Lenard Adler, MD ADHD in AdultsSilverstein et al. (2017) recently published a study which reported a validation of two expanded adult ADHD scales, self-report (Adult ADHD Self Report Rating Scale (ASRS) v1.1 Symptom Checklist) and clinician/investigator (Adult ADHD Investigator Symptom Rating Scale – AISRS); both scale were expanded beyond the classic 18 DSM symptoms of inattention (IA) and hyperactivity-impulsivity (HI) to include 13 additional commonly co-traveling items of executive function deficits (EFDs) (eg. difficulty with organization, planning, task execution and procrastination) and emotional control deficits (EC) (eg. moodiness, over-reactivity of mood), creating 31 item scales.

Data was examined on 297 individuals (either referred adults with ADHD or individuals in a primary care practice, who were mostly controls) at the NYU School of Medicine. The psychometric properties of both scales were examined in terms of internal consistency (Cronbach’s alpha) and cut-off’s from normative data to predict a diagnosis. The internal consistency was high on both scales for measuring not only DSM IA and HI symptoms but also symptoms of EFD and EC (subscales ranging from 0.84 to 0.96); however, the internal consistency for EC was less for EFD, indicating that EC symptoms are less homogeneous than those of EFD, as had been suggested in a factor analysis by Adler et al (2017). Cut-off scores predictive of adult ADHD on the AISRS for dsm IA and HI 18 symptoms were between 23 and 26; this validates the empirical choice utilized in many clinical trials in adult ADHD of a cut-off score of 24.

This study highlights the importance to clinicians of assessing not only DSM symptoms of IA and HI, but also the co-traveling symptoms of EFD and EC and that clinician or self-report scales can be utilized in clinical practice. Also, the assessment of EFD and EC is especially important for clinicians as these symptom sets are less robustly responsive to pharmacotherapy than classic symptoms of IA and HI and may be more amenable to the addition of psycho-social interventions, such as cognitive behavioral therapy.

REFERENCES
Adler LA, Faraone SV, Spencer TJ, Berglund P, Alperin S, Kessler RC. The structure of adult ADHD. Int J Methods Psychiatr Res. 2017 Mar;26(1). doi: 10.1002/mpr.1555. Epub 2017 Feb 17

Silverstein MJ, Faraone SV, Alperin S, Leon TL, Biederman J, Spencer TJ, Adler LA. Validation of the Expanded Versions of the Adult ADHD Self-Report Scale v1.1 Symptom Checklist and the Adult ADHD Investigator Symptom Rating Scale. J Atten Disord. 2018 Feb 1:1087054718756198. doi: 10.1177/1087054718756198. [Epub ahead of print].

Lenard A. Adler, MD

About Lenard A. Adler, MD

Dr. Adler is Professor, Department of Psychiatry, and Department of Child and Adolescent Psychiatry, as well as the Director of the Adult ADHD Program at NYU Langone Medical Center in Manhattan, New York. He is a member of APSARD, the American Professional Society of ADHD and Related Disorders, and is on the Advisory Board of ADHD in Adults.com