title: 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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: New York State Psychiatric Institute, Columbia University, College of Physicians and Surgeons, 1051 Riverside Dr, Unit 66, New York, NY 10032, USA. dakware@nyspi.columbia.edu
authors.forename: Elias
authors.initials: E
authors.lastname: Dakwar
authors.forename: Amy
authors.initials: A
authors.lastname: Mahony
authors.forename: Martina
authors.initials: M
authors.lastname: Pavlicova
authors.forename: Andrew
authors.initials: A
authors.lastname: Glass
authors.forename: Daniel
authors.initials: D
authors.lastname: Brooks
authors.forename: John J
authors.initials: JJ
authors.lastname: Mariani
authors.forename: John
authors.initials: J
authors.lastname: Grabowski
authors.forename: Frances Rudnick
authors.initials: FR
authors.lastname: Levin
mesh_terms: D000328:Adult; D001289:Attention Deficit Disorder with Hyperactivity / Q000175:diagnosis* / Q000453:epidemiology* / Q000534:rehabilitation; D019970:Cocaine-Related Disorders / Q000175:diagnosis* / Q000453:epidemiology* / Q000534:rehabilitation; D015897:Comorbidity; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000453:epidemiology / Q000534:rehabilitation; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006801:Humans; D007406:Interview, Psychological; D008297:Male; D008403:Mass Screening / Q000706:statistics & numerical data*; D010555:Personality Inventory / Q000706:statistics & numerical data*; D011594:Psychometrics / Q000706:statistics & numerical data; D015203:Reproducibility of Results; D012174:Retinitis Pigmentosa