title: Diagnostic accuracy of a brief screening tool for attention deficit hyperactivity disorder in UK prison inmates.
abstract: BACKGROUND
  Attention deficit hyperactivity disorder (ADHD) is overrepresented in prison, making it imperative to identify a screening tool that can be quickly applied to efficiently detect the disorder. We explored the discrimination ability of a widely used ADHD screen, the Barkley Adult ADHD Rating Scale (BAARS-IV), against a clinical diagnostic interview. A brief version of the screen was then developed in order to simplify its use in the prison context, and maximize its diagnostic properties.
  
  
  METHODS
  A cross-sectional study of 390 male prison inmates was performed in the UK, all participants were screened and interviewed via the Diagnostic Interview for ADHD in Adults 2.0 (DIVA-2).
  
  
  RESULTS
  A total of 47 (12.1%) inmates screened positive for ADHD using the full BAARS-IV, and 96 (24.6%) were clinically diagnosed, for a sensitivity of 37.9 and a specificity of 96.3. Our models identified the six items that most predicted ADHD diagnosis, with adjusted odds ratios ranging from 2.66 to 4.58. Sensitivity, specificity and accuracy were 0.82, 0.84 and 0.84, respectively, for the developed brief scale, and 0.71, 0.85 and 0.81 for its validation. Weighted probability scores produced an area under the curve of 0.89 for development, and 0.82 for validation of the brief scale.
  
  
  CONCLUSIONS
  The original BAARS-IV performed poorly at identifying prison inmates with ADHD. Our developed brief scale substantially improved diagnostic accuracy. The brief screening instrument has great potential to be used as an accurate and resource-effective tool to screen young people and adults for likely ADHD in the criminal justice system.
authors: Division of Brain Sciences,Department of Medicine,Centre for Mental Health,Imperial College,London,UK.
authors: S
authors: S
authors: Young
authors: Division of Brain Sciences,Department of Medicine,Centre for Mental Health,Imperial College,London,UK.
authors: R A
authors: RA
authors: González
authors: Institute of Psychiatry,Psychology and Neuroscience,King's College London,UK.
authors: L
authors: L
authors: Mutch
authors: Institute of Psychiatry,Psychology and Neuroscience,King's College London,UK.
authors: I
authors: I
authors: Mallet-Lambert
authors: Institute of Psychiatry,Psychology and Neuroscience,King's College London,UK.
authors: L
authors: L
authors: O'Rourke
authors: Division of Brain Sciences,Department of Medicine,Centre for Mental Health,Imperial College,London,UK.
authors: N
authors: N
authors: Hickey
authors: Institute of Psychiatry,Psychology and Neuroscience,King's College London,UK.
authors: P
authors: P
authors: Asherson
authors: Reykjavik University,Reykjavík,Iceland.
authors: G H
authors: GH
authors: Gudjonsson
mesh_terms: D000328:Adult; D001289:Attention Deficit Disorder with Hyperactivity / Q000175:diagnosis* / Q000453:epidemiology; D003430:Cross-Sectional Studies; D006801:Humans; D008297:Male; D011329:Prisoners / Q000523:psychology* / Q000706:statistics & numerical data; D011569:Psychiatric Status Rating Scales / Q000592:standards*; D012680:Sensitivity and Specificity; D006113:United Kingdom
keywords: ADHD; criminal justice system; diagnosis; prison; screening