The utility of attention-deficit/hyperactivity disorder screening instruments in individuals seeking treatment for substance use disorders

Elias Dakwar, Amy Mahony, Martina Pavlicova, Andrew Glass, Daniel Brooks, John J. Mariani, John Grabowski, Frances Rudnick Levin

Research output: Contribution to journalArticle

31 Citations (Scopus)

Abstract

Objective: Several screening tools for attention-deficit/ hyperactivity disorder (ADHD) have been validated in non-substance-abusing populations, but limited data are available regarding their utility in adults with current substance use disorders. The aim of this study was to determine the sensitivity, specificity, and positive and negative predictive values of 3 commonly used ADHD screening instruments in cocaine-dependent individuals. Method: Adults seeking treatment for cocaine dependence (N = 102) were administered 3 self-report instruments between May 2009 and April 2011: the Conners Adult ADHD Rating Scale (CAARS), the Wender Utah Rating Scale (WURS), and the Adult ADHD Self-Report Scale-Version 1.1 (ASRS-V1.1). They then met with master's-level clinicians who administered the Conners Adult ADHD Diagnostic Interview for DSM-IV (CAADID). With the CAADID serving as the gold standard, the validity of the screening instruments was determined, both singly and in combination. Results: Twenty-five (25%) of the 102 patients met DSM-IV criteria for ADHD or ADHD not otherwise specified (NOS) based on the CAADID. Kappa scores determining agreement between the screening tools and the CAADID (with ADHD NOS labeled as ADHD or labeled as not ADHD) ranged from 0.37 to 0.69. Sensitivity scores for the broadest range of ADHD cases were 80.0%, 87.5%, and 60.9% for the CAARS, WURS, and ASRS-V1.1, respectively. Positive predictive value was highest for the CAARS, at 74.1%, and negative predictive value was highest for the WURS, at 95.1%. The highest sensitivity (96.0%) was found with coadministration of the WURS and CAARS. Conclusion: While all of the screening instruments were found to have adequate sensitivity and specificity, the CAARS outperformed the other instruments in regard to agreement with the CAADID and positive predictive values. However, the WURS, with the highest sensitivity in regard to the broadest range of ADHD cases, may be the single best instrument for preliminary screening purposes. Further, because the ASRS-V1.1 is the simplest and shortest instrument to administer, it may have advantages when a large number of patients need to be screened.

Original languageEnglish (US)
Pages (from-to)e1372-e1378
JournalJournal of Clinical Psychiatry
Volume73
Issue number11
DOIs
StatePublished - Nov 2012

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Attention Deficit Disorder with Hyperactivity
Substance-Related Disorders
Diagnostic and Statistical Manual of Mental Disorders
Self Report
Interviews
Therapeutics
Sensitivity and Specificity
Cocaine-Related Disorders
Cocaine

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The utility of attention-deficit/hyperactivity disorder screening instruments in individuals seeking treatment for substance use disorders. / Dakwar, Elias; Mahony, Amy; Pavlicova, Martina; Glass, Andrew; Brooks, Daniel; Mariani, John J.; Grabowski, John; Levin, Frances Rudnick.

In: Journal of Clinical Psychiatry, Vol. 73, No. 11, 11.2012, p. e1372-e1378.

Research output: Contribution to journalArticle

Dakwar, Elias ; Mahony, Amy ; Pavlicova, Martina ; Glass, Andrew ; Brooks, Daniel ; Mariani, John J. ; Grabowski, John ; Levin, Frances Rudnick. / The utility of attention-deficit/hyperactivity disorder screening instruments in individuals seeking treatment for substance use disorders. In: Journal of Clinical Psychiatry. 2012 ; Vol. 73, No. 11. pp. e1372-e1378.
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abstract = "Objective: Several screening tools for attention-deficit/ hyperactivity disorder (ADHD) have been validated in non-substance-abusing populations, but limited data are available regarding their utility in adults with current substance use disorders. The aim of this study was to determine the sensitivity, specificity, and positive and negative predictive values of 3 commonly used ADHD screening instruments in cocaine-dependent individuals. Method: Adults seeking treatment for cocaine dependence (N = 102) were administered 3 self-report instruments between May 2009 and April 2011: the Conners Adult ADHD Rating Scale (CAARS), the Wender Utah Rating Scale (WURS), and the Adult ADHD Self-Report Scale-Version 1.1 (ASRS-V1.1). They then met with master's-level clinicians who administered the Conners Adult ADHD Diagnostic Interview for DSM-IV (CAADID). With the CAADID serving as the gold standard, the validity of the screening instruments was determined, both singly and in combination. Results: Twenty-five (25{\%}) of the 102 patients met DSM-IV criteria for ADHD or ADHD not otherwise specified (NOS) based on the CAADID. Kappa scores determining agreement between the screening tools and the CAADID (with ADHD NOS labeled as ADHD or labeled as not ADHD) ranged from 0.37 to 0.69. Sensitivity scores for the broadest range of ADHD cases were 80.0{\%}, 87.5{\%}, and 60.9{\%} for the CAARS, WURS, and ASRS-V1.1, respectively. Positive predictive value was highest for the CAARS, at 74.1{\%}, and negative predictive value was highest for the WURS, at 95.1{\%}. The highest sensitivity (96.0{\%}) was found with coadministration of the WURS and CAARS. Conclusion: While all of the screening instruments were found to have adequate sensitivity and specificity, the CAARS outperformed the other instruments in regard to agreement with the CAADID and positive predictive values. However, the WURS, with the highest sensitivity in regard to the broadest range of ADHD cases, may be the single best instrument for preliminary screening purposes. Further, because the ASRS-V1.1 is the simplest and shortest instrument to administer, it may have advantages when a large number of patients need to be screened.",
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AU - Mahony, Amy

AU - Pavlicova, Martina

AU - Glass, Andrew

AU - Brooks, Daniel

AU - Mariani, John J.

AU - Grabowski, John

AU - Levin, Frances Rudnick

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N2 - Objective: Several screening tools for attention-deficit/ hyperactivity disorder (ADHD) have been validated in non-substance-abusing populations, but limited data are available regarding their utility in adults with current substance use disorders. The aim of this study was to determine the sensitivity, specificity, and positive and negative predictive values of 3 commonly used ADHD screening instruments in cocaine-dependent individuals. Method: Adults seeking treatment for cocaine dependence (N = 102) were administered 3 self-report instruments between May 2009 and April 2011: the Conners Adult ADHD Rating Scale (CAARS), the Wender Utah Rating Scale (WURS), and the Adult ADHD Self-Report Scale-Version 1.1 (ASRS-V1.1). They then met with master's-level clinicians who administered the Conners Adult ADHD Diagnostic Interview for DSM-IV (CAADID). With the CAADID serving as the gold standard, the validity of the screening instruments was determined, both singly and in combination. Results: Twenty-five (25%) of the 102 patients met DSM-IV criteria for ADHD or ADHD not otherwise specified (NOS) based on the CAADID. Kappa scores determining agreement between the screening tools and the CAADID (with ADHD NOS labeled as ADHD or labeled as not ADHD) ranged from 0.37 to 0.69. Sensitivity scores for the broadest range of ADHD cases were 80.0%, 87.5%, and 60.9% for the CAARS, WURS, and ASRS-V1.1, respectively. Positive predictive value was highest for the CAARS, at 74.1%, and negative predictive value was highest for the WURS, at 95.1%. The highest sensitivity (96.0%) was found with coadministration of the WURS and CAARS. Conclusion: While all of the screening instruments were found to have adequate sensitivity and specificity, the CAARS outperformed the other instruments in regard to agreement with the CAADID and positive predictive values. However, the WURS, with the highest sensitivity in regard to the broadest range of ADHD cases, may be the single best instrument for preliminary screening purposes. Further, because the ASRS-V1.1 is the simplest and shortest instrument to administer, it may have advantages when a large number of patients need to be screened.

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