Defining ADHD symptom persistence in adulthood: optimizing sensitivity and specificity.

Journal Article (Journal Article)

OBJECTIVE: Longitudinal studies of children diagnosed with ADHD report widely ranging ADHD persistence rates in adulthood (5-75%). This study documents how information source (parent vs. self-report), method (rating scale vs. interview), and symptom threshold (DSM vs. norm-based) influence reported ADHD persistence rates in adulthood. METHOD: Five hundred seventy-nine children were diagnosed with DSM-IV ADHD-Combined Type at baseline (ages 7.0-9.9 years) 289 classmates served as a local normative comparison group (LNCG), 476 and 241 of whom respectively were evaluated in adulthood (Mean Age = 24.7). Parent and self-reports of symptoms and impairment on rating scales and structured interviews were used to investigate ADHD persistence in adulthood. RESULTS: Persistence rates were higher when using parent rather than self-reports, structured interviews rather than rating scales (for self-report but not parent report), and a norm-based (NB) threshold of 4 symptoms rather than DSM criteria. Receiver-Operating Characteristics (ROC) analyses revealed that sensitivity and specificity were optimized by combining parent and self-reports on a rating scale and applying a NB threshold. CONCLUSION: The interview format optimizes young adult self-reporting when parent reports are not available. However, the combination of parent and self-reports from rating scales, using an 'or' rule and a NB threshold optimized the balance between sensitivity and specificity. With this definition, 60% of the ADHD group demonstrated symptom persistence and 41% met both symptom and impairment criteria in adulthood.

Full Text

Duke Authors

Cited Authors

  • Sibley, MH; Swanson, JM; Arnold, LE; Hechtman, LT; Owens, EB; Stehli, A; Abikoff, H; Hinshaw, SP; Molina, BSG; Mitchell, JT; Jensen, PS; Howard, AL; Lakes, KD; Pelham, WE; MTA Cooperative Group,

Published Date

  • June 2017

Published In

Volume / Issue

  • 58 / 6

Start / End Page

  • 655 - 662

PubMed ID

  • 27642116

Pubmed Central ID

  • PMC5809153

Electronic International Standard Serial Number (EISSN)

  • 1469-7610

Digital Object Identifier (DOI)

  • 10.1111/jcpp.12620


  • eng

Conference Location

  • England