An Investigation of Reported Symptoms of ADHD in a University Population

1. An Investigation of Reported Symptoms ofADHD in a University Population Dr. Allyson G. Harrison Regional Assessment & Resource Centre

2. Published in…. • ADHD Report (2004), V12, 8-11.

3. Dx criteria for ADHD • Symptoms have to have appeared early in life (usually before age 7, certainly before age 12) • Symptoms have been chronic • Symptoms cause significant impairment in at least TWO major life areas • Symptoms are not the result of co-existing disorders (rule out clause)

4. ADHD epidemic? • Concern about dramatic rise in number of adults presenting to professionals for primary investigation of possible ADHD • No one “definitive” test for ADHD • Question of whether & to what extent DSM symptoms of ADHD, especially inattentive, are common • Retrospective dx often difficult-memory is fallible

5. How common are inattentive symptoms? • Adults commonly describe their childhood behaviors as ADHD–like (Murphy, Gordon, and Barkley, 2000) • 80% of adults report six or more of the DSM–IV symptoms occasionally, & 25% of adults report such symptoms very often. • Over 30% of college students complain of significant problems remembering things, paying attention, concentrating, being irritable & impatient, having sleep problems, procrastinating…Wong et al. (1994) • ? Stressful, competitive, busy life with many new changes may lead to development of ADHD-like symptoms?

6. Problems with prior research • Most studies only attempt to discriminate between well-validated ADHD and “normals” • In practice, rarely have to determine if a “normal” person has a disorder • Inattentive symptoms are common to a number of disorders, including: • PTSD, Depression, DID, substance abuse, anxiety disorder, Chronic Pain • Overreliance on checklists can lead to misdiagnosis

7. Brown Attention Activation Disorders (BAADS) • Brown (1996) developed own method to identify people with “inattentive ADHD”. • Based on his own notion of core symptoms of ADHD-I • Scales do not have objective anchors to denote frequency or intensity (very subjective ratings). • No data to indicate extent to which these symptoms are common in students

8. Present study • 224 students presenting to Health/ Counselling Service first 2 weeks January • Exclusion criteria was prior dx ADHD • 180 students from Health • 32 Counselling & Academic skills • 12 Psychiatry • Median age 21 • 65% female, but no difference by sex

9. TABLE 1. Number and Frequency of BADDS—Adult Scores with Cutoff Scores of 50 and 55

10. Cut off? • Cut off score of 84 required to obtain false positive rate of 4%! • This is 34 points higher than manual’s cut off for “probable ADD”, and 29 points above the “HIGHLY PROBABLE” label.

11. Results continued • Significantly more students attending Counselling & Psychiatry endorsed symptoms typical of ADHD (63-67%) • None had prior diagnoses of ADHD. • Difficult to believe all these students being followed by professionals could have undiagnosed ADHD • Possible there are some with undiagnosed disorder, but hard to believe 21% of students going in for routine medical c/o have undiagnosed ADHD when base rate is 1%.

12. Conclusions • Findings raise serious concerns about potential overidentification of ADHD in students if relying solely on BAADS • Suggest self-report scales should include scale anchors for more objective reporting • Cut off score need to be re-examined, comparing scores of known ADHD with “clinical” controls. • Imperative that clinicians obtain objective information about long-time history of impairments across settings before diagnosing ADHD.

13. Conclusions • Misdiagnosis puts clients at risk for inappropriate and potentially harmful treatment (cf. Adderall) • Possible development of tic disorder • Possible exacerbation of anxiety in PTSD • Real cause of problems left untreated • Overdiagnosis leads to loss of credibility, both for the disorder and the clinicians!

14. Conclusion DON’T DIAGNOSE ADHD BASED SOLELY ON SELF-REPORTED SYMPTOMS