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Global Assessment of Attention Deficit Hyperactivity Disorder: Examining Objective Measures of Hyperactivity, Impulsivity and Inattention in Adults
Karlstad University, Faculty of Economic Sciences, Communication and IT, Department of Psychology.
2012 (English)Doctoral thesis, comprehensive summary (Other academic)Alternative title
Global Bedöming av Aktivitets- och Uppmärksamhetsstörning : Objektiva Mätningar av Hyperaktivitet, Impulsivitet och Ouppmärksamhet hos Vuxna Personer (Swedish)
Abstract [en]

The aim of this thesis is to examine objective laboratory measures of Attention Deficit Hyperactivity Disorder (ADHD) in adult persons and to develop measures for diagnosis and treatment using a psychometric instrument called the Quantified Behavior Test Plus. The instrument objectively quantifies cardinal symptom manifestations in adult ADHD using motion tracking devices and continuous performance testing. Paper I-IV suggest that ADHD predisposes adult persons to perform poorer on continuous performance tasks and to have higher levels of motor activity while performing these tasks as compared to other clinical as well as non-clinical groups. Performance by adults with ADHD is normalized following stimulant treatment which implicates therapeutic effects and measures of response to treatment and remission for ADHD is suggested.

Paper I concludes that the psychometric instrument needs to be calibrated with regard to adult ADHD and emphasizes the importance of a composite measure for the disorder. Paper II generates two new measures, the Weighed Core Symptom scale (WCS) - a composite measure of adult ADHD ranging from 0 to 100, and Prediction of ADHD (PADHD) - a categorical variable of the diagnostic status with good predictive power. A majority of participants with ADHD has low points on WCS (indicating high levels of symptoms) and a majority of non-ADHD normative participants has high points on WCS (indicating low levels of symptoms). Paper III examines WCS and PADHD among complex clinical groups with shared symptoms vis-à-vis ADHD. Here, findings from Paper II are replicated since participants with ADHD present the highest level of global symptoms, followed by participants with bipolar II disorder and borderline personality disorder, participant with diconfirmed ADHD and finally, non-clinical participants has the lowest level of global symptoms. In Paper IV, the measures are proposed as indications of response to treatment and remission after titration with stimulant treatment and WCS indicates response to small changes in dose level.

The major findings of the present thesis may be summarized as the construction of two new objective measures for ADHD in adult persons with practical implications for diagnosis and treatment. Hyperactivity is the most specific marker of ADHD in both men and women, followed by the cognitive markers of inattention and impulsivity. The composite measure, WCS, quantifies the global amount of ADHD symptoms and provides the most sensitive measure for the disorder. PADHD and WCS may not replace a thorough neuropsychiatric assessment and further studies promoting diagnostic subtype stratification is suggested. Future studies may want to consider these measures in outcome-based investigations of treatment efficacy as well as in the study of neuropsychological endophenotypes. Practical implications include clinical strategies to enhance objectivity during assessment as well as optimizing beneficial effects of treatment and attaining remission.

 

 

Place, publisher, year, edition, pages
Karlstad: Karlstads universitet, 2012. , 192 p.
Series
Karlstad University Studies, ISSN 1403-8099 ; 2012:49
Keyword [en]
Attention Deficit Hyperactivity Disorder, Objective measures, Adults, Psychometrics, Diagnosis, Treatment
National Category
Social Sciences
Research subject
Psychology
Identifiers
URN: urn:nbn:se:kau:diva-15186ISBN: 978-91-7063-460-4OAI: oai:DiVA.org:kau-15186DiVA: diva2:561184
Public defence
2012-12-14, Sjöströmsalen, 1B 309, Karlstads Universitet, Karlstad, 10:00 (English)
Opponent
Supervisors
Available from: 2012-11-21 Created: 2012-10-17 Last updated: 2014-05-20Bibliographically approved
List of papers
1. In search for objective measures of hyperactivity, impulsivity and inattention in adult attention deficit hyperactivity disorder using the Quantified Behaviour Test Plus
Open this publication in new window or tab >>In search for objective measures of hyperactivity, impulsivity and inattention in adult attention deficit hyperactivity disorder using the Quantified Behaviour Test Plus
Show others...
2011 (English)In: Europe's Journal of Psychology, ISSN 1841-0413, Vol. 7, no 3, 443-457 p.Article in journal (Refereed) Published
Abstract [en]

