Question: What is the validity of current diagnostic criteria for adult attention deficit hyperactivity disorder (ADHD) and how accurate are they for distinguishing ADHD from other disorders?

Answer:

Six diagnostic accuracy studies suggested variable accuracy of the ASRS v1.1 in diagnosing ADHD. A key strength of this tool is that it is short (6 questions) and simple to complete. The majority of studies found reasonable sensitivity (>84%) with specificity reported to be lower. However, this finding was not consistent with two studies reporting considerably lower sensitivity. The majority of studies (4/6) were conducted in substance abuse populations, the applicability of results from these studies to a more general population is unclear; one study conducted in primary care reported similar accuracy to most studies conducted in this focused population but a study in a US managed care plan was one of the studies to report lower sensitivity. Overall, the evidence suggests that the ASRS v1.1 may be useful in ruling out ADHD but further studies are needed to confirm this, especially in more general populations. Evidence on the accuracy of other scales (CAARS, WURS and ADSA) was limited with single studies evaluating these. The limited evidence suggested that ADSA may be less accurate than the ASRS v1.1. The study that evaluated the CAARS and WURS scales, both of which are more complex scales than the ASRS v1.1., also provided data on the ASRS v1.1. This study found that when evaluated alone CAARS had the highest sensitivity and specificity but that combining scores from two or more of these tools could maximise sensitivity or specificity. The diagnostic accuracy studies were generally well conducted; the main limitation was not reported whether the reference standard (DSM-IV criteria) was interpreted blind to the results of the scale being evaluated.

A systematic review provided an evaluation of the validity of the DSM-IV criteria; it not provide accuracy data. This review was generally well conducted but the quality of the included studies was not formally assessed. It found that DSM-IV criteria for ADHD identify individuals with significant functional impairment, that DSM-IV inattention and hyperactivity-impulsivity symptom dimensions are valid and that evidence is mixed regarding the discriminant validity of DSM-IV ADHD subtypes.

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