lübeck, Germany
| | - Alexander Münchau
- Institute of Systems Motor Science, University of Lübeck, Lübeck, Germany
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15
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Harrison AG, Armstrong IT. A comparison of the self-report patterns of analog versus real-world malingerers of attention deficit hyperactivity disorder. J Neural Transm (Vienna) 2020; 128:1065-1077. [PMID: 33151414 DOI: 10.1007/s00702-020-02273-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 10/14/2020] [Indexed: 11/26/2022]
Abstract
Much of what we know about malingering of attention deficit hyperactivity disorder (ADHD) has been learned from the performance of analog malingerers, typically first-year psychology students given credit for study participation. It is not clear, however, whether their performance is similar to that found in actual clinical settings. Indeed, past research suggests that analog malingerers may overexaggerate deficits relative to real-world malingerers, making them easier to identify in controlled studies. The purpose of the current study was, therefore, to compare the performance of analog malingers to post-secondary students strongly suspected of malingering ADHD on a self-report measure of ADHD symptoms. Their scores were, in turn, compared to those returned by students with genuine ADHD and clinical controls. Results demonstrated that, apart from analog subjects overexaggerating symptoms of hyperactivity, few differences exist between the scores returned by analog malingerers relative to clinical malingerers. While newly devised symptom validity measures show promise in identifying malingered ADHD, neither the analog nor the clinical malingers consistently failed these symptom validity scales. Furthermore, a good portion in both malingering groups failed to endorse high levels of ADHD symptoms in general. Clinical implications are discussed.
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Affiliation(s)
- Allyson G Harrison
- Regional Assessment and Resource Centre, Queens University, Kingston, ON, Canada.
| | - Irene T Armstrong
- Regional Assessment and Resource Centre, Queens University, Kingston, ON, Canada
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16
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Harrison AG, Armstrong IT. Differences in performance on the test of variables of attention between credible vs. noncredible individuals being screened for attention deficit hyperactivity disorder. APPLIED NEUROPSYCHOLOGY-CHILD 2020; 9:314-322. [DOI: 10.1080/21622965.2020.1750115] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Allyson G. Harrison
- Regional Assessment and Resource Centre, Queens University, Kingston, Canada
| | - Irene T. Armstrong
- Regional Assessment and Resource Centre, Queens University, Kingston, Canada
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17
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Ben-Sheetrit J, Peskin M, Newcorn JH, Daniely Y, Shbiro L, Rotem A, Weizman A, Manor I. Characterizing the Placebo Response in Adults With ADHD. J Atten Disord 2020; 24:425-433. [PMID: 29926752 DOI: 10.1177/1087054718780328] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Objective: Several ADHD pharmacological trials reported high placebo response (PR) rates. This study aims to characterize the PR in adult ADHD. Method: A retrospective cohort analysis of the placebo arm (140 adults with ADHD, 18-55 yrs, M:F 46.4%-53.6%) of a 6-week randomized, multicenter, double-blind metadoxine study, using Conners' Adult ADHD Rating Scale (CAARS) and the Adult ADHD Self-Report Scale (ASRS), was conducted. Results: Pre-post changes in placebo-treated adults were significant for both the CAARS and ASRS, F(2.9, 404.5) = 61.2, p < .00001, F(2.8, 383.0) = 43.1, p < .00001, respectively. Less than half of the participants had a PR which began early in treatment and persisted; almost 50% had a variable, inconsistent PR. Conclusion: In the current sample, PR in adult ADHD was prominent on both symptom scales and the investigator-rater instrument. Therefore, using investigator ratings as a primary endpoint does not necessarily attenuate PR. Of note, about half of the PR is variable, suggesting unreliable determination of efficacy.
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Affiliation(s)
| | - Miriam Peskin
- Geha Mental Health Center, Petah Tikva, Israel.,Tel-Aviv University, Israel
| | | | | | - Liat Shbiro
- Geha Mental Health Center, Petah Tikva, Israel
| | - Ann Rotem
- Geha Mental Health Center, Petah Tikva, Israel
| | - Abraham Weizman
- Geha Mental Health Center, Petah Tikva, Israel.,Tel-Aviv University, Israel
| | - Iris Manor
- Geha Mental Health Center, Petah Tikva, Israel.,Tel-Aviv University, Israel
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Marshall P, Hoelzle J, Nikolas M. Diagnosing Attention-Deficit/Hyperactivity Disorder (ADHD) in young adults: A qualitative review of the utility of assessment measures and recommendations for improving the diagnostic process. Clin Neuropsychol 2019; 35:165-198. [PMID: 31791193 DOI: 10.1080/13854046.2019.1696409] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Objective: Identify assessment measures that augment the clinical interview and improve the diagnostic accuracy of adult ADHD assessment.Method: The sometimes limited research literatures concerning the diagnostic efficacies of the clinical interview, standard and novel ADHD behavior rating scales, performance and symptom validity testing, and cognitive tests are critically reviewed.Results: Based on this qualitative review, both clinical interviews alone and ADHD behavior rating scales alone have adequate sensitivity but poor specificity in diagnosing ADHD. Response validity and symptom validity tests have reasonably good sensitivity and very good specificity in detecting invalid symptom presentation. Cognitive test batteries have inadequate sensitivity and specificity in identifying ADHD. Using cognitive tests in conjunction with behavior rating scales significantly improves the specificity of an assessment battery. Executive function behavior rating scales and functional impairment rating scales are unlikely to improve the diagnostic accuracy of ADHD assessment.Conclusions: Based on this review, key clinical interview questions, behavior rating scales, symptom validity tests, and cognitive tests that have promise to enhance current assessment practices are recommended. These are the authors' personal opinions, not consensus standards, or guidelines promulgated by any organization. These measures are incorporated in a practical, somewhat abbreviated, battery that has the potential to improve clinicians' ability to diagnose adult ADHD.
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Affiliation(s)
- Paul Marshall
- Department of Psychiatry, Hennepin Healthcare Systems, Minneapolis, MN, USA
| | - James Hoelzle
- Department of Psychology, Marquette University, Milwaukee, WI, USA
| | - Molly Nikolas
- Department of Psychological and Brain Sciences, University of Iowa, Iowa City, IA, USA
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19
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Detecting Feigned Attention-Deficit/Hyperactivity Disorder (ADHD): Current Methods and Future Directions. PSYCHOLOGICAL INJURY & LAW 2017. [DOI: 10.1007/s12207-017-9286-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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20
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Nielsen F, Georgiadou E, Bartsch M, Langenberg S, Müller A, de Zwaan M. Attention Deficit Hyperactivity Disorder Prevalence and Correlates Pre- and Post-Bariatric Surgery: A Comparative Cross-Sectional Study. Obes Facts 2017; 10:1-11. [PMID: 28103594 PMCID: PMC5644936 DOI: 10.1159/000452999] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Revised: 10/27/2016] [Accepted: 10/27/2016] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVE Previous research shows an association between obesity and attention deficit hyperactivity disorder (ADHD). The present study compares pre- and post-bariatric surgery patients using the internationally used Conners' Adult ADHD Rating Scale (CAARS™) to screen for ADHD. METHODS Matched samples pre- (N = 120) and post-bariatric surgery (N = 128) were compared using self-rating instruments to assess ADHD-relevant symptomatology, depression, eating-related psychopathology, and BMI. RESULTS Prevalence of probable ADHD did not differ between groups using the CAARS Index Scale T-scores; however, CAARS subscales Inattention/Memory and Self-Concept showed significantly lower scores in post-surgery patients. All CAARS subscales correlated significantly with each other, with depression and eating-related psychopathology. There was no correlation between ADHD and excess BMI loss in post-surgery patients. CONCLUSION The findings suggest that a considerable number of patients before and after bariatric surgery screened positive for ADHD. It can be hypothesized that some core ADHD symptoms improve after surgery. Future studies are warranted to investigate the influence of ADHD on long-term surgery outcomes.
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Affiliation(s)
- Friedrich Nielsen
- Department of Psychosomatic Medicine and Psychotherapy, Hanover Medical School, Hanover, Germany, Erlangen, Germany
| | - Ekaterini Georgiadou
- Department of Psychosomatic Medicine and Psychotherapy, Hanover Medical School, Hanover, Germany, Erlangen, Germany
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Erlangen, University Erlangen-Nuremberg, Erlangen, Germany
| | - Merle Bartsch
- Department of Psychosomatic Medicine and Psychotherapy, Hanover Medical School, Hanover, Germany, Erlangen, Germany
| | - Svenja Langenberg
- Department of Psychosomatic Medicine and Psychotherapy, Hanover Medical School, Hanover, Germany, Erlangen, Germany
| | - Astrid Müller
- Department of Psychosomatic Medicine and Psychotherapy, Hanover Medical School, Hanover, Germany, Erlangen, Germany
| | - Martina de Zwaan
- Department of Psychosomatic Medicine and Psychotherapy, Hanover Medical School, Hanover, Germany, Erlangen, Germany
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