Clinical assessment tools for adult ADHD such as rating scales, interviews and behavior observations are often based on subjective judgments which enhance the risk of overlooking or misinterpreting symptoms. In search for objective measures of adult ADHD, the present study investigated levels of sensitivity and specificity for the Quantified Behavior Test Plus, QbTest-Plus, in adult patients (N = 19) awaiting clinical assessment for ADHD. QbTest-Plus report objective measures of ADHD core symptoms using an infrared motion tracking system and a continuous performance test. The measures were collected and evaluated previous to clinical assessment and compared regarding the diagnosis of ADHD. Sensitivity for detecting ADHD with QbTest-Plus was 83 % and specificity was 57 %. The results, possibly affected by confounding factors, suggest further examination of calibrated and objective measure for the QbTest-Plus with regard to ADHD in adults.

 

Place, publisher, year, edition, pages
Trier: , 2011
Keyword
attention deficit hyperactivity disorder, objective measures, clinical assessment, adults, the quantified behavior test plus.
National Category
Psychology
Research subject
Psychology
Identifiers
urn:nbn:se:kau:diva-8147 (URN)
Available from: 2011-09-02 Created: 2011-09-02 Last updated: 2012-11-29Bibliographically approved
2. Measuring Adult Attention Deficit Hyperactivity Disorder using the Quantified Behaviour Test Plus
Open this publication in new window or tab >>Measuring Adult Attention Deficit Hyperactivity Disorder using the Quantified Behaviour Test Plus
2013 (English)In: PsyCh Journal, ISSN 2046-0260, Vol. 2, no 1, 48-62 p.Article in journal (Refereed) Published
Abstract [en]

Attention Deficit Hyperactivity Disorder, ADHD, occurs in about 5 % of the adult population and includes cardinal symptoms of hyperactivity, inattention, and impulsivity that may be difficult to identify with clinical routine methods. Continuous performance tests are objective measures of inattention and impulsivity that, combined with objective measures of motor activity, facilitate identification of ADHD among adults. The aim of the present study was to examine sensitivity, specificity and a composite measure of ADHD using objective measures of the ADHD-cardinal symptoms in adult participants with ADHD and non-ADHD normative participants.

Cardinal symptoms were measured in 55 participants having ADHD, 202 non-ADHD normative participants, as well as 84 ADHD normative participants using the Quantified Behavior Test Plus, QbTest-Plus. This test measures inattention and impulsivity with a continuous performance test and hyperactivity with a motion tracking system.

A predictive variable for detection of ADHD called Prediction of ADHD, PADHD, yielded 86 % sensitivity and 83 % specificity. A composite measure of ADHD cardinal symptoms was developed with a Weighed Core Symptoms scale, WCS, that indicates the total amount of ADHD symptoms on a numeric scale from 0 to 100.

The total amount of ADHD symptoms was measured on a scale and predicted with the categorical variable in a majority of the cases in the present study. Further studies are needed in order to confirm the results with regard to additional clinical and normative samples. Careful consideration of potential gender and diagnostic subtype differences are noteworthy aspects for future examinations of the new instruments.

Keyword
Adults, Attention Deficit Hyperactivity Disorder, Psychometrics, Objective measures
National Category
Psychology
Research subject
Psychology
Identifiers
urn:nbn:se:kau:diva-8148 (URN)10.1002/pchj.17 (DOI)
Note

Work is also part of H. Edebols licentiate thesis "Measuring Cardinal Symptoms of Attention Deficit Hyperactivity Disorder in Adults". Status of the article changed from submitted to in press since then.

Available from: 2011-09-02 Created: 2011-09-02 Last updated: 2013-06-27Bibliographically approved
3. Objective measures of behavior manifestations in adult ADHD and differentiation from participants with Bipolar II disorder, Borderline personality disorder, participants with disconfirmed ADHD as well as Normative participants.
Open this publication in new window or tab >>Objective measures of behavior manifestations in adult ADHD and differentiation from participants with Bipolar II disorder, Borderline personality disorder, participants with disconfirmed ADHD as well as Normative participants.
2012 (English)In: Clinical Practice and Epidemiology in Mental Health, ISSN 1745-0179, Vol. 8, 134-143 p.Article in journal (Refereed) Published
Abstract [en]

Background: The present study evaluated two psychometric instruments derived from the objective measurement of adult ADHD using the Quantified Behavior Test Plus. The instruments were examined in ADHD versus a clinical group with overlapping symptoms including borderline personality disorder and bipolar II disorder, and another clinical group with participants assessed for but disconfirmed a diagnosis of ADHD as well as adult normative participants.

