Attention-deficit hyperactivity disorder monitoring response to therapy
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief:
Overview
Monitoring response to treatment
Methods of monitoring treatment for ADHD have been reviewedCHADD (2017). Which ADHD Rating Scales Should Primary Care Physicians Use? Available at https://chadd.org/adhd-weekly/which-adhd-rating-scales-should-primary-care-physicians-use/[1][2].
The Wender-Reimherr Adult Attention Deficit Disorder Scale (WRAADDS) has higher diagnostic accuracy than the WHO Adult ADHD Self-Report Scale (ASRS)[3].
Wender-Reimherr Adult Attention Deficit Disorder Scale (WRAADDS)
One method is the Wender-Reimherr Adult Attention Deficit Disorder Scale (WRAADDS). The WRAADDS has been validated in a clinician administered format[4] and a self-administered format[5]. The self-administered version typically reports about 2 points higher than the clinician adminsitered version. The WRAADDS asks 30 questions in 7 domains, each with Cronbach alpha > 0.7:
- Attention Difficulties
- Hyperactivity/Restlessness
- Temper
- Affective Lability
- Emotional Over-Reactivity
- Disorganization
- Impulsivity
Benchmarks for the self-reported version (SR-WRAADDS) are[5]:
- Subjects without ADHD: 8.5 ± 4.6
- Subjects with ADHD: 23.4 ± 4.3
- After treatment, score typically drops by 5 points or effect size (different / standard deviation) of 0.7
Definitions of treatment response or 'normalization' include[2]:
- "Follow-up scores falling within 1.0 standard deviation of the normal mean". For example, SR-WRAADD of less than 13.1
- "30% reduction in symptoms" or score
The Wender-Reimherr Adult Attention Deficit Disorder Scale (WRAADDS)m has higher diagnostic accuracy than the WHO Adult ADHD Self-Report Scale (ASRS)[3].
Conners Abbreviated Symptom Questionnaire (CAARS)
This scale includes the Conners Adult ADHD Rating Scales (CAARS). It has 66 items. It is available for download[6].
The CAARS has been used to measure response to treatment in randomized controlled trials.
Affective Lability Scale–Short Form (ALS)
The ALS has 18 items.[7]
Vanderbilt NICHQ
WHO Adult ADHD Self-Report Scale (ASRS)
The Adult ADHD Self-Report Scale (ASRS) is the World Health Organization's (WHO) rating scale for adult ADHD. It has 18 items. It also has a 6 item scale for screening. ASRS-v1.1 is available for download at the Attention Deficit Disorder Association[8]
The Wender-Reimherr Adult Attention Deficit Disorder Scale (WRAADDS)m has higher diagnostic accuracy than the WHO Adult ADHD Self-Report Scale (ASRS)[3].
ADHD Rating Scale (for children and adolescents)
For children and adolescents, the ADHD Rating Scale[9] has been used in systematic reviews[10]. In a systematic review, "A clinically meaningful response is generally considered to be improvement of 25% or greater from baseline (a within-group reduction of approximately 10-15 absolute points or a mean difference of approximately 6-7 points between the treatment and placebo groups"[10].
- ↑ Gaba P, Giordanengo M (2019). "Attention Deficit/Hyperactivity Disorder: Screening and Evaluation". Am Fam Physician. 99 (11): 712. PMID 31150173.
- ↑ 2.0 2.1 Ramsay JR (2017). "Assessment and monitoring of treatment response in adult ADHD patients: current perspectives". Neuropsychiatr Dis Treat. 13: 221–232. doi:10.2147/NDT.S104706. PMC 5291336. PMID 28184164.
- ↑ 3.0 3.1 3.2 Brevik EJ, Lundervold AJ, Haavik J, Posserud MB (2020). "Validity and accuracy of the Adult Attention-Deficit/Hyperactivity Disorder (ADHD) Self-Report Scale (ASRS) and the Wender Utah Rating Scale (WURS) symptom checklists in discriminating between adults with and without ADHD". Brain Behav. 10 (6): e01605. doi:10.1002/brb3.1605. PMC 7303368 Check
|pmc=value (help). PMID 32285644 Check|pmid=value (help). - ↑ Marchant BK, Reimherr FW, Robison D, Robison RJ, Wender PH (2013). "Psychometric properties of the Wender-Reimherr Adult Attention Deficit Disorder Scale". Psychol Assess. 25 (3): 942–50. doi:10.1037/a0032797. PMID 23647041.
- ↑ 5.0 5.1 Marchant BK, Reimherr FW, Wender PH, Gift TE (2015). "Psychometric properties of the Self-Report Wender-Reimherr Adult Attention Deficit Disorder Scale". Ann Clin Psychiatry. 27 (4): 267–77, quiz 278-82. PMID 26554368.
- ↑ Australian Council for Educational Research. Available at
- ↑ Weibel S, Micoulaud-Franchi JA, Brandejsky L, Lopez R, Prada P, Nicastro R; et al. (2019). "Psychometric Properties and Factor Structure of the Short Form of the Affective Lability Scale in Adult Patients With ADHD". J Atten Disord. 23 (10): 1079–1089. doi:10.1177/1087054717690808. PMID 28152669.
- ↑ Attention Deficit Disorder Association. https://add.org/wp-content/uploads/2015/03/adhd-questionnaire-ASRS111.pdf
- ↑ DuPaul GJ, Power TJ, Anastopoulos AD, Reid R. ADHD Rating Scale IV (for Children and Adolescents): Checklists, Norms, and Clinical Interpretation. New York, NY: Guilford Press; 1998
- ↑ 10.0 10.1 Chan E, Fogler JM, Hammerness PG (2016). "Treatment of Attention-Deficit/Hyperactivity Disorder in Adolescents: A Systematic Review". JAMA. 315 (18): 1997–2008. doi:10.1001/jama.2016.5453. PMID 27163988.