title: Defining ADHD symptom persistence in adulthood: optimizing sensitivity and specificity.
abstract: OBJECTIVE
  Longitudinal studies of children diagnosed with ADHD report widely ranging ADHD persistence rates in adulthood (5-75%). This study documents how information source (parent vs. self-report), method (rating scale vs. interview), and symptom threshold (DSM vs. norm-based) influence reported ADHD persistence rates in adulthood.
  
  
  METHODS
  Five hundred seventy-nine children were diagnosed with DSM-IV ADHD-Combined Type at baseline (ages 7.0-9.9 years) 289 classmates served as a local normative comparison group (LNCG), 476 and 241 of whom respectively were evaluated in adulthood (Mean Age = 24.7). Parent and self-reports of symptoms and impairment on rating scales and structured interviews were used to investigate ADHD persistence in adulthood.
  
  
  RESULTS
  Persistence rates were higher when using parent rather than self-reports, structured interviews rather than rating scales (for self-report but not parent report), and a norm-based (NB) threshold of 4 symptoms rather than DSM criteria. Receiver-Operating Characteristics (ROC) analyses revealed that sensitivity and specificity were optimized by combining parent and self-reports on a rating scale and applying a NB threshold.
  
  
  CONCLUSIONS
  The interview format optimizes young adult self-reporting when parent reports are not available. However, the combination of parent and self-reports from rating scales, using an 'or' rule and a NB threshold optimized the balance between sensitivity and specificity. With this definition, 60% of the ADHD group demonstrated symptom persistence and 41% met both symptom and impairment criteria in adulthood.
authors.affiliation: Department of Psychiatry & Behavioral Health, Florida International University, Miami, FL, USA.
authors.forename: Margaret H
authors.initials: MH
authors.lastname: Sibley
authors.affiliation: Child Development Center, School of Medicine, University of California, Irvine, CA, USA.
authors.forename: James M
authors.initials: JM
authors.lastname: Swanson
authors.affiliation: Department of Psychiatry, Nisonger Center, Ohio State University, Columbus, OH, USA.
authors.forename: L Eugene
authors.initials: LE
authors.lastname: Arnold
authors.affiliation: Division of Child Psychiatry, Montreal Children's Hospital, McGill University, Montreal, QC, Canada.
authors.forename: Lily T
authors.initials: LT
authors.lastname: Hechtman
authors.affiliation: Institute of Human Development, University of California, Berkeley, CA, USA.
authors.forename: Elizabeth B
authors.initials: EB
authors.lastname: Owens
authors.affiliation: Department of Pediatrics, University of California, Irvine, CA, USA.
authors.forename: Annamarie
authors.initials: A
authors.lastname: Stehli
authors.affiliation: Child Study Center at New York University Langone Medical Center, New York, NY, USA.
authors.forename: Howard
authors.initials: H
authors.lastname: Abikoff
authors.affiliation: Department of Psychology, University of California, Berkeley, CA, USA.
authors.forename: Stephen P
authors.initials: SP
authors.lastname: Hinshaw
authors.affiliation: Departments of Psychiatry and Psychology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
authors.forename: Brooke S G
authors.initials: BSG
authors.lastname: Molina
authors.affiliation: Department of Psychiatry & Behavioral Sciences, Duke University Medical Center, Durham, NC, USA.
authors.forename: John T
authors.initials: JT
authors.lastname: Mitchell
authors.affiliation: The REACH Institute, New York, NY, USA.
authors.forename: Peter S
authors.initials: PS
authors.lastname: Jensen
authors.affiliation: Department of Psychology, Carleton University, Ottawa, ON, Canada.
authors.forename: Andrea L
authors.initials: AL
authors.lastname: Howard
authors.affiliation: Department of Pediatrics, University of California, Irvine, CA, USA.
authors.forename: Kimberley D
authors.initials: KD
authors.lastname: Lakes
authors.affiliation: Department of Psychology, Florida International University, Miami, FL, USA.
authors.forename: William E
authors.initials: WE
authors.lastname: Pelham
mesh_terms: D000328:Adult; D001289:Attention Deficit Disorder with Hyperactivity / Q000175:diagnosis* / Q000453:epidemiology*; D002648:Child; D006801:Humans; D007406:Interview, Psychological / Q000592:standards*; D008137:Longitudinal Studies; D010290:Parents; D015995:Prevalence; D011569:Psychiatric Status Rating Scales / Q000592:standards*; D057566:Self Report / Q000592:standards*; D012680:Sensitivity and Specificity; D055815:Young Adult
keywords: Adult ADHD; DSM-5; diagnosis