Assessing Attention-Deficit/Hyperactivity Disorder in Post-9/11 Veterans: Prevalence, Measurement Correspondence, and...

Area of Science:

• Psychiatry
• Military Health
• Neurodevelopmental Disorders

Background:

• Attention-deficit/hyperactivity disorder (ADHD) is frequently observed in Veterans.
• Overlapping symptoms with conditions like posttraumatic stress disorder (PTSD) can hinder accurate ADHD diagnosis.
• Combat-deployed post-9/11 Veterans represent a key demographic for studying these comorbidities.

Purpose of the Study:

• To determine the prevalence of ADHD in combat-deployed post-9/11 Veterans.
• To assess the agreement between different ADHD self-report instruments.
• To investigate the association between ADHD and PTSD in this Veteran cohort.

Main Methods:

• The study included 332 combat-deployed post-9/11 Veterans.
• Participants completed the Clinician-Administered PTSD Rating Scale and two ADHD self-report questionnaires (Wender Utah Rating Scale-25 [WURS-25] and Adult ADHD Self-Report Scale v1.1 [ASRSv1.1]).
• WURS-25 served as the criterion standard, with its results compared to historical ADHD diagnoses and ASRS-v1.1; log-binomial regression analyzed ADHD and PTSD relationships.

Main Results:

• 12.7% of Veterans met ADHD criteria based on the WURS-25.
• The WURS-25 showed low sensitivity (27.7%) for identifying historical ADHD diagnoses but adequate specificity (90.3%).
• Agreement between WURS-25 and ASRS-v1.1 was poor (sensitivity 60.7%, specificity 60.8%). ADHD prevalence was 2.53 times higher in those with a history of PTSD and 2.19 times higher in those with current PTSD.

Conclusions:

• ADHD is prevalent among Veterans and significantly associated with increased risk for current and lifetime PTSD.
• The poor agreement among self-report ADHD measures highlights diagnostic challenges in this comorbid population.
• Clinicians must consider PTSD as a potential contributing factor when diagnosing ADHD in Veterans to ensure accurate assessment and treatment.