Self-reported childhood attention-deficit/hyperactivity disorder symptoms are not specific to the disorder

Abstract

Objective: The present study examined the specificity of self-reported childhood attention-deficit/hyperactivity disorder (ADHD) symptoms using the Wender Utah Rating Scale (WURS) in young adults with (1) a previous diagnosis of ADHD, (2) comorbid ADHD and psychological symptoms or diagnoses, (3) psychological diagnoses or symptoms without comorbid ADHD, and (4) controls.

Method: One thousand four hundred thirty-one non-treatment-seeking individuals (508 males), aged 18 to 25 years, were assigned to 1 of 4 groups (psychological controls, controls, ADHD, ADHD comorbid), based on responses to psychological, demographic, and health history questionnaires completed as part of a larger study. Responses to the WURS were analyzed at the individual item and subtest levels for their specificity to ADHD using area under the curve analyses.

Results: The standard WURS cutoff score of 46 was neither sensitive nor specific to ADHD, with a high rate of false positives in psychological controls. Factor analyses supported a 5-factor model (conduct problems, impulsivity problems, mood difficulties, inattention/anxiety symptoms, poor academic functioning) that accounted for 62% of the total variance; these factors were used to generate factor-based WURS subscales. Three subscales (impulsivity, poor academic functioning, and inattention/anxiety symptoms) showed potential for discriminating ADHD from controls among females. No subscales showed adequate sensitivity or specificity for discriminating ADHD from psychological controls among the males.

Conclusions: Results provide further evidence that retrospective self-report of childhood ADHD symptoms is not specific to ADHD and highlight concerns about the reliance on self-report of childhood ADHD symptoms for diagnostic purposes. Results suggest consideration of specific types of symptoms, and sex differences might increase diagnostic use of self-reported childhood symptoms.