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. 2017 Jun;58(6):655-662.
doi: 10.1111/jcpp.12620. Epub 2016 Sep 19.

Defining ADHD Symptom Persistence in Adulthood: Optimizing Sensitivity and Specificity

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Defining ADHD Symptom Persistence in Adulthood: Optimizing Sensitivity and Specificity

Margaret H Sibley et al. J Child Psychol Psychiatry. .
Free PMC 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.

Keywords: Adult ADHD; DSM-5; diagnosis.

Conflict of interest statement

Conflict of interest statement: See Acknowledgements for full disclosures.

The remaining authors have no conflicts to disclose.

The remaining authors have declared that they have no competing or potential conflicts of interest to declare.


Figure 1
Figure 1. Receiver Operating Characteristics for Method and Threshold

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