Psychometrically Informed Approach to Integration of Multiple Informant Ratings in Adult ADHD in a Community-Recruited Sample

Abstract

Although Diagnostic and Statistical Manual of Mental Disorders–Fifth edition requires that attention-deficit/hyperactivity disorder (ADHD) symptoms are apparent across settings, assessed by multiple informants, there remains no standardized approach to integration of multiple sources in adult ADHD diagnosis. The goal of the study was to evaluate informant effects on adult ADHD symptom ratings. Participants were 406 adults, ages 18 to 37, and identified second reporters, recruited from the community, and completing a comprehensive diagnostic and cognitive assessment, including a clinician-administered diagnostic interview and self- and other-report questionnaires of ADHD symptoms. Structural equation modeling indicated good fit for a trifactor model of ADHD, including general ADHD, specific inattention and hyperactivity–impulsivity, and self- and other-perspective factors. Yet there were a number of symptoms on the specific hyperactive–impulsive and self-factors that exhibited nonsignificant loadings. Significant differential item functioning across self-ratings and informant ratings was also noted. The external validation indices of laboratory executive function and diagnostic team-rated impairment was significantly correlated with the specific inattentive factor. While executive function was marginally significantly correlated with the other perspective factor, impairment was associated with the self-perspective factor. Overall, inattentive symptoms may be more sensitive measures of adult ADHD, and other and self-ratings may provide different information in relation to external criteria.

Keywords

assessment diagnosis adults structural equation modeling ADHD

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