Caution with self-reported ADHD symptoms in adults with epilepsy: discrepancy between subjective perception and
Celina Schmidt1, Christoph Helmstaedter1, Juri-Alexander Witt1
1Department of Epileptology, University Hospital of Bonn, Venusberg-Campus 1, Bonn, D 53127, Germany.
Purpose:
Beyond seizure control, additional health issues are increasingly recognized as important aspects in the care of people with epilepsy (PwE). Cognitive impairments and psychiatric comorbidities, including attention-deficit/hyperactivity disorder (ADHD), are commonly reported in this population. However, the widespread use of self-report screening tools and readily accessible online questionnaires raises concerns about the validity of subjective ADHD symptom identification in PwE and the potential for overdiagnosis. Therefore, this study examined the relationship between self-reported ADHD symptoms and objectively assessed attention and executive functions in PwE.
Methods:
A total of 289 adult PwE were included. ADHD symptoms were assessed using the Adult ADHD Self-Report Scale (ASRS v1.1) and ADHD self-report (ADHS-SB) based on DSM-IV (ADHS-SB/DSM-IV) and ICD-10 criteria (ADHS-SB/ICD 10). Cognitive performance was evaluated using the EpiTrack®, a neuropsychological screening tool assessing attention and executive functions (n = 129). Agreement was assessed using chi-square tests, McNemar tests, and Cohen's kappa.
Results:
ADHD screening positivity ranged from 14.9% to 21.8%, with 6.6% positive across all instruments, attention and executive functions were impaired in 41.9%. ASRS results showed weak agreement with ADHS-SB/DSM-IV results (κ = .248) and ADHS-SB/ICD 10 results (κ = .321). ADHS-SB/DSM-IV and ADHS-SB/ICD 10 results showed substantial agreement (κ = .702, p < .001). Positive ADHD screening was showed no meaningful association with attention and executive functions (κ = -.050 to .146). EpiTrack® performance correlated with higher seizure frequency and polytherapy (p < .05).
Conclusion:
Subjective ADHD symptoms show limited overlap with objectively measured cognitive impairment in people with epilepsy. Attention and executive dysfunction appear to be driven primarily by epilepsy-related factors rather than reported ADHD symptoms, underscoring the need for comprehensive clinical assessment.
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