A clinically useful screen for attention-deficit/hyperactivity disorder in adult psychiatric outpatients

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Abstract

BACKGROUND

Attention-deficit/hyperactivity disorder (ADHD) is a serious illness that is frequently underdiagnosed in adults. The goal of this report from the Rhode Island Methods to Improve Diagnostic Assessment and Services project was to determine if it was possible to identify 1 or 2 ADHD criteria that could serve as “gate” criteria to screen for the disorder.

METHODS

Psychiatric outpatients (N = 1,134) were evaluated using a semi-structured diagnostic interview for DSM-IV criteria of ADHD. We computed the sensitivity, specificity, and positive and negative predictive values of each of the 18 ADHD criteria to identify 1 or 2 criteria that could be used to screen for the disorder. We conducted a validation and cross-validation analysis by splitting the sample in half.

RESULTS

In both the validation and cross-validation samples, a 2-item screen of difficulty sustaining attention and fidgetiness had a sensitivity of >90%. The negative predictive value of the 2-item screen was >95%.

CONCLUSIONS

Clinicians can screen for ADHD in adults by inquiring about 2 features of the disorder (ie, difficulty sustaining attention and fidgetiness), the presence of which captures most patients with the disorder and the absence of which rules out the disorder.

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