title: Attention-Deficit/Hyperactivity Disorder Symptom Profiles in Medication-Treated Adults Entering a Psychosocial Treatment Program.
abstract: BACKGROUND
  Although medications are the most widely studied effective treatments for adults with attention-deficit/hyperactivity disorder (ADHD), patients treated with medications often have significant residual symptoms that may be amenable to psychosocial intervention. Few studies, however, report on the structure and severity of specific residual ADHD symptoms in adult patients who have been treated with medications. This information may be important in identifying the most important psychosocial treatment targets for medicated adults with ADHD with residual symptoms.
  
  
  OBJECTIVE
  Identify which symptoms of ADHD are most frequent and severe for medication-treated adults. Identify meaningful factors underlying self-report and clinician ratings in this group.
  
  
  METHODS
  Self-reported and clinician-rated ADHD symptom data from 105 adults in the community already receiving medication treatment who were entering cognitive behavioral therapy studies were examined. First, we examined the frequency and severity of each of the 18 ADHD symptoms that were present in the sample. Second, we conducted exploratory factor analyses of self-reported and clinician-rated ADHD symptoms to best describe the structure of residual symptoms in medication-treated adults, Lastly, we examined the association of the resulting factor scores with clinician-rated global ADHD severity (Clinical Global Impressions) and functional impairment (Global Assessment of Functioning) scales to determine which factors relate to overall severity.
  
  
  RESULTS
  The 2 most frequent (self-reported and clinician-rated) residual symptoms were disorganization (85%-88%) and distractibility (74%-83%). Exploratory factor analyses for both self-reported and clinician-rated data yielded a 3-factor model: (1) Hyperactivity/Restlessness, (2) Impulsivity/Poor Prospective Memory, and (3) Inattention. Using multiple regression, the Inattention factor from self-reported and clinician-rated data was most strongly, consistently, and uniquely related to clinician ratings of both illness severity and functioning.
  
  
  CONCLUSIONS
  In this sample, disorganization and distractibility were the most frequent and clinically significant residual symptoms; therefore, these should be important targets in psychosocial treatments for this population. Scoring symptom rating scales in medication-treated adults with ADHD using Hyperactivity. Restlessness, Impulsivity/Poor Prospective Memory, and Inattention factors may be more informative with respect to evaluating psychosocial treatment outcome than overall scale scores alone.
authors.affiliation: Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.
authors.forename: Laura E
authors.initials: LE
authors.lastname: Knouse
authors.affiliation: Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.
authors.forename: Susan
authors.initials: S
authors.lastname: Sprich
authors.affiliation: Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.
authors.forename: Christine
authors.initials: C
authors.lastname: Cooper-Vince
authors.affiliation: Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.
authors.forename: Steven A
authors.initials: SA
authors.lastname: Safren
keywords: hyperactivity/restlessness; impulsivity/poor prospective memory; inattention