The Validation of an Assessment Tool to Identify Attention Deficit Hyperactivity Disorder (ADHD), in the Adult General Population.

Background

Attention Deficit Hyperactivity Disorder (ADHD) affects 3-4% of adults worldwide. ADHD is characterised by developmentally inappropriate and impairing levels of inattentive, hyperactive and impulsive symptoms. Waiting times for ADHD services in England are unacceptably long, delaying diagnosis and treatment access.

Aim

To inform future studies and ADHD clinical care pathways by:

1) Interviewing a subset of the general population Adult Psychiatric Morbidity Survey (APMS) using the Diagnostic Interview for Adult ADHD (DIVA);

2) Assessing the validity of ADHD screening measures used in the 2014 APMS;

3) Providing statistics on comorbidity of ADHD and other psychiatric conditions; and

4) Providing statistics on factors associated with ADHD.

Methods

The APMS programme is a probability-based sampling survey of community-based adults living in England, conducted every 7 years, to provide information on complex mental health conditions. The 2014 APMS, for the first time, made use of a systematic clinical evaluation of adult ADHD, by extending the Schedules for Clinical Assessment in Neuropsychiatry (SCAN) currently used to assess psychosis in the APMS. Using the DIVA as the ‘Reference Standard’, the ADHD screening tools were validated and comorbidity, risk and protective factors were explored.

Results

Using 67 adults from phase III of the 2014 APMS, covering a full range of baseline ADHD scores, the SCAN ADHD screener proved to be a good discriminator of ADHD (AUC=0.84); whereas the Adult ADHD Self-Report Scale (ASRS) screener showed to be a fair discriminator. Individuals who screen positive for ADHD have higher comorbidity for several mental health conditions, poorer outcomes and the proportion of diagnosed and/or recognised ADHD is low.

Conclusions

The SCAN ADHD screener is a good general population discriminator of ADHD and therefore has potential to be used in health service assessment settings to improve the efficient identification and management of ADHD in primary and secondary healthcare.