ADHD is a multifactorial disorder presenting a heterogeneous psychopathological profile with heterogeneous neurocognitive deficits, but with core symptoms implicating function of the frontal-subcortical-cerebellar pathways that control attention, saliency, inhibitory control and response to reward1. This condition is classically looked as one of the most common childhood disease, but recent longitudinal studies accumulated evidences that ADHD persists into adulthood, with varying displayed characteristics among age2–4. In fact, while about 5% of children and adolescents are affected in the general population, this condition may persist in adulthood for at least half of these patients5. Several authors pointed out that this classical looking at ADHD has led to an underdiagnosis and undertreatment of adult ADHD6, because some professionals still express the fear of “treating a non-existent disease”7, while others are unsure about the diagnosis and the appropriate treatment of ADHD in adult mental health. These issues has led to strong international efforts to share information to clinicien, for example in the rework of the widely-used Diagnostic and Statistical Manual of Mental Disorders - Fifth Edition8, which highlighted the possible differential expression of ADHD throughout the patient’s lifetime, and the European consensus statement on diagnosis and treatment of adult ADHD4, in order to facilitate the identification and the treatment of ADHD.
Actually, the recognition of the importance of diagnosing and treating ADHD is growing, as it was recently shown that there is a higher prevalence of ADHD in some clinical populations such as addictive, forensic, and personality disorder patients9. In fact, in a general manner, ADHD was massively reported as a condition impairing individuals interaction with his environment, increasing the risk of the occurrence of harmful events such as injuries10, traffic accidents11, and substance abuse12, leading to increased healthcare utilization2, unemployment13, and suicide14. These observations pointed out the particular importance of screening within this high-risk populations.
However, ADHD is usually diagnosed through a time-consuming multidisciplinary evaluation process, including at least the visit to behavioral specialists such as psychologists and to mental functioning specialists such as neurologists or psychiatrists, increasing the diagnostic process duration which can extend over long periods of time. With the increasing need of screening, this led to the creation of psychometric auto-administered scales, such as the well-known Adult ADHD Self-Report Scale15, which was recently updated to the DSM-516, in order to shorten the diagnostic process. However, this work concerns a scale that has not been validated in French and thus cannot benefit to the French ADHD population and its need in terms of screening.
In order to meet this demand, we have developed an adult ADHD screening scale based on the DSM-5. We generated 45 preliminary items based on the DSM-5 criteria, and administered this scale to 110 ADHD subjects and 110 controls. We then statistically selected the most discriminating items in regard to the presence or absence of the subject's clinical condition. We then analyzed its psychometric properties, in terms of internal consistency, as well as factor structure, under the prism of a 3-factor model accounting for the behavioral expression of cognitive symptomatology (i.e., attention; inhibition/impulsivity; and working memory). Finally, we examined the predictive power of the scale using a machine-learning approach, relying on operational metrics such as sensitivity, specificity, and predictive values.