Methods: The Quantified Behavior Test Plus includes Continuous Performance Testing and a Motion Tracking System with parameters related to attention and activity operationalized as the cardinal symptoms of ADHD and then summarized into a Weighed Core Symptoms scale with ten cut-points ranging from 0 to 100. A categorical predictor variable called Prediction of ADHD was used to examine the levels of sensitivity and specificity for the Quantified Behavior Test Plus with regard to ADHD.

Results: The Weighed Core Symptoms scale separated ADHD and normative participants from each other as well as from the two clinical reference groups. The scale reported highest levels of core symptoms in the ADHD group and the lowest level of core symptoms in the normative group. Analyses with Prediction of ADHD yielded 85 % specificity for the normative group, 87 % sensitivity for the ADHD group, 36 % sensitivity for the bipolar II and borderline group and 41 % sensitivity for the group with a disconfirmed diagnosis of ADHD.

Conclusions: The Weighed Core Symptoms scale facilitated objective assessment of adult ADHD insofar that the ADHD group presented more core symptoms than the other two clinical groups and the normative group. Sensitivity for the Quantified Behavior Test Plus was lower in complex clinical groups with Bipolar II disorder, Borderline disorder and in patients with a disconfirmed diagnosis of ADHD. The psychometric instruments may be further evaluated with regard to well-documented and effective treatment programs for ADHD core symptoms.

Keyword
Adults, Attention Deficit Hyperactivity Disorder, Behavior, Hyperactivity, Objective measures, Psychometrics, Quantified Behavior Test Plus
National Category
Social Sciences
Research subject
Psychology
Identifiers
urn:nbn:se:kau:diva-15219 (URN)
Available from: 2012-10-18 Created: 2012-10-18 Last updated: 2013-07-10Bibliographically approved
4. The Weighed Core Symptom Scale and Prediction of ADHD in adults: Objective Measures of Remission and Response to Treatment with Methylphenidate
Open this publication in new window or tab >>The Weighed Core Symptom Scale and Prediction of ADHD in adults: Objective Measures of Remission and Response to Treatment with Methylphenidate
2013 (English)In: Clinical Practice and Epidemiology in Mental Health, ISSN 1745-0179, no 9, 171-179 p.Article in journal (Refereed) Published
Abstract [en]

Objective: Two measures of the response rate and the optimal treatment response for adult ADHD were evaluated using methylphenidate. The hypotheses were that Prediction of ADHD (PADHD) defines remission, the Weighed Core Symptom (WCS) scale registers direct effects of medication and that WCS may indicate the optimal dose level during titration.

Design: PADHD and WCS were analyzed at baseline and after intake of low doses of either short-acting or modifiedrelease formulations of methylphenidate, MPH (Study I), during titration with modified-release formulations of MPH (18/27, 36, 54, 72 mg) and at three months follow-up (Study II).

Patients: Study I consisted of 63 participants (32 females) and Study II consisted of 10 participants (6 females) diagnosed with ADHD and who was to start with treatment.

Outcome measures: Prediction of ADHD (PADHD) indicates the occurrence of ADHD (No, Yes) and the Weighed Core Symptom scale (WCS) quantifies ADHD from 0 to 100 (max-min).

Results: The number of clinical cases of ADHD decreased after methylphenidate treatment according to PADHD. WCS increased (p < 0.001) from 9.75 (SD = 12.27) to 47.50 (SD = 29.75) with about 10 mg of methylphenidate (N = 63). During titration, symptoms improved after 18/27 mg and 36 mg of methylphenidate and baseline-follow up comparisons showed WCS increments (p = 0.005) from 31.00 (N = 10, SD = 26.85) to 69.00 (N = 10, SD = 22.34).

Conclusions: PADHD defined remission and WCS measured therapeutic effects of methylphenidate in adult ADHD.

Keyword
Objective measures, Weighed Core Symptom scale, Prediction of ADHD, remission, ADHD
National Category
Social Sciences
Research subject
Psychology
Identifiers
urn:nbn:se:kau:diva-15220 (URN)10.2174/1745017901309010171 (DOI)
Available from: 2012-10-18 Created: 2012-10-18 Last updated: 2013-11-05Bibliographically approved

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