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The World Health Organization Adult Attention-Deficit/Hyperactivity Disorder Self-Report Screening Scale for DSM-5.

Publication ,  Journal Article
Ustun, B; Adler, LA; Rudin, C; Faraone, SV; Spencer, TJ; Berglund, P; Gruber, MJ; Kessler, RC
Published in: JAMA psychiatry
May 2017

Recognition that adult attention-deficit/hyperactivity disorder (ADHD) is common, seriously impairing, and usually undiagnosed has led to the development of adult ADHD screening scales for use in community, workplace, and primary care settings. However, these scales are all calibrated to DSM-IV criteria, which are narrower than the recently developed DSM-5 criteria.To update for DSM-5 criteria and improve the operating characteristics of the widely used World Health Organization Adult ADHD Self-Report Scale (ASRS) for screening.Probability subsamples of participants in 2 general population surveys (2001-2003 household survey [n = 119] and 2004-2005 managed care subscriber survey [n = 218]) who completed the full 29-question self-report ASRS, with both subsamples over-sampling ASRS-screened positives, were blindly administered a semistructured research diagnostic interview for DSM-5 adult ADHD. In 2016, the Risk-Calibrated Supersparse Linear Integer Model, a novel machine-learning algorithm designed to create screening scales with optimal integer weights and limited numbers of screening questions, was applied to the pooled data to create a DSM-5 version of the ASRS screening scale. The accuracy of the new scale was then confirmed in an independent 2011-2012 clinical sample of patients seeking evaluation at the New York University Langone Medical Center Adult ADHD Program (NYU Langone) and 2015-2016 primary care controls (n = 300). Data analysis was conducted from April 4, 2016, to September 22, 2016.The sensitivity, specificity, area under the curve (AUC), and positive predictive value (PPV) of the revised ASRS.Of the total 637 participants, 44 (37.0%) household survey respondents, 51 (23.4%) managed care respondents, and 173 (57.7%) NYU Langone respondents met DSM-5 criteria for adult ADHD in the semistructured diagnostic interview. Of the respondents who met DSM-5 criteria for adult ADHD, 123 were male (45.9%); mean (SD) age was 33.1 (11.4) years. A 6-question screening scale was found to be optimal in distinguishing cases from noncases in the first 2 samples. Operating characteristics were excellent at the diagnostic threshold in the weighted (to the 8.2% DSM-5/Adult ADHD Clinical Diagnostic Scale population prevalence) data (sensitivity, 91.4%; specificity, 96.0%; AUC, 0.94; PPV, 67.3%). Operating characteristics were similar despite a much higher prevalence (57.7%) when the scale was applied to the NYU Langone clinical sample (sensitivity, 91.9%; specificity, 74.0%; AUC, 0.83; PPV, 82.8%).The new ADHD screening scale is short, easily scored, detects the vast majority of general population cases at a threshold that also has high specificity and PPV, and could be used as a screening tool in specialty treatment settings.

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Published In

JAMA psychiatry

DOI

EISSN

2168-6238

ISSN

2168-622X

Publication Date

May 2017

Volume

74

Issue

5

Start / End Page

520 / 527

Related Subject Headings

  • Young Adult
  • World Health Organization
  • Sensitivity and Specificity
  • Self Report
  • Reproducibility of Results
  • Psychometrics
  • Psychiatric Status Rating Scales
  • Male
  • Machine Learning
  • Humans
 

Citation

APA
Chicago
ICMJE
MLA
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Ustun, B., Adler, L. A., Rudin, C., Faraone, S. V., Spencer, T. J., Berglund, P., … Kessler, R. C. (2017). The World Health Organization Adult Attention-Deficit/Hyperactivity Disorder Self-Report Screening Scale for DSM-5. JAMA Psychiatry, 74(5), 520–527. https://doi.org/10.1001/jamapsychiatry.2017.0298
Ustun, Berk, Lenard A. Adler, Cynthia Rudin, Stephen V. Faraone, Thomas J. Spencer, Patricia Berglund, Michael J. Gruber, and Ronald C. Kessler. “The World Health Organization Adult Attention-Deficit/Hyperactivity Disorder Self-Report Screening Scale for DSM-5.JAMA Psychiatry 74, no. 5 (May 2017): 520–27. https://doi.org/10.1001/jamapsychiatry.2017.0298.
Ustun B, Adler LA, Rudin C, Faraone SV, Spencer TJ, Berglund P, et al. The World Health Organization Adult Attention-Deficit/Hyperactivity Disorder Self-Report Screening Scale for DSM-5. JAMA psychiatry. 2017 May;74(5):520–7.
Ustun, Berk, et al. “The World Health Organization Adult Attention-Deficit/Hyperactivity Disorder Self-Report Screening Scale for DSM-5.JAMA Psychiatry, vol. 74, no. 5, May 2017, pp. 520–27. Epmc, doi:10.1001/jamapsychiatry.2017.0298.
Ustun B, Adler LA, Rudin C, Faraone SV, Spencer TJ, Berglund P, Gruber MJ, Kessler RC. The World Health Organization Adult Attention-Deficit/Hyperactivity Disorder Self-Report Screening Scale for DSM-5. JAMA psychiatry. 2017 May;74(5):520–527.

Published In

JAMA psychiatry

DOI

EISSN

2168-6238

ISSN

2168-622X

Publication Date

May 2017

Volume

74

Issue

5

Start / End Page

520 / 527

Related Subject Headings

  • Young Adult
  • World Health Organization
  • Sensitivity and Specificity
  • Self Report
  • Reproducibility of Results
  • Psychometrics
  • Psychiatric Status Rating Scales
  • Male
  • Machine Learning
  • Humans