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Measuring Adult Attention Deficit Hyperactivity Disorder using the Quantified Behaviour Test Plus
Karlstad University, Faculty of Economic Sciences, Communication and IT, Department of Psychology.
Department of Psychiatry, NU-health care, Trollhättan, Sweden.
Evidence Research and Development Center Göteborg Sweden.
2013 (English)In: PsyCh Journal, ISSN 2046-0260, Vol. 2, no 1, p. 48-62Article in journal (Refereed) Published
Abstract [en]

Attention Deficit Hyperactivity Disorder, ADHD, occurs in about 5 % of the adult population and includes cardinal symptoms of hyperactivity, inattention, and impulsivity that may be difficult to identify with clinical routine methods. Continuous performance tests are objective measures of inattention and impulsivity that, combined with objective measures of motor activity, facilitate identification of ADHD among adults. The aim of the present study was to examine sensitivity, specificity and a composite measure of ADHD using objective measures of the ADHD-cardinal symptoms in adult participants with ADHD and non-ADHD normative participants.

Cardinal symptoms were measured in 55 participants having ADHD, 202 non-ADHD normative participants, as well as 84 ADHD normative participants using the Quantified Behavior Test Plus, QbTest-Plus. This test measures inattention and impulsivity with a continuous performance test and hyperactivity with a motion tracking system.

A predictive variable for detection of ADHD called Prediction of ADHD, PADHD, yielded 86 % sensitivity and 83 % specificity. A composite measure of ADHD cardinal symptoms was developed with a Weighed Core Symptoms scale, WCS, that indicates the total amount of ADHD symptoms on a numeric scale from 0 to 100.

The total amount of ADHD symptoms was measured on a scale and predicted with the categorical variable in a majority of the cases in the present study. Further studies are needed in order to confirm the results with regard to additional clinical and normative samples. Careful consideration of potential gender and diagnostic subtype differences are noteworthy aspects for future examinations of the new instruments.

Place, publisher, year, edition, pages
2013. Vol. 2, no 1, p. 48-62
Keywords [en]
Adults, Attention Deficit Hyperactivity Disorder, Psychometrics, Objective measures
National Category
Psychology
Research subject
Psychology
Identifiers
URN: urn:nbn:se:kau:diva-8148DOI: 10.1002/pchj.17OAI: oai:DiVA.org:kau-8148DiVA, id: diva2:438316
Note

Work is also part of H. Edebols licentiate thesis "Measuring Cardinal Symptoms of Attention Deficit Hyperactivity Disorder in Adults". Status of the article changed from submitted to in press since then.

Available from: 2011-09-02 Created: 2011-09-02 Last updated: 2013-06-27Bibliographically approved
In thesis
1. Measuring Cardinal Symptoms of Attention Deficit Hyperactivity Disorder in Adults: Examining objective measures of hyperactivity, impulsivity, and inattention
Open this publication in new window or tab >>Measuring Cardinal Symptoms of Attention Deficit Hyperactivity Disorder in Adults: Examining objective measures of hyperactivity, impulsivity, and inattention
2011 (English)Licentiate thesis, comprehensive summary (Other academic)
Abstract [en]

The purpose of this licentiate thesis is to examine measures of ADHD in adult persons. An instrument that reports objective measures of cardinal symptoms of ADHD in adult persons is used for this purpose. The instrument is called the Quantified Behavior Test Plus and records motor activity by means of an infrared motion tracking system and cognitive deficits with a continuous performance test. Paper I investigates sensitivity and specificity for the test with regard to ADHD in a clinic-referred sample. When the test was compared to clinical assessments, results yielded 83 % sensitivity and 57 % specificity. The high level of comorbid psychiatric disorders motivates continuous search for a composite measure of ADHD cardinal symptoms and better understanding of normative behavior in healthy participants. In Paper II, a composite measure of ADHD called the Weighed Core Symptom scale (WCS) is developed. WCS integrates measures of ADHD cardinal symptoms on a ten point scale. A majority of participants with ADHD has low points on the scale (indicating high levels of symptoms) and a majority of healthy normative participants has high points on the scale (indicating low levels of symptoms). Levels of sensitivity and specificity for the test were examined with a measure called Prediction of ADHD (PADHD), and results yielded 86 % sensitivity and 83 % specificity. The measures developed in Paper II are tentative and needs to be tested in further studies in order to better understand behavior manifestations of ADHD in adult persons.

Place, publisher, year, edition, pages
Karlstad: Karlstad University, 2011. p. 93
Series
Karlstad University Studies, ISSN 1403-8099 ; 2011:39
Keywords
Attention Deficit Hyperactivity Disorder, Objective measures, Adults, the Quantified Behavior Test Plus, Psychometrics
National Category
Psychology
Research subject
Psychology
Identifiers
urn:nbn:se:kau:diva-8004 (URN)978-91-7063-374-4 (ISBN)
Presentation
2011-10-28, Undénsalen, 11C 413, Karlstads universitet,, Karlstad, 00:00 (Swedish)
Opponent
Supervisors
Available from: 2011-09-02 Created: 2011-08-08 Last updated: 2011-10-24Bibliographically approved
2. 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)
Alternative title[sv]
Global bedöming av aktivitets- och uppmärksamhetsstörning : objektiva mätningar av hyperaktivitet, impulsivitet och ouppmärksamhet hos vuxna personer
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 diconfirmed 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: Karlstads universitet, 2012. p. 192
Series
Karlstad University Studies, ISSN 1403-8099 ; 2012:49
Keywords
Attention Deficit Hyperactivity Disorder, Objective measures, Adults, Psychometrics, Diagnosis, Treatment
National Category
Other Medical Sciences not elsewhere specified Psychiatry Psychology (excluding Applied Psychology)
Research subject
Psychology
Identifiers
urn:nbn:se:kau:diva-15186 (URN)978-91-7063-460-4 (ISBN)
Public defence
2012-12-14, Sjöströmsalen, 1B 309, Karlstads Universitet, Karlstad, 10:00 (English)
Opponent
Supervisors
Available from: 2012-11-21 Created: 2012-10-17 Last updated: 2018-07-16Bibliographically approved

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