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

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.

Figure 1. Sensitivity, Specificity, Positive Predictive Value, Negative Predictive Value, and κ of Each Self-Reporting Screening Test Versus CAADID (ADHD NOS labeled as not ADHD)

Abbreviations: ADHD = attention-deficit/hyperactivity disorder, ASRS-V1.1 = Adult ADHD Self-Report Scale-Version 1.1, CAADID = Conners Adult ADHD Diagnostic Interview for DSM-IV, CAARS = Conners Adult ADHD Rating Scale, NOS = not otherwise specified, WURS = Wender Utah Rating Scale.

Figure 2. Sensitivity, Specificity, Positive Predictive Value, Negative Predictive Value, and κ of Each Self-Report Screening Test Versus CAADID (ADHD NOS labeled as ADHD)

Abbreviations: ADHD = attention-deficit/hyperactivity disorder, ASRS-V1.1 = Adult ADHD Self-Report Scale-Version 1.1, CAADID = Conners Adult ADHD Diagnostic Interview for DSM-IV, CAARS = Conners Adult ADHD Rating Scale, NOS = not otherwise specified, WURS = Wender Utah Rating Scale.