Validation of self-report instruments to assess attention deficit hyperactivity disorder symptoms in adults attending community drug and alcohol services.

BACKGROUND: : Symptoms of attention deficit disorder of predominantly inattentive, predominantly hyperactive-impulsive subtype, or combined (hereafter referred to as ADHD), may persist into adulthood, although the diagnosis in adults remains controversial. The study aimed to validate self-report instruments for assessment of adult ADHD in a sample of treatment-seeking adults attending community drug and alcohol teams. METHODS: : Adult patients attending 3 National Health Service (NHS) community drug and alcohol teams in England completed several self-report instruments for assessment of adult ADHD symptoms, and a diagnosis of adult ADHD was determined using Diagnostic and Statistical Manual of Mental Disorders, fourth edition criteria with an interview with both the patient and an informant. RESULTS: : One hundred seven subjects completed the project. Thirty-nine percent of subjects had an undisputed diagnosis of adult ADHD. The most accurate self-report instrument for diagnosis of adult ADHD was the Connors Adult ADHD Rating Scale Self-report Long version-a cutoff of 91 of 198 gave a sensitivity of 97% and specificity of 83%. Analysis of the WHO Adult ADHD Self-report Screener confirmed the optimal recommended cutoff as 12 of 13 giving 89% sensitivity and 83% specificity for adult ADHD against diagnostic interview. Although the Wender Utah adult ADHD scale is designed to retrospectively assess symptoms of ADHD in childhood it gave a sensitivity of 88% and specificity of 70% for diagnosis of ADHD in adults. CONCLUSION: : The symptoms of ADHD in adults can be reliably assessed by self-report instruments.

A retrospective sibling study of childhood adjustment in adults with substance use disorders.

PURPOSE: : Research has suggested that people who develop serious substance use disorders have delinquent traits as children before using any illicit drugs. This study was designed to retrospectively identify differences in antisocial and delinquent behavior between siblings discordant for serious substance use disorders. METHODS: : A retrospective survey was conducted of 50 pairs of adult siblings who were discordant for serious substance use disorders. The self-report early delinquency scale (SRED) was used to retrospectively assess delinquent traits in childhood and adolescence. RESULTS: : The mean SRED 29 (illegal item) score in treatment seeking opiate-dependent people (mean age = 33.5 years) was 19.6 (standard error [SE] = 0.9) compared with 4.8 (SE = 0.6) in same-sex, nonsubstance-dependent siblings (P < 0.0001; paired Wilcoxon test). The mean SRED 58 (norm violation) score in treatment seeking opiate-dependent people was 36.8 (SE = 1.7) compared with 10.5 (SE = 1.4) in same-sex siblings (P < 0.0001; paired Wilcoxon test). Forty percent of patients were expelled from school compared with 12% of siblings (Yates-corrected χ = 8.78; P = 0.003). Ninety-six percent of patients reported problems with the police as adolescence compared with 48% of controls (Yates-corrected χ = 26.24; P < 0.0001). Police problems in substance users predated first use of illicit substances by 5.5 years. CONCLUSIONS: : The study used a validated instrument and objective reports to confirm significantly higher rates of delinquent behavior and social dysfunction in childhood for substance users compared with nonsubstance-dependent siblings. The delinquent behaviors usually predated serious substance misuse.

Co-morbidity and cannabis use in a mental health trust in South East England.

AIM: The prevalence of co-morbidity (severe mental illness and substance) may be less in rural and semi-rural areas than inner cities. The aims were therefore to measure the prevalence of co-morbidity among patients of attending a mental health service in a semi-rural area South East England. DESIGN AND PARTICIPANTS: Cross-sectional prevalence survey of 1,808 patients with detailed assessments from a representative sample of 373 patients identified as having a combination of severe mental illness and substance misuse. Interviews with key workers were performed using validated methods from the COSMIC study. RESULTS: The response rates equalled or exceeded 90% for the various parts of the study. One-tenth of patients attending the Community Mental Health Teams (CMHTs) reported problematic use of illicit drugs and 17% reported alcohol problems in the past year. 22% of Community Drug and Alcohol Service (CDAS) clients reported a severe mental illness and 46% reported some other form of psychiatric disorder. Of patients with a combined diagnosis of mental illness and substance misuse, cannabis use was 4-fold more common amongst patients attending the CMHT than CDAS (33% vs. 8%) while use of amphetamine was five-fold higher in the CMHT group (10% vs. 2%). Patients with concurrent psychiatric and substance misuse problems represent a similar proportion of the aggregate caseload of both treatment services with observed prevalence amongst the CDAS and CMHT patients with a diagnosis for anxiety disorder (18% vs. 26%), minor depression (42% vs. 32%), personality disorders (32% vs. 36%), histories of self-harm (52% vs. 46%) and violence (33% vs. 30%) respectively. CONCLUSIONS: Co-morbidity is common in clients amongst CMHT and CDAS clients although use of cannabis was significantly more common in CMHT clients than in CDAS clients.

Prevalence of childhood attention deficit hyperactivity disorder in opiate-dependent adults.

Background. There is a clear association between childhood attention deficit hyperactivity disorder and substance use disorders in adulthood. Symptoms of attention deficit disorder may also persist into adulthood. The study aimed to determine the prevalence of childhood ADHD in a sample of treatment seeking opiate-dependent adults. Methods. Treatment-seeking opiate-dependent subjects completed the Utah adult ADHD screening test and the self-report early delinquency scale. Results. A total of 15% were "likely" and 49 were "highly likely" to have suffered ADHD in childhood. The averages scores for the delinquency scales were over 6 times those reported from population norms. Conclusion. Symptoms of childhood ADHD is common in adults with opiate dependence. The residual symptoms in adults should be investigated as may be amenable to newer treatments for adult attention deficit disorder.