Self-reported childhood attention-deficit/hyperactivity disorder symptoms are not specific to the disorder

The present study examined the specificity of self-reported childhood attention-deficit/hyperactivity disorder (ADHD) symptoms using the Wender Utah Rating Scale (WURS) in young adults with (1) a previous diagnosis of ADHD, (2) comorbid ADHD and psychological symptoms or diagnoses, (3) psychological diagnoses or symptoms without comorbid ADHD, and (4) controls.

One thousand four hundred thirty-one non-treatment-seeking individuals (508 males), aged 18 to 25 years, were assigned to 1 of 4 groups (psychological controls, controls, ADHD, ADHD comorbid), based on responses to psychological, demographic, and health history questionnaires completed as part of a larger study. Responses to the WURS were analyzed at the individual item and subtest levels for their specificity to ADHD using area under the curve analyses.

The standard WURS cutoff score of 46 was neither sensitive nor specific to ADHD, with a high rate of false positives in psychological controls. Factor analyses supported a 5-factor model (conduct problems, impulsivity problems, mood difficulties, inattention/anxiety symptoms, poor academic functioning) that accounted for 62% of the total variance; these factors were used to generate factor-based WURS subscales. Three subscales (impulsivity, poor academic functioning, and inattention/anxiety symptoms) showed potential for discriminating ADHD from controls among females. No subscales showed adequate sensitivity or specificity for discriminating ADHD from psychological controls among the males.

Results provide further evidence that retrospective self-report of childhood ADHD symptoms is not specific to ADHD and highlight concerns about the reliance on self-report of childhood ADHD symptoms for diagnostic purposes. Results suggest consideration of specific types of symptoms, and sex differences might increase diagnostic use of self-reported childhood symptoms.