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. 2012 Feb;80(1):139-150.
doi: 10.1037/a0026577. Epub 2011 Dec 12.

Diagnosing ADHD in adolescence

Margaret H Sibley  1 , William E Pelham  1 , Brooke S G Molina  2 , Elizabeth M Gnagy  3 , Daniel A Waschbusch  3 , Allison C Garefino  4 , Aparajita B Kuriyan  3 , Dara E Babinski  3 , Kathryn M Karch  5
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Diagnosing ADHD in adolescence

Margaret H Sibley et al. J Consult Clin Psychol. 2012 Feb.

Abstract

Objective: This study examines adolescent-specific practical problems associated with current practice parameters for diagnosing attention-deficit/hyperactivity disorder (ADHD) to inform recommendations for the diagnosis of ADHD in adolescents. Specifically, issues surrounding the use of self- versus informant ratings, diagnostic threshold, and retrospective reporting of childhood symptoms were addressed.

Method: Using data from the Pittsburgh ADHD Longitudinal Study (PALS), parent, teacher, and self-reports of symptoms and impairment were examined for 164 adolescents with a childhood diagnosis of ADHD (age M = 14.74 years) and 119 demographically similar non-ADHD controls (total N = 283).

Results: Results indicated that 70% of the well-diagnosed childhood ADHD group continued to meet Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.; American Psychiatric Association, 2000) diagnostic criteria for ADHD in adolescence; however, an additional 17% possessed clinically significant impairment in adolescence but did not qualify for a current ADHD diagnosis. The optimal source of information was combined reports from the parent and a core academic teacher. Adolescents with ADHD met criteria for very few symptoms of hyperactivity/impulsivity, suggesting a need to revisit the diagnostic threshold for these items. Additionally, emphasis on impairment, rather than symptom threshold, improved identification of adolescents with a gold-standard childhood diagnosis of ADHD and persistent ADHD symptoms. Parent retrospective reports of baseline functioning, but not adolescent self-reports, were significantly correlated with reports collected at baseline in childhood.

Conclusions: Recommendations are offered for diagnosing ADHD in adolescence based on these findings.

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Figures

Figure 1
Figure 1. ADHD Symptomatology and Impairment by Rater and Group
Note. Graphs reflect estimated marginal means at the mean of the covariates.
Figure 2
Figure 2. Mean Symptom Endorsement at each IRS Impairment Level within ADHD Group
Note. Clinically significant impairment is indicated by a score of “3” or higher on the Impairment Rating Scale (Evans et al., under review; Fabiano et al., 2006).
Figure 3
Figure 3. Group-level Retrospective Reporting within the ADHD Sample
Note. Values represent estimated marginal means at the mean of the covariate (years since baseline).
See this image and copyright information in PMC

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