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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.
Karlstad University, Karlstad, Sweden.ORCID iD: 0000-0001-8451-6263
NU health Care, Trollhättan, Sweden.
Evidens Research and Development Center, Göteborg, Sweden; Karolinska Institutet, Solna, Sweden .ORCID iD: 0000-0002-4905-5673
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.

Place, publisher, year, edition, pages
2012. Vol. 8, 134-143 p.
Keyword [en]
Adults, Attention Deficit Hyperactivity Disorder, Behavior, Hyperactivity, Objective measures, Psychometrics, Quantified Behavior Test Plus
National Category
Psychology
Research subject
Psychology
Identifiers
URN: urn:nbn:se:oru:diva-39855DOI: 10.2174/1745017901208010134PubMedID: 23166565Scopus ID: 2-s2.0-84878121484OAI: oai:DiVA.org:oru-39855DiVA: diva2:772717
Available from: 2014-12-17 Created: 2014-12-17 Last updated: 2015-03-09Bibliographically approved
In thesis
1. Global Assessment of Attention Deficit Hyperactivity Disorder: Examining objective Measures of Hyperactivity, Impulsivity and Inattention in Adults
Open this publication in new window or tab >>Global Assessment of Attention Deficit Hyperactivity Disorder: Examining objective Measures of Hyperactivity, Impulsivity and Inattention in Adults
2012 (English)Doctoral thesis, comprehensive summary (Other academic)
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 disconfirmed 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: Karlstad University, 2012. 192 p.
Series
Karlstad University Studies, ISSN 1403-8099 ; 2012:49
Keyword
Attention Deficit Hyperactivity Disorder, Objective measures, Adults, Psychometrics, Diagnosis, Treatment
National Category
Psychology
Research subject
Psychology
Identifiers
urn:nbn:se:oru:diva-39863 (URN)978-91-7063-460-4 (ISBN)
Public defence
2012-12-14, Sjöströmsalen, IB 309, Karlstad, 10:00 (English)
Opponent
Supervisors
Available from: 2015-03-09 Created: 2014-12-17 Last updated: 2015-03-09Bibliographically approved

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