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Low self-awareness of ADHD in adults using a self-report screening questionnaire

Published online by Cambridge University Press:  15 April 2020

I. Manor ,
N. Vurembrandt ,
S. Rozen ,
D. Gevah ,
A. Weizman  and
G. Zalsman
I. Manor*
Affiliation:
Division of Child and Adolescent Psychiatry, ADHD Unit, Geha Mental Health Center, 100, Jabotinski Street, 3rd fl., Petah Tikva, Israel Sackler Mental Health Center, Tel Aviv University, Tel Aviv, Israel
N. Vurembrandt
Affiliation:
Kibbutzim College of Education Technology and Arts, Tel Aviv, Israel
S. Rozen
Affiliation:
Division of Child and Adolescent Psychiatry, ADHD Unit, Geha Mental Health Center, 100, Jabotinski Street, 3rd fl., Petah Tikva, Israel
D. Gevah
Affiliation:
Service for Clinical Statistics, Tel Aviv University, Tel Aviv, Israel
A. Weizman
Affiliation:
Sackler Mental Health Center, Tel Aviv University, Tel Aviv, Israel Felsenstein Medical Research Center, Petah Tikva, Israel Research Unit, Geha Mental Health Center, Petah Tikva, Israel
G. Zalsman
Affiliation:
Division of Child and Adolescent Psychiatry, ADHD Unit, Geha Mental Health Center, 100, Jabotinski Street, 3rd fl., Petah Tikva, Israel Sackler Mental Health Center, Tel Aviv University, Tel Aviv, Israel Division of Molecular Imaging and Neuropathology, Psychiatry Department, Columbia University, NY, USA
*
*Corresponding author. E-mail address: [email protected] (I. Manor).
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Abstract

Introduction

Awareness of attention deficit hyperactivity disorder (ADHD) in adults has been growing over the last decade. One of the most interesting issues related to this topic is these adults’ self-awareness of their ADHD symptoms and their estimation of their own impairments. Our hypothesis while studying young adult ADHD populations was that there would be a significant difference between their self-report and their clinical assessment.

Method

One hundred and three students volunteered for this study. In order to validate our ADHD screening questionnaire (ADHD-SQ), and to assess the level of awareness they have of their own symptoms, participants underwent a complete clinical assessment for ADHD. They were divided into a control group (n = 24), and an ADHD study group (n = 79), which in turn was composed of two sub-groups, one comprising 24 ADHD predominantly inattentive (ADHD-I) and the other 55 ADHD combined type (ADHD-C).

Results

Factor analysis yielded two factors explaining 41% of the variance. The Inattention (IA) subscale score tended to be higher in both ADHD sub-groups as compared to the control group (6.5±2.1 vs. 2.34±2.3 with P<0.001), with no significant difference between the two ADHD sub-groups. Hyperactivity Impulsivity (HI) subscale was significantly higher for the ADHD-C sub-group than in the ADHD-I sub-group, whose score was similar to that of the control group (control: 1.6±2.1; ADHD-I: 1.55±1.0; ADHD-C: 4.5±2.6, P<0.0001). Receiver Operating Characteristics (ROC) analysis showed similar results. The area under the curve (AUC) of IA subscale score was 0.90 (95% confidence: 0.83–0.96) and for HI subscale score was 0.75, (95% confidence: 0.63–0.86). Classification into groups used a cut-off point of 3+ items out of nine, in the SQ and 6+ items out of nine in the clinical assessment. These two classifications showed 68% agreement (46% sensitivity and 95% specificity). In both ADHD sub-groups, the self-reported average number of positive symptoms per student was relatively low for both clusters; this phenomenon was pronounced in the specific subtypes. The self-rated HI cluster score was considerably low in the ADHD-C sub-group (4.5±2.6), and the IA one was particularly low in the ADHD-IADHD-I sub-group (5.9±1.9).

Conclusion

This study's results indicate that ADHD symptoms are under-reported for both inattentive and hyperactive-impulsive clusters, indicating that adults with ADHD tend to under-estimate their own ADHD-related impairments. We suggest that this questionnaire may be used both in research and academic settings to help counsellors and students to obtain early indication of ADHD and to refer students suspected of having ADHD to full clinical assessment.

Keywords

ADHDAdultsObjectiveScreening questionnaireSelf-awarenessSubjective
Type
Original articles
Information
European Psychiatry , Volume 27 , Issue 5 , July 2012 , pp. 314 - 320
Copyright
Copyright © Elsevier Masson SAS 2012

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