title: The structure of adult ADHD.
abstract: Although DSM-5 stipulates that symptoms of attention-deficit hyperactivity disorder (ADHD) are the same for adults as children, clinical observations suggest that adults have more diverse deficits than children in higher-level executive functioning and emotional control. Previous psychometric analyses to evaluate these observations have been limited in ways addressed in the current study, which analyzes the structure of an expanded set of adult ADHD symptoms in three pooled US samples: a national household sample, a sample of health plan members, and a sample of adults referred for evaluation at an adult ADHD clinic. Exploratory factor analysis found four factors representing executive dysfunction/inattention (including, but not limited to, all the DSM-5 inattentive symptoms, with non-DSM symptoms having factor loadings comparable to those of DSM symptoms), hyperactivity, impulsivity, and emotional dyscontrol. Empirically-derived multivariate symptom profiles were broadly consistent with the DSM-5 inattentive-only, hyperactive/impulsive-only, and combined presentations, but with inattention including executive dysfunction/inattention and hyperactivity-only limited to hyperactivity without high symptoms of impulsivity. These results show that executive dysfunction is as central as DSM-5 symptoms to adult ADHD, while emotional dyscontrol is more distinct but nonetheless part of the combined presentation of adult ADHD.
authors.affiliation: Department of Psychiatry and Child and Adolescent Psychiatry, New York University Langone School of Medicine and Psychiatry Service, New York, NY, USA.
authors.forename: Lenard A
authors.initials: LA
authors.lastname: Adler
authors.affiliation: Departments of Psychiatry and of Neuroscience and Physiology, SUNY Upstate Medical University, Syracuse, NY, USA.
authors.forename: Stephen V
authors.initials: SV
authors.lastname: Faraone
authors.affiliation: Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Spencer
authors.affiliation: Institute for Social Research, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Patricia
authors.initials: P
authors.lastname: Berglund
authors.affiliation: Department of Psychiatry and Child and Adolescent Psychiatry, New York University Langone School of Medicine and Psychiatry Service, New York, NY, USA.|Hofstra Northwell School of Medicine, Hofstra University, Hempstead, NY, USA.
authors.forename: Samuel
authors.initials: S
authors.lastname: Alperin
authors.affiliation: Department of Health Care Policy, Harvard Medical School, Boston, MA, USA.
authors.forename: Ronald C
authors.initials: RC
authors.lastname: Kessler
mesh_terms: D000293:Adolescent; D000328:Adult; D001289:Attention Deficit Disorder with Hyperactivity / Q000145:classification* / Q000503:physiopathology*; D056344:Executive Function / Q000502:physiology*; D005260:Female; D006801:Humans; D007175:Impulsive Behavior / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D055815:Young Adult
keywords: ADHD; adults; attention-deficit hyperactivity disorder; epidemiology