Results from a large clinical sample indicate that retrospective collateral reporting of childhood ADHD symptoms/impairments may not be useful for the diagnosis of adults, a Brazilian study shows.
The aim of this study was to assess the value of collateral information* regarding the presence of childhood ADHD symptoms when diagnosing adults with ADHD. Adult outpatients with ADHD (n=449; ≥18 years old) underwent diagnostic evaluations based upon results of clinical interviews and DSM-IV† criteria. Adults without ADHD were also recruited and similarly assessed (n=143; control group). Both adults with ADHD and a relative cohabiting during childhood were asked to independently complete the collateral ADHD symptom report form of the Barkley’s scale (assessing the frequency and impairment of ADHD symptoms between ages 5 and 12 years). The two sources of retrospective information were compared, and the adults with ADHD subsequently divided into two groups: those whose relatives agreed (agreement group: n=277) or disagreed (disagreement group: n=172) with their reports of childhood ADHD symptoms. Stimulant pharmacological treatment was initiated over 6 months for those with ADHD who desired it (n=232).
Compared with the control group, adults in both ADHD groups were more likely to present with: school failure, problems with authority/discipline, problems with the law/police and previous psychopharmacological treatment (all p<0.001); a higher frequency of certain comorbidities (all p<0.001); and higher ADHD symptom scores (p<0.001). Furthermore, compared with the control and disagreement groups, the agreement group were more likely to present with school suspensions and problems with authority/discipline (p<0.001), as well as higher ADHD symptom scores (p<0.001). However, the disagreement and agreement groups did not differ in terms of school failure, problems with the law/police, previous psychopharmacological treatment, comorbidity profile and treatment response.
The results of this study demonstrate that ~40% of relatives reported dubious/inexistent ADHD diagnosis during childhood for adults with a self-reported lifetime history of ADHD. The researchers conclude that although collateral information may aid the diagnosis of patients with difficulties recalling childhood symptoms, this type of evidence should be subjected to critical clinical judgement.
*Information reported by parents/caregivers and teachers, where available
†Diagnostic and Statistical Manual of Mental Disorders, 4th Edition
Breda V, Rovaris DL, Vitola ES, et al. Does collateral retrospective information about childhood attention-deficit/hyperactivity disorder symptoms assist in the diagnosis of attention-deficit/hyperactivity disorder in adults? Findings from a large clinical sample. Aust N Z J Psychiatry 2016; 50: 557-565.