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The Weighed Core Symptom Scale and Prediction of ADHD in adults: Objective Measures of Remission and Response to Treatment with Methylphenidate
1Nutrition Gut Brain Interactions Research Centre, Örebro University.
Department of Psychiatry, the NU-Health Care, Trollhättan, Sweden.
Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Solna, Sweden.
2013 (English)In: Clinical Practice and Epidemiology in Mental Health, ISSN 1745-0179, no 9, 171-179 p.Article in journal (Refereed) Published
Abstract [en]

Objective: Two measures of the response rate and the optimal treatment response for adult ADHD were evaluated using methylphenidate. The hypotheses were that Prediction of ADHD (PADHD) defines remission, the Weighed Core Symptom (WCS) scale registers direct effects of medication and that WCS may indicate the optimal dose level during titration.

Design: PADHD and WCS were analyzed at baseline and after intake of low doses of either short-acting or modifiedrelease formulations of methylphenidate, MPH (Study I), during titration with modified-release formulations of MPH (18/27, 36, 54, 72 mg) and at three months follow-up (Study II).

Patients: Study I consisted of 63 participants (32 females) and Study II consisted of 10 participants (6 females) diagnosed with ADHD and who was to start with treatment.

Outcome measures: Prediction of ADHD (PADHD) indicates the occurrence of ADHD (No, Yes) and the Weighed Core Symptom scale (WCS) quantifies ADHD from 0 to 100 (max-min).

Results: The number of clinical cases of ADHD decreased after methylphenidate treatment according to PADHD. WCS increased (p < 0.001) from 9.75 (SD = 12.27) to 47.50 (SD = 29.75) with about 10 mg of methylphenidate (N = 63). During titration, symptoms improved after 18/27 mg and 36 mg of methylphenidate and baseline-follow up comparisons showed WCS increments (p = 0.005) from 31.00 (N = 10, SD = 26.85) to 69.00 (N = 10, SD = 22.34).

Conclusions: PADHD defined remission and WCS measured therapeutic effects of methylphenidate in adult ADHD.

Place, publisher, year, edition, pages
2013. no 9, 171-179 p.
Keyword [en]
Objective measures, Weighed Core Symptom scale, Prediction of ADHD, remission, ADHD
National Category
Social Sciences
Research subject
Psychology
Identifiers
URN: urn:nbn:se:kau:diva-15220DOI: 10.2174/1745017901309010171OAI: oai:DiVA.org:kau-15220DiVA: diva2:561316
Available from: 2012-10-18 Created: 2012-10-18 Last updated: 2013-11-05Bibliographically 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)
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. 192 p.
Series
Karlstad University Studies, ISSN 1403-8099 ; 2012:49
Keyword
Attention Deficit Hyperactivity Disorder, Objective measures, Adults, Psychometrics, Diagnosis, Treatment
National Category
Social Sciences
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: 2014-05-20Bibliographically approved